[Federal Register Volume 73, Number 36 (Friday, February 22, 2008)]
[Rules and Regulations]
[Pages 9860-9933]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 08-671]



[[Page 9859]]

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Part II





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 410, 412, et al.



 Medicare and Medicaid Programs; Correction; Final Rule

  Federal Register / Vol. 73, No. 36 / Friday, February 22, 2008 / 
Rules and Regulations  

[[Page 9860]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410, 411, 412, 413, 414, 416, 419, 482, and 485

[(CMS-1392-CN), (CMS-1533-CN), and (CMS-1531-CN)]
RIN 0938-AO71, RIN 0938-AO70, and RIN 0938-AO35


Medicare Program; Changes to the Hospital Outpatient Prospective 
Payment System and CY 2008 Payment Rates, the Ambulatory Surgical 
Center Payment System and CY 2008 Payment Rates, the Hospital Inpatient 
Prospective Payment System and FY 2008 Payment Rates; and Payments for 
Graduate Medical Education for Affiliated Teaching Hospitals in Certain 
Emergency Situations Medicare and Medicaid Programs: Hospital 
Conditions of Participation; Necessary Provider Designations of 
Critical Access Hospitals; Correction

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Correction of final rule with comment period.

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SUMMARY: This document corrects technical errors that appeared in the 
final rule with comment period published in the Federal Register (FR) 
on November 27, 2007, entitled ``Changes to the Hospital Outpatient 
Prospective Payment System and CY 2008 Payment Rates, the Ambulatory 
Surgical Center Payment System and CY 2008 Payment Rates, the Hospital 
Inpatient Prospective Payment System and FY 2008 Payment Rates; and 
Payments for Graduate Medical Education for Affiliated Teaching 
Hospitals in Certain Emergency Situations Medicare and Medicaid 
Programs: Hospital Conditions of Participation; Necessary Provider 
Designations of Critical Access Hospitals.''

DATES: Effective Date: January 1, 2008 except that the correction to 
Sec. 485.610(e) is effective February 22, 2008.

FOR FURTHER INFORMATION CONTACT: Alberta Dwivedi, (410) 786-0378.

SUPPLEMENTARY INFORMATION: 

I. Background

    In FR Doc. 07-5507 of November 27, 2007 (72 FR 66579), we have 
identified a number of technical and typographical errors that we 
describe in the ``Summary of Errors'' section and correct in the 
``Correction of Errors'' section below. The provisions in this 
correction notice are effective as if they had been included in the 
document published on November 27, 2007. Accordingly, the corrections 
are effective January 1, 2008.

II. Summary of Errors

    On November 27, 2007, we published a final rule with comment period 
entitled, ``Changes to the Hospital Outpatient Prospective Payment 
System and CY 2008 Payment Rates, the Ambulatory Surgical Center 
Payment System and CY 2008 Payment Rates, the Hospital Inpatient 
Prospective Payment System and FY 2008 Payment Rates; and Payments for 
Graduate Medical Education for Affiliated Teaching Hospitals in Certain 
Emergency Situations Medicare and Medicaid Programs: Hospital 
Conditions of Participation; Necessary Provider Designations of 
Critical Access Hospitals,'' (hereinafter referred to as the OPPS/ASC 
final rule with comment period). Included in that document were 
technical and typographical errors.
    We incorrectly stated that the application deadline for submitting 
applications for a new class of new technology intraocular lenses in 
the ``Dates'' section under Application Deadline--New Class of New 
Technology Intraocular Lens was April 1, 2008. In the preamble to the 
OPPS/ASC final rule with comment period (72 FR 66855), we stated the 
correct application deadline date as March 14, 2008. We are changing 
the application deadline in the ``Dates'' section to reflect the 
correct date of March 14, 2008. We also stated that approximately 131 
million final action claims were used for hospital outpatient 
department services furnished on or after January 1, 2006 and before 
January 1, 2007 for the purpose of recalibrating the OPPS relative 
weights for CY 2008. The actual number of final action claims used was 
141 million. In addition, we stated that we would provide further 
instructions about reporting echocardiography procedures with and 
without contrast in the January 2007 OPPS update. The correct reference 
should have been to the January 2008 OPPS update and we are correcting 
the statement. Furthermore, we are correcting the typographical errors 
that mistakenly reversed the listings for the composite APC procedure 
codes for APC 8001 and APC 8000.
    We also inadvertently failed to address in the OPPS/ASC final rule 
with comment period two timely public comments. This document includes 
summaries of those public comments and our responses.
    The OPPS/ASC final rule with comment period included several 
addenda. We are adding three HCPCS codes (CPT codes 90650, 90681, and 
90696) to Addendum B because they are new active CPT codes for CY 2008 
that we omitted from the CY 2008 OPPS/ASC final rule with comment 
period. In publishing Addenda A and B, we inadvertently published 
incorrect minimum unadjusted copayment rates for several pass-through 
drugs and biologicals. Additionally, for several HCPCS codes where 
payment is based on mean costs from hospital claims, we inadvertently 
published CY 2007 payment rates instead of CY 2008 payment rates. In 
addition, in Addendum B, we inadvertently assigned status indicator 
``L'' to new CPT codes 90661, 90662, and 90663 that indicated these 
codes would be paid in CY 2008. These three CPT codes actually describe 
vaccines where there are currently no FDA-approved products and, 
therefore, these codes are noncovered by Medicare as of January 2008. 
We are changing the status indicator to ``E'', to reflect the correct 
status. Furthermore, we inadvertently assigned a payable status 
indicator to HCPCS code G0377. We note that this is a noncovered 
service under Medicare Part B in accordance with the statute as of 
January 1, 2008. Also, in Addendum B, we incorrectly assigned status 
indicator ``M'', indicating services not billable to the fiscal 
intermediary, to new CY 2008 HCPCS code G9140, when this service may be 
paid off another fee schedule by fiscal intermediaries.
    In addition, we are republishing Addenda AA and BB to take into 
account updated Medicare Physician Fee Schedule (MPFS) CY 2008 
information. As required at 42 CFR Sec.  416.171(d), the revised ASC 
payment system limits payment for office-based procedures and covered 
ancillary radiology services to the lesser of the ASC rate or the 
amount calculated by multiplying the nonfacility practice expense (PE) 
relative value units (RVUs) for the service by the conversion factor 
under the MPFS. However, the PE RVUs listed for many CPT codes in 
Addendum B of the CY 2008 MPFS final rule (72 FR 66222) were incorrect 
due to a methodological error and consequently, have been corrected in 
a correction notice to that final rule (73 FR 2568). Since the ASC 
payment amounts for office-based procedures and covered ancillary 
services are determined using the amounts in the MPFS final rule, we 
must correct the CY 2008 payment amounts for ASC procedures and 
services using the

[[Page 9861]]

corrected MPFS amounts. The corrected payment amounts are reflected in 
Addenda AA and BB to this correction notice. Lastly, we inadvertently 
labeled two Addendum as Addendum DD2 and are correcting ``Addendum DD2-
OPPS Comment Indicators'' to read ``Addendum D2-OPPS Comment 
Indicators.'' In Addendum M, we inadvertently assigned incorrect APCs 
to HCPCS codes 90862, 96102, and M0064. The APC assignments of these 
individual services were correct in Addendum B to the CY 2008 OPPS/ASC 
final rule with comment period (72 FR 67096, 67103, and 67160) that 
identified OPPS payment by HCPCS code. Therefore, we are correcting 
their assignments in Addendum M that identified HCPCS codes that may be 
paid through composite APCs to reflect their correct OPPS treatment if 
they are paid through a single code APC.

III. Correction of Errors

    In FR Doc. 07-5507 (72 FR 66579), we are making the following 
corrections:
    1. On page 66580, in the second column, line 6 of the paragraph 
entitled, ``Application Deadline--New Class of New Technology 
Intraocular Lens:'' in the ``Dates'' section, the application deadline 
date ``April 1, 2008'' is corrected to read ``March 14, 2008''.
    2. On page 66589, in the first column, in line 15, the number ``131 
million'' is corrected to read ``141 million.''
    3. On page 66644, in the third column, in lines 12 and 13, the date 
``January 2007'' is corrected to read ``January 2008.''
    4. On page 66669, in the third column, fourth full paragraph, the 
paragraph is deleted and replaced in its entirety to read as follows:
    We received one comment related to our proposal.
    Comment: A commenter disagreed with the statement in the CY 2008 
OPPS/ASC proposed rule that the circumstances in which total body 
hypothermia would be provided to a Medicare beneficiary would be 
extremely rare. The commenter stated that approximately 72 percent of 
all U.S. hospitals do not have cardiac catheterization or open heart 
surgery capabilities. The commenter also stated that it would be common 
for many post-cardiac arrest patients who are treated in these 
hospitals to be transferred to another facility that can provide the 
necessary services. The commenter also disagreed that low-cost methods 
to induce hypothermia, such as applying ice packs to the patient, are 
viable alternatives to technologically advanced methods of inducing 
hypothermia, specifically because the low-cost methods are ineffective 
and inconvenient. According to the commenter, the small number of 
claims (39 in CY 2006) and low median cost ($35) for CPT code 99816 
(Hypothermia; total body) mean that a hospital receives no additional 
payment when providing hypothermia. The commenter recommended that CMS 
create a Level II HCPCS G-code for technologically advanced methods of 
inducing hypothermia, and that CMS pay separately for this new code.
    Response: We proposed to package payment for CPT code 99816 for CY 
2008. We continue to believe that when a patient presents to one 
hospital and then is cooled and transported to another hospital without 
admission to the first hospital, payment for the hypothermia service 
would be most appropriately packaged into payment for the many other 
separately payable services that it most likely accompanied and that 
would be paid to the first hospital under the OPPS. To the extent that 
technologically advanced methods to induce hypothermia may become an 
adopted standard of care by more hospitals over time based on the 
evolution of clinical practice, the median cost for CPT code 99186 may 
change to reflect contemporary utilization patterns. In general, if a 
service is described by an existing CPT code, we do not create an 
additional Level II HCPCS code for payment. Instead, the commenter may 
wish to discuss the hypothermia service with the AMA's CPT Editorial 
Panel in order to assess the need for any changes to CPT codes. 
Therefore, we are finalizing our proposal to maintain the packaged 
status of CPT code 99186 for CY 2008.
    5. On page 66726, in the second column, first full paragraph, under 
the heading ``b. Endovenous Ablation (APC 0092)'', the paragraph is 
deleted and replaced in its entirety to read as follows:
    ``For CY 2008, we proposed to pay approximately $1,684 for CPT 
codes 36476 (Endovenous ablation therapy of incompetent vein, 
extremity, inclusive of all imaging guidance and monitoring, 
percutaneous, radiofrequency; second and subsequent veins treated in a 
single extremity, each through separate access sites) and 36478 
(Endovenous ablation therapy of incompetent vein, extremity, inclusive 
of all imaging guidance and monitoring, percutaneous, laser; first vein 
treated) through their proposed assignment to APC 0092 (Level I 
Vascular Ligation). In CY 2007, CPT code 36476 is assigned to APC 0091 
(Level II Vascular Ligation), which has a proposed CY 2008 payment rate 
of $2,781. The proposed APC assignment for CPT code 36478 is the same 
as its CY 2007 APC assignment.
    6. On page 66726, in the second column, second full paragraph, 
under the heading ``b. Endovenous Ablation (APC 0092)'', the paragraph 
is deleted and replaced in its entirety to read as follows:
    ``We received several public comments on the proposed CY 2008 
payment for CPT codes 36476 and 36478. A summary of the public comments 
and our response follow.''
    Comment: A commenter disagreed with our proposed reassignment of 
add-on CPT code 36476 (Endovenous ablation therapy of incompetent vein, 
extremity, inclusive of all imaging guidance and monitoring, 
percutaneous, radiofrequency; second and subsequent veins treated in a 
single extremity, each through separate access sites) from APC 0091 
(Level II Vascular Ligation), with a proposed CY 2008 payment of 
approximately $2,781, to APC 0092 (Level I Vascular Ligation), with a 
proposed CY 2008 payment of approximately $1,684. According to the 
commenter, CPT code 36476 should remain in APC 0091, the same APC to 
which its associated primary CPT code, 36475 (Endovenous ablation 
therapy of incompetent vein, extremity, inclusive of all imaging 
guidance and monitoring, percutaneous, radiofrequency; first vein 
treated), was proposed for assignment in CY 2008. The commenter 
asserted that the procedures described by CPT codes 36475 and 36476 are 
clinically similar and use comparable resources, and that the 
application of the multiple procedure reduction to lower-paying APC 
0092 would result in inaccurate payment for the CPT code 36476 add-on 
procedure, which always must be performed in conjunction with the 
primary procedure.
    Response: We proposed to reassign 36476 from APC 0091 to APC 0092 
because proposed rule claims data indicated that the costs associated 
with CPT code 36476 are more similar to the costs of other procedures 
assigned to APC 0092, taking into account the multiple surgical 
procedure 50 percent payment reduction that would be applied in the 
typical cases where CPT code 36476 was reported in conjunction with CPT 
code 36475. Final rule claims data support this reassignment; the 
median cost for CPT code 36476 is approximately $971, while the CY 2008 
payment rate for APC 0092 is approximately $1,646, and the payment rate 
for APC 0091 is approximately $2,714. The median cost for the first 
vessel CPT code 36475 is much higher than that of CPT code 36476, at 
approximately $2,396, which we believe

[[Page 9862]]

to be a reflection of the significantly higher relative cost of 
furnishing the initial service described by CPT code 36475 compared to 
the additional service described by CPT code 36476, likely due in part 
to the radiofrequency catheter cost that is associated with the initial 
service. We disagree with the commenter that CPT codes 36475 and 36476 
are similar in terms of resource utilization based on this cost data.
    The application of the multiple procedure reduction of 50 percent 
to APC 0092 when CPT code 36476 is billed with another procedure with 
status indicator ``T,'' such as CPT code 36475, would result in a 
payment of approximately $823, a sum that is only slightly less than 
the approximate $971 median cost of CPT code 36476. In contrast, if CPT 
code 36476 were assigned to APC 0091, the payment with the multiple 
procedure reduction would be approximately $1,357, a substantial 
overpayment. Therefore, we disagree with the commenter that assignment 
of CPT code 36476 to APC 0092 would result in inaccurate payment, even 
with application of the multiple procedure reduction. While it is true 
that the procedure described by CPT code 36476 is clinically similar to 
the procedure described by CPT code 36475 which is assigned to APC 0091 
as the commenter asserts, it also is clinically similar to other 
procedures in APC 0092, which includes a variety of surgical procedures 
involving veins.
    In summary, we continue to believe that the procedure described by 
CPT code 36476 is similar both clinically and in terms of resource 
utilization to other procedures assigned to APC 0092, even with 
application of the multiple procedure reduction. Therefore, after 
review of the public comment received, we are finalizing our proposal, 
without modification, to reassign CPT code 36476 to APC 0092 for CY 
2008.
    7. On page 66726, in the third column, the third full paragraph, 
the paragraph is deleted and replaced in its entirety to read as 
follows:
    ``After consideration of the public comments received, we are 
finalizing our CY 2008 proposal, without modification, to assign CPT 
codes 36476 and 36478 to APC 0092, with a median cost of about 
$1,626''.
    8. On page 66906, in the third column, in the first full 
paragraph--
    A. In line 16, the APC code ``8000'' is corrected to read ``8001.''
    B. In line 24, the APC code, ``8001'' is corrected to read 
``8000.''

Correction to Regulations Text

0
On page 66934, the introductory text of Sec.  485.610(e) is revised to 
read as follows:


Sec.  485.610  Conditions of participation: Status and location.

* * * * *
    (e) Standard: Off-campus and co-location requirements for CAHs. A 
CAH may continue to meet the location requirements of paragraph (c) of 
this section only if the CAH meets the following:
* * * * *

Corrections to Addenda

Addendum A.--OPPS APCS for CY 2008

0
1. On page 66939, for APC 0825, in line 74, in column 7, the minimum 
unadjusted copayment ``$17.37'' is corrected to read ``$17.20.''

0
2. On page 66940, for APC 0911, in line 43--
0
A. In column 5, the payment rate ``$129.75'' is corrected to read 
``$20.89.''
0
B. In column 7, the minimum unadjusted copayment ``25.95'' is corrected 
to read ``$4.18.''

0
3. On page 66940, for APC 0951, in line 7 from the bottom of the page, 
in column 7, the minimum unadjusted copayment ``$44.16'' is corrected 
to read ``$43.74.''

0
4. On page 66941, for APC 0998, in line 11--
0
A. In column 5, the payment rate ``$88.15'' is corrected to read 
``$12.24.''
0
B. In column 7, the minimum unadjusted copayment ``$17.63'' is 
corrected to read ``$2.45.''

0
5. On page 66941, for APC 1041, in line 27--
0
A. In column 5, the payment rate ``$172.41'' is corrected to read 
``$19.81.''
0
B. In column 7, the minimum unadjusted copayment ``$34.48'' is 
corrected to read ``$3.96.''

0
6. On page 66941, for APC 1141, in line 36--
0
A. In column 5, the payment rate ``$67.96'' is corrected to read 
``$42.24.''
0
B. In column 7, the minimum unadjusted copayment ``$13.59'' is 
corrected to read ``$8.37.''

0
7. On page 66941, for APC 1168, in line 42, in column 7, the minimum 
unadjusted copayment ``$9.68'' is corrected to read ``$9.59.''

0
8. On page 66941, for APC 1169, in line 43--
0
A. In column 5, the payment rate ``$482.56'' is corrected to read 
``$407.56.''
0
B. In column 7, the minimum unadjusted copayment ``$96.51'' is 
corrected to read ``$80.74.''

0
9. On page 66942, for APC 1606, in line 52--
0
A. In column 5, the payment rate ``$2,693.80'' is corrected to read 
``$1,706.04.''
0
B. In column 7, the minimum unadjusted copayment ``$538.76'' is 
corrected to read ``$341.21.''

0
10. On page 66943, for APC 2940, in line 37--
0
A. In column 5, the payment rate ``$168.90'' is corrected to read 
``$42.69.''
0
B. In column 7, the minimum unadjusted copayment ``$33.78'' is 
corrected to read ``$8.54.''

0
11. On page 66944, for APC 9051, in line 5--
0
A. In column 5, the payment rate ``$74.16'' is corrected to read 
``$23.23.''
0
B. In column 7, the minimum unadjusted copayment ``$14.83'' is 
corrected to read ``$4.65.''

0
12. On page 66944, for APC 9126, in line 17, in column 7, the minimum 
unadjusted copayment ``$1.50'' is corrected to read ``$1.49.''

0
13. On page 66944, for APC 9140, in line 23--
0
A. In column 5, the payment rate ``$119.86'' is corrected to read 
``$118.82.''
0
B. In column 7, the minimum unadjusted copayment ``$23.97'' is 
corrected to read ``$23.76.''

0
14. On page 66944, for APC 9141, in line 24--
0
A. In column 5, the payment rate ``$45.53'' is corrected to read 
``$66.38.''
0
B. In column 7, the minimum unadjusted copayment ``$9.11'' is corrected 
to read ``$13.28.''

0
15. On page 66944, for APC 9167, in line 29--
0
A. In column 5, the payment rate ``$77.96'' is corrected to read 
``$219.39.''
0
B. In column 7, the minimum unadjusted copayment ``$15.59'' is 
corrected to read ``$43.88.''

0
16. On page 66944--
0
A. For APC 9227, in line 43, in column 7, the minimum unadjusted 
copayment ``$0.29'' is corrected to read ``$0.28.''
0
B. For APC 9229, in line 45, in column 7, the minimum unadjusted 
copayment ``$27.79'' is corrected to read ``$27.53.''
0
C. For APC 9230, in line 46, in column 7, the minimum unadjusted 
copayment ``$3.74'' is corrected to read ``$3.70.''
0
D. For APC 9232, in line 48, in column 7, the minimum unadjusted 
copayment ``$91.01'' is corrected to read ``$90.15.''

[[Page 9863]]

0
E. For APC 9233, in line 49, in column 7, the minimum unadjusted 
copayment ``$406.05'' is corrected to read ``$402.22.''
0
F. For APC 9235, in line 51, in column 7, the minimum unadjusted 
copayment ``$16.63'' is corrected to read ``$16.47.''
0
G. For APC 9236, in line 52, in column 7, the minimum unadjusted 
copayment ``$35.28'' is corrected to read ``$34.94.''

0
17. On page 66944, for APC 9350, in line 55--
0
A. In column 5, the payment rate ``$482.56'' is corrected to read 
``$496.87.''
0
B. In column 7, the minimum unadjusted copayment ``$96.51'' is 
corrected to read ``$98.44.''

0
18. On page 66944, for APC 9351, in line 56--
0
A. In column 5, the payment rate ``$67.96'' is corrected to read 
``$95.32.''
0
B. In column 7, the minimum unadjusted copayment ``$13.59'' is 
corrected to read ``$18.88.''

ADDENDUM AA.--ASC COVERED SURGICAL PROCEDURES FOR CY 2008

    We are republishing Addendum AA in its entirety. See attached 
chart.

ADDENDUM B.--OPPS PAYMENT BY HCPCS CODE FOR CY 2008

0
1. On page 67095, the chart for HCPCS codes starting with HCPCS code 
90649 through HCPCS code 90708 should read as follows:

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                  National     Minimum
     HCPCS code           Short descriptor               CI                  SI              APC        Relative     Payment     unadjusted   unadjusted
                                                                                                         weight        rate      copayment    copayment
--------------------------------------------------------------------------------------------------------------------------------------------------------
90650..............  Hpv typ bival 3 dose, im..  NI................  E.................  ...........  ...........  ...........  ...........  ...........
90655..............  Flu vaccine no preserv 6-   ..................  L.................  ...........  ...........  ...........  ...........  ...........
                      35m.
90656..............  Flu vaccine no preserv 3 &  ..................  L.................  ...........  ...........  ...........  ...........  ...........
                      >.
90657..............  Flu vaccine, 3 yrs, im....  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90658..............  Flu vaccine, 3 yrs & >, im  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90660..............  Flu vaccine, nasal........  ..................  L.................  ...........  ...........  ...........  ...........  ...........
90661..............  Flu vacc cell cult prsv     NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      free.
90662..............  Flu vacc prsv free inc      NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      antig.
90663..............  Flu vacc pandemic.........  NI................  E.................  ...........  ...........  ...........  ...........  ...........
90665..............  Lyme disease vaccine, im..  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90669..............  Pneumococcal vacc, ped <5.  CH................  L.................  ...........  ...........  ...........  ...........  ...........
90675..............  Rabies vaccine, im........  ..................  K.................         9139  ...........      $150.80  ...........       $30.16
90676..............  Rabies vaccine, id........  ..................  K.................         9140  ...........      $118.82  ...........       $23.76
90680..............  Rotavirus vacc 3 dose,      ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      oral.
90681..............  Rotavirus vacc 2 dose,      NI................  E.................  ...........  ...........  ...........  ...........  ...........
                      oral.
90690..............  Typhoid vaccine, oral.....  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90691..............  Typhoid vaccine, im.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90692..............  Typhoid vaccine, h-p, sc/   ..................  N.................  ...........  ...........  ...........  ...........  ...........
                      id.
90693..............  Typhoid vaccine, akd, sc..  ..................  B.................  ...........  ...........  ...........  ...........  ...........
90696..............  Dtap-ipv vacc 4-6 yr, im..  NI................  E.................  ...........  ...........  ...........  ...........  ...........
90698..............  Dtap-hib-ip vaccine, im...  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90700..............  Dtap vaccine, < 7 yrs, im.  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90701..............  Dtp vaccine, im...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90702..............  Dt vaccine < 7, im........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90703..............  Tetanus vaccine, im.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90704..............  Mumps vaccine, sc.........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90705..............  Measles vaccine, sc.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90706..............  Rubella vaccine, sc.......  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90707..............  Mmr vaccine, sc...........  ..................  N.................  ...........  ...........  ...........  ...........  ...........
90708..............  Measles-rubella vaccine,    ..................  K.................         9141  ...........       $66.38  ...........       $13.28
                      sc.
--------------------------------------------------------------------------------------------------------------------------------------------------------


0
2. On page 67118, for HCPCS code C9239, in line 25, in column 9, the 
minimum unadjusted copayment ``$9.68'' is corrected to read ``$9.59.''

0
3. On page 67118, for HCPCS code C9352, in line 28--
0
A. In column 7, the payment rate ``$482.56'' is corrected to read 
``$496.87.''
0
B. In column 9, the minimum unadjusted copayment ``$96.51'' is 
corrected to read ``$98.44.''

0
4. On page 67118, for HCPCS code C9353, in line 29--
0
A. In column 7, the payment rate ``$482.56'' is corrected to read 
``$407.56.''
0
B. In column 9, the minimum unadjusted copayment ``$96.51'' is 
corrected to read ``$80.74.''

0
5. On page 67134, for HCPCS code G0377, in line 47--
0
A. In column 4, the SI code ``S'' is corrected to read ``E.''
0
B. In column 5, the APC code ``0437'' is removed.
0
C. In column 6, the relative weight number ``0.3945'' is removed.
0
D. In column 7, the payment rate ``$25.13'' is removed.
0
E. In column 9, the minimum unadjusted copayment ``$5.03'' is removed.

0
6. On page 67139, for HCPCS code G9140, in line 40, in column 4, the SI 
code ``M'' is corrected to read ``A''.

0
7. On page 67139, for HCPCS code J0129, in line 43, in column 9, the 
minimum unadjusted copayment ``$3.74'' is corrected to read ``$3.70.''

0
8. On page 67139, for HCPCS code J0190, in line 52--
0
A. In column 7, the payment rate ``$88.15'' is corrected to read 
``$12.24.''
0
B. In column 9, the minimum unadjusted copayment ``$17.63'' is 
corrected to read ``$2.45.''

0
9. On page 67139, for HCPCS code J0350, in line 74--
0
A. In column 7, the payment rate ``$2,693.80'' is corrected to read 
``$1,706.04.''
0
B. In column 9, the minimum unadjusted copayment ``$538.76'' is 
corrected to read ``$341.21.''

0
10. On page 67141, for HCPCS code J1300, in line 17, in column 9, the 
minimum unadjusted copayment ``$35.28'' is corrected to read 
``$34.94.''

0
11. On page 67142--
0
A. For HCPCS code J1740, in line 4, in column 9, the minimum unadjusted 
copayment ``$27.79'' is corrected to read ``$27.53.''
0
B. For HCPCS code J1743, in line 6, in column 9, the minimum unadjusted 
copayment ``$91.01'' is corrected to read ``$90.15.''

0
C. For HCPCS code J2248, in line 43, in column 9, the minimum 
unadjusted copayment ``$0.29'' is corrected to read ``$0.28.''
0
D. For HCPCS code J2323, in line 57, in column 9, the minimum 
unadjusted

[[Page 9864]]

copayment ``$1.50'' is corrected to read ``$1.49.''

0
12. On page 67143 for HCPCS code J2778, in line 21, in column 9, the 
minimum unadjusted copayment ``$406.05'' is corrected to read 
``$402.22.''

0
13. On page 67143, for HCPCS code J2940, in line 39--
0
A. In column 7, the payment rate ``$168.90'' is corrected to read 
``$42.69.''
0
B. In column 9, the minimum unadjusted copayment ``$33.78'' is 
corrected to read ``$8.54.''

0
14. On page 67143, for HCPCS code J2995, in line 43--
0
A. In column 7, the payment rate ``$129.75'' is corrected to read 
``$20.89.''
0
B. In column 9, the minimum unadjusted copayment ``$25.95'' is 
corrected to read ``$4.18.''

0
15. On page 67143, for HCPCS code J3350, in line 72--
0
A. In column 7, the payment rate ``$74.16'' is corrected to read 
``$23.23.''
0
B. In column 9, the minimum unadjusted copayment ``$14.83'' is 
corrected to read ``$4.65.''

0
16. On page 67144, for HCPCS code J3488, in line 15, in column 9, the 
minimum unadjusted copayment ``$44.16'' is corrected to read 
``$43.74.''

0
17. On page 67144, for HCPCS code J7348, in line 65--
0
A. In column 7, the payment rate ``$67.96'' is corrected to read 
``$95.32,''
0
B. In column 9, the minimum unadjusted copayment ``$13.59'' is 
corrected to read ``$18.88.''

0
18. On page 67144, for HCPCS code J7349, in line 66--
0
A. In column 7, the payment rate ``$67.96'' is corrected to read 
``$42.24,''
0
B. In column 9, the minimum unadjusted copayment ``$13.59'' is 
corrected to read ``$8.37.''

0
19. On page 67146, for HCPCS code J9261, in line 65, in column 9, the 
minimum unadjusted copayment ``$17.37'' is corrected to read 
``$17.20.''

0
20. On page 67146, for HCPCS code J9270, in line 71--
0
A. In column 7, the payment rate ``$172.41'' is corrected to read 
``$19.81.''
0
B. In column 9, the minimum unadjusted copayment ``$34.48'' is 
corrected to read ``$3.96.''

0
21. On page 67146, for HCPCS code J9303, in line 77, in column 9, the 
minimum unadjusted copayment ``$16.63'' is corrected to read 
``$16.47.''

0
22. On page 67147, for HCPCS code J9357, in line 4--
0
A. In column 7, the payment rate ``$77.96'' is corrected to read 
``$219.39.''
0
B. In column 9, the minimum unadjusted copayment ``$15.59'' is 
corrected to read ``$43.88.''

ADDENDUM BB.--ASC COVERED ANCILLARY SERVICES INTEGRAL TO COVERED 
SURGICAL PROCEDURES FOR CY 2008

    We are republishing Addendum BB in its entirety, see attached 
chart.

ADDENDUM DD2.--OPPS COMMENT INDICATORS

0
On page 67190, in line 1, the header ``ADDENDUM DD2--OPPS COMMENT 
INDICATORS'' is corrected to read ``ADDENDUM D2--OPPS COMMENT 
INDICATORS.''

ADDENDUM M.--HCPCS CODES FOR ASSIGNMENT TO COMPOSITE APCS FOR CY 2008

0
On page 67225--
0
A. For HCPCS code 90862, in line 19, in column 5, the single code APC 
assignment number ``0605'' is corrected to read ``0606.''
0
B. For HCPCS code 96102, in line 24, in column 5, the single code APC 
assignment number ``0373'' is corrected to read ``0382.''
0
C. For HCPCS code M0064, in line 37, in column 5, the single code APC 
assignment number ``0605'' is corrected to read ``0606.''

IV. Waiver of Proposed Rulemaking and Delay in Effective Date

    We ordinarily publish a notice of proposed rulemaking in the 
Federal Register to provide a period for public comment before the 
provisions of a notice such as this takes effect in accordance with 
section 553(b) of the Administrative Procedure Act (APA) (5 U.S.C. 
553(b)). We also ordinarily provide a 30-day delay in the effective 
date of the provisions of a notice in accordance with section 553(d) of 
the APA (5 U.S.C. 553(d)). However, we can waive both the notice and 
comment procedure and the 30-day delay in effective date if the 
Secretary finds, for good cause, that it is impracticable, unnecessary 
or contrary to the public interest, and incorporates a statement of the 
finding and the reasons therefore in the notice. The policies and 
payment methodology finalized in the CY 2008 OPPS/ASC final rule with 
comment period have previously been subjected to notice and comment 
procedures.
    This correction notice merely provides technical corrections to the 
CY 2008 OPPS/ASC final rule with comment period that was promulgated 
through notice and comment rulemaking, and does not make substantive 
changes to the policies or payment methodologies that were finalized in 
the final rule with comment period. For example, in order to conform 
the document to the final policies of the CY 2008 OPPS/ASC final rule 
with comment period, this notice corrects typographical errors, makes 
clarifications to the preamble text, and revises inaccurate tabular 
data. Therefore, we find it unnecessary to undertake further notice and 
comment procedures with respect to this correction notice. For the 
reasons stated above, we find that both notice and comment and the 30-
day delay in effective date for this correction notice are unnecessary. 
Therefore, we find there is good cause to waive notice and comment 
procedures and the 30-day delay in effective date for this correction 
notice.
(Catalog of Federal Domestic Assistance Program No. 93.774, 
Medicare--Supplementary Medical Insurance Program)

    Dated: February 5, 2008.
Ann Agnew,
Executive Secretary to the Department.

[[Page 9865]]



                                                Addendum AA.--ASC Covered Surgical Procedures for CY 2008
                                              [Including Surgical Procedures for Which Payment Is Packaged]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                     CY 2008                   CY 2008
                                                 Subject to                                           CY 2007 ASC     fully       CY 2008       first
    HCPCS code         Short descriptor           multiple      Comment indicator  Payment indicator    payment    implemented     fully      transition
                                                 procedure                                                rate       payment    implemented      year
                                                discounting                                                           weight      payment      payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
0016T............  Thermotx choroid vasc     Y................  .................  R2...............  ...........       4.1331      $171.11      $171.11
                    lesion.
0017T............  Photocoagulat macular     Y................  .................  R2...............  ...........       4.1331      $171.11      $171.11
                    drusen.
0027T............  Endoscopic epidural       Y................  .................  G2...............  ...........      18.0518      $747.36      $747.36
                    lysis.
0031T............  Speculoscopy............  N................  .................  N1...............  ...........  ...........  ...........  ...........
0032T............  Speculoscopy w/direct     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    sample.
0046T............  Cath lavage, mammary      Y................  .................  R2...............  ...........      16.1001      $666.56      $666.56
                    duct(s).
0047T............  Cath lavage, mammary      Y................  .................  R2...............  ...........      16.1001      $666.56      $666.56
                    duct(s).
0062T............  Rep intradisc annulus;1   Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    lev.
0063T............  Rep intradisc annulus;    Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    >1 lev.
0084T............  Temp prostate urethral    Y................  .................  G2...............  ...........       2.0077       $83.12       $83.12
                    stent.
0088T............  Rf tongue base vol        Y................  CH...............  G2...............  ...........      16.3288      $676.03      $676.03
                    reduxn.
0099T *..........  Implant corneal ring....  Y................  .................  R2...............  ...........       16.171      $669.50      $669.50
0100T............  Prosth retina receive &   Y................  .................  G2...............  ...........      37.2078    $1,540.44    $1,540.44
                    gen.
0101T............  Extracorp shockwv tx,hi   Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    enrg.
0102T............  Extracorp shockwv         Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    tx,anesth.
0123T............  Scleral fistulization...  Y................  .................  G2...............  ...........      23.1758      $959.50      $959.50
0124T *..........  Conjunctival drug         Y................  .................  R2...............  ...........       5.1169      $211.84      $211.84
                    placement.
0137T............  Prostate saturation       Y................  CH...............  G2...............  ...........      11.0338      $456.81      $456.81
                    sampling.
0170T............  Anorectal fistula plug    Y................  CH...............  G2...............  ...........      30.1606    $1,248.68    $1,248.68
                    rpr.
0176T............  Aqu canal dilat w/o       Y................  .................  A2...............    $1,339.00      39.7101    $1,644.04    $1,415.26
                    retent.
0177T............  Aqu canal dilat w retent  Y................  .................  A2...............    $1,339.00      39.7101    $1,644.04    $1,415.26
0186T............  Suprachoroidal drug       Y................  NI...............  G2...............  ...........       18.235      $754.95      $754.95
                    delivery.
10021............  Fna w/o image...........  Y................  .................  P2...............  ...........       1.1097       $45.94       $45.94
10022............  Fna w/image.............  Y................  .................  G2...............  ...........        4.327      $179.14      $179.14
10040............  Acne surgery............  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
10060............  Drainage of skin abscess  Y................  .................  P3...............  ...........       1.1191       $46.33       $46.33
10061............  Drainage of skin abscess  Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
10080............  Drainage of pilonidal     Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
                    cyst.
10081............  Drainage of pilonidal     Y................  .................  P3...............  ...........       3.1106      $128.78      $128.78
                    cyst.
10120............  Remove foreign body.....  Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
10121............  Remove foreign body.....  Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
10140............  Drainage of hematoma/     Y................  .................  P3...............  ...........       1.6623       $68.82       $68.82
                    fluid.
10160............  Puncture drainage of      Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
                    lesion.
10180............  Complex drainage, wound.  Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
11000............  Debride infected skin...  Y................  .................  P3...............  ...........       0.5348       $22.14       $22.14
11001............  Debride infected skin     Y................  .................  P3...............  ...........       0.1894        $7.84        $7.84
                    add-on.
11010............  Debride skin, fx........  Y................  .................  A2...............      $251.52       4.3039      $178.19      $233.19
11011............  Debride skin/muscle, fx.  Y................  .................  A2...............      $251.52       4.3039      $178.19      $233.19
11012............  Debride skin/muscle/      Y................  .................  A2...............      $251.52       4.3039      $178.19      $233.19
                    bone, fx.
11040............  Debride skin, partial...  Y................  .................  P3...............  ...........       0.4937       $20.44       $20.44
11041............  Debride skin, full......  Y................  .................  P3...............  ...........       0.5679       $23.51       $23.51
11042............  Debride skin/tissue.....  Y................  .................  A2...............      $164.42       2.6604      $110.14      $150.85
11043............  Debride tissue/muscle...  Y................  .................  A2...............      $164.42       2.6604      $110.14      $150.85
11044............  Debride tissue/muscle/    Y................  .................  A2...............      $423.10       6.8816      $284.91      $388.55
                    bone.
11055............  Trim skin lesion........  Y................  .................  P3...............  ...........       0.5596       $23.17       $23.17
11056............  Trim skin lesions, 2 to   Y................  .................  P3...............  ...........       0.6253       $25.89       $25.89
                    4.
11057............  Trim skin lesions, over   Y................  .................  P3...............  ...........       0.7077       $29.30       $29.30
                    4.
11100............  Biopsy, skin lesion.....  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11101............  Biopsy, skin add-on.....  Y................  .................  P3...............  ...........       0.3046       $12.61       $12.61
11200............  Removal of skin tags....  Y................  CH...............  P2...............  ...........        0.793       $32.83       $32.83
11201............  Remove skin tags add-on.  Y................  .................  P3...............  ...........       0.1316        $5.45        $5.45
11300............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11301............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11302............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11303............  Shave skin lesion.......  Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
11305............  Shave skin lesion.......  Y................  .................  P3...............  ...........       0.7901       $32.71       $32.71
11306............  Shave skin lesion.......  Y................  CH...............  P2...............  ...........        0.793       $32.83       $32.83
11307............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11308............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11310............  Shave skin lesion.......  Y................  CH...............  P2...............  ...........        0.793       $32.83       $32.83
11311............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11312............  Shave skin lesion.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
11313............  Shave skin lesion.......  Y................  CH...............  P2...............  ...........        0.793       $32.83       $32.83
11400............  Exc tr-ext b9+marg 0.5 <  Y................  .................  P3...............  ...........       1.5963       $66.09       $66.09
                    cm.
11401............  Exc tr-ext b9+marg 0.6-1  Y................  .................  P3...............  ...........       1.7444       $72.22       $72.22
                    cm.
11402............  Exc tr-ext b9+marg 1.1-2  Y................  .................  P3...............  ...........       1.9009       $78.70       $78.70
                    cm.
11403............  Exc tr-ext b9+marg 2.1-3  Y................  .................  P3...............  ...........       2.0408       $84.49       $84.49
                    cm.
11404............  Exc tr-ext b9+marg 3.1-4  Y................  .................  A2...............      $333.00      16.1001      $666.56      $416.39
                    cm.
11406............  Exc tr-ext b9+marg > 4.0  Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    cm.
11420............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       1.4811       $61.32       $61.32
                    0.5 <.
11421............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       1.7611       $72.91       $72.91
                    0.6-1.
11422............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       1.9338       $80.06       $80.06
                    1.1-2.
11423............  Exc h-f-nk-sp b9+marg     Y................  .................  P3...............  ...........       2.1642       $89.60       $89.60
                    2.1-3.
11424............  Exc h-f-nk-sp b9+marg     Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    3.1-4.
11426............  Exc h-f-nk-sp b9+marg >   Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    4 cm.
11440............  Exc face-mm b9+marg 0.5   Y................  .................  P3...............  ...........        1.728       $71.54       $71.54
                    < cm.
11441............  Exc face-mm b9+marg 0.6-  Y................  .................  P3...............  ...........        1.942       $80.40       $80.40
                    1 cm.

[[Page 9866]]

 
11442............  Exc face-mm b9+marg 1.1-  Y................  .................  P3...............  ...........       2.1313       $88.24       $88.24
                    2 cm.
11443............  Exc face-mm b9+marg 2.1-  Y................  .................  P3...............  ...........       2.3864       $98.80       $98.80
                    3 cm.
11444............  Exc face-mm b9+marg 3.1-  Y................  .................  A2...............      $333.00        8.685      $359.57      $339.64
                    4 cm.
11446............  Exc face-mm b9+marg > 4   Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    cm.
11450............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11451............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11462............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11463............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11470............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11471............  Removal, sweat gland      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
11600............  Exc tr-ext mlg+marg 0.5   Y................  .................  P3...............  ...........       2.2135       $91.64       $91.64
                    < cm.
11601............  Exc tr-ext mlg+marg 0.6-  Y................  .................  P3...............  ...........       2.5263      $104.59      $104.59
                    1 cm.
11602............  Exc tr-ext mlg+marg 1.1-  Y................  .................  P3...............  ...........       2.7485      $113.79      $113.79
                    2 cm.
11603............  Exc tr-ext mlg+marg 2.1-  Y................  .................  P3...............  ...........       2.9294      $121.28      $121.28
                    3 cm.
11604............  Exc tr-ext mlg+marg 3.1-  Y................  .................  A2...............      $418.49        8.685      $359.57      $403.76
                    4 cm.
11606............  Exc tr-ext mlg+marg > 4   Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    cm.
11620............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       2.2384       $92.67       $92.67
                    0.5 <.
11621............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       2.5509      $105.61      $105.61
                    0.6-1.
11622............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       2.8224      $116.85      $116.85
                    1.1-2.
11623............  Exc h-f-nk-sp mlg+marg    Y................  .................  P3...............  ...........       3.0692      $127.07      $127.07
                    2.1-3.
11624............  Exc h-f-nk-sp mlg+marg    Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    3.1-4.
11626............  Exc h-f-nk-sp mlg+mar >   Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    4 cm.
11640............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........       2.3536       $97.44       $97.44
                    0.5 <.
11641............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........       2.7403      $113.45      $113.45
                    0.6-1.
11642............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........        3.061      $126.73      $126.73
                    1.1-2.
11643............  Exc face-mm malig+marg    Y................  .................  P3...............  ...........       3.3246      $137.64      $137.64
                    2.1-3.
11644............  Exc face-mm malig+marg    Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    3.1-4.
11646............  Exc face-mm mlg+marg > 4  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    cm.
11719............  Trim nail(s)............  Y................  .................  P3...............  ...........       0.2551       $10.56       $10.56
11720............  Debride nail, 1-5.......  Y................  .................  P3...............  ...........       0.3292       $13.63       $13.63
11721............  Debride nail, 6 or more.  Y................  .................  P3...............  ...........       0.4031       $16.69       $16.69
11730............  Removal of nail plate...  Y................  CH...............  P2...............  ...........        0.793       $32.83       $32.83
11732............  Remove nail plate, add-   Y................  .................  P3...............  ...........       0.4031       $16.69       $16.69
                    on.
11740............  Drain blood from under    Y................  CH...............  P2...............  ...........       0.2963       $12.27       $12.27
                    nail.
11750............  Removal of nail bed.....  Y................  .................  P3...............  ...........       2.1065       $87.21       $87.21
11752............  Remove nail bed/finger    Y................  .................  P3...............  ...........       2.9048      $120.26      $120.26
                    tip.
11755............  Biopsy, nail unit.......  Y................  .................  P3...............  ...........       1.4811       $61.32       $61.32
11760............  Repair of nail bed......  Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
11762............  Reconstruction of nail    Y................  CH...............  P3...............  ...........       2.7072      $112.08      $112.08
                    bed.
11765............  Excision of nail fold,    Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    toe.
11770............  Removal of pilonidal      Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    lesion.
11771............  Removal of pilonidal      Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    lesion.
11772............  Removal of pilonidal      Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    lesion.
11900............  Injection into skin       Y................  .................  P3...............  ...........       0.6418       $26.57       $26.57
                    lesions.
11901............  Added skin lesions        Y................  .................  P3...............  ...........       0.6831       $28.28       $28.28
                    injection.
11920............  Correct skin color        Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    defects.
11921............  Correct skin color        Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    defects.
11922............  Correct skin color        Y................  .................  P3...............  ...........       0.8476       $35.09       $35.09
                    defects.
11950............  Therapy for contour       Y................  .................  P3...............  ...........       0.8311       $34.41       $34.41
                    defects.
11951............  Therapy for contour       Y................  .................  P3...............  ...........       0.9874       $40.88       $40.88
                    defects.
11952............  Therapy for contour       Y................  CH...............  P2...............  ...........       1.2792       $52.96       $52.96
                    defects.
11954............  Therapy for contour       Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    defects.
11960............  Insert tissue             Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
                    expander(s).
11970............  Replace tissue expander.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
11971............  Remove tissue             Y................  .................  A2...............      $333.00      21.1098      $873.97      $468.24
                    expander(s).
11976............  Removal of contraceptive  Y................  .................  P3...............  ...........       1.4154       $58.60       $58.60
                    cap.
11980............  Implant hormone           N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    pellet(s).
11981............  Insert drug implant       N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    device.
11982............  Remove drug implant       N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    device.
11983............  Remove/insert drug        N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    implant.
12001............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12002............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12004............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12005............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12006............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12007............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12011............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12013............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12014............  Repair superficial        Y................  .................  P2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12015............  Repair superficial        Y................  .................  G2...............  ...........       1.2792       $52.96       $52.96
                    wound(s).
12016............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12017............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12018............  Repair superficial        Y................  .................  A2...............       $91.24       1.2792       $52.96       $81.67
                    wound(s).
12020............  Closure of split wound..  Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
12021............  Closure of split wound..  Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
12031............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12032............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).

[[Page 9867]]

 
12034............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12035............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12036............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12037............  Layer closure of          Y................  .................  A2...............      $323.28       2.1051       $87.15      $264.25
                    wound(s).
12041............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12042............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12044............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12045............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12046............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12047............  Layer closure of          Y................  .................  A2...............      $323.28       2.1051       $87.15      $264.25
                    wound(s).
12051............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12052............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12053............  Layer closure of          Y................  .................  P2...............  ...........       2.1051       $87.15       $87.15
                    wound(s).
12054............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12055............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12056............  Layer closure of          Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    wound(s).
12057............  Layer closure of          Y................  .................  A2...............      $323.28       2.1051       $87.15      $264.25
                    wound(s).
13100............  Repair of wound or        Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    lesion.
13101............  Repair of wound or        Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    lesion.
13102............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
                    on.
13120............  Repair of wound or        Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    lesion.
13121............  Repair of wound or        Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
                    lesion.
13122............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    on.
13131............  Repair of wound or        Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
                    lesion.
13132............  Repair of wound or        Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
                    lesion.
13133............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       4.5263      $187.39      $115.28
                    on.
13150............  Repair of wound or        Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    lesion.
13151............  Repair of wound or        Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    lesion.
13152............  Repair of wound or        Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    lesion.
13153............  Repair wound/lesion add-  Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    on.
13160............  Late closure of wound...  Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
14000............  Skin tissue               Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    rearrangement.
14001............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14020............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14021............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14040............  Skin tissue               Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    rearrangement.
14041............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14060............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14061............  Skin tissue               Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    rearrangement.
14300............  Skin tissue               Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    rearrangement.
14350............  Skin tissue               Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    rearrangement.
15002............  Wnd prep, ch/inf, trk/    Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    arm/lg.
15003............  Wnd prep, ch/inf addl     Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    100 cm.
15004............  Wnd prep ch/inf, f/n/hf/  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    g.
15005............  Wnd prep, f/n/hf/g, addl  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    cm.
15040............  Harvest cultured skin     Y................  .................  A2...............       $91.24       2.1051       $87.15       $90.22
                    graft.
15050............  Skin pinch graft........  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
15100............  Skin splt grft, trnk/arm/ Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
                    leg.
15101............  Skin splt grft t/a/l,     Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    add-on.
15110............  Epidrm autogrft trnk/arm/ Y................  .................  A2...............      $446.00       4.5263      $187.39      $381.35
                    leg.
15111............  Epidrm autogrft t/a/l     Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    add-on.
15115............  Epidrm a-grft face/nck/   Y................  .................  A2...............      $446.00       4.5263      $187.39      $381.35
                    hf/g.
15116............  Epidrm a-grft f/n/hf/g    Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    addl.
15120............  Skn splt a-grft fac/nck/  Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
                    hf/g.
15121............  Skn splt a-grft f/n/hf/g  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    add.
15130............  Derm autograft, trnk/arm/ Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    leg.
15131............  Derm autograft t/a/l add- Y................  .................  A2...............      $333.00      15.0458      $622.91      $405.48
                    on.
15135............  Derm autograft face/nck/  Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    hf/g.
15136............  Derm autograft, f/n/hf/g  Y................  .................  A2...............      $333.00      15.0458      $622.91      $405.48
                    add.
15150............  Cult epiderm grft t/arm/  Y................  .................  A2...............      $446.00       4.5263      $187.39      $381.35
                    leg.
15151............  Cult epiderm grft t/a/l   Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    addl.
15152............  Cult epiderm graft t/a/l  Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    +%.
15155............  Cult epiderm graft, f/n/  Y................  .................  A2...............      $446.00       4.5263      $187.39      $381.35
                    hf/g.
15156............  Cult epidrm grft f/n/hfg  Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    add.
15157............  Cult epiderm grft f/n/    Y................  .................  A2...............      $333.00       4.5263      $187.39      $296.60
                    hfg +%.
15200............  Skin full graft, trunk..  Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
15201............  Skin full graft trunk     Y................  .................  A2...............      $323.28      15.0458      $622.91      $398.19
                    add-on.
15220............  Skin full graft sclp/arm/ Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    leg.
15221............  Skin full graft add-on..  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
15240............  Skin full grft face/      Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    genit/hf.
15241............  Skin full graft add-on..  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
15260............  Skin full graft een &     Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    lips.
15261............  Skin full graft add-on..  Y................  .................  A2...............      $323.28      15.0458      $622.91      $398.19
15300............  Apply skinallogrft, t/    Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    arm/lg.
15301............  Apply sknallogrft t/a/l   Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    addl.
15320............  Apply skin allogrft f/n/  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    hf/g.
15321............  Aply sknallogrft f/n/hfg  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add.

[[Page 9868]]

 
15330............  Aply acell alogrft t/arm/ Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    leg.
15331............  Aply acell grft t/a/l     Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add-on.
15335............  Apply acell graft, f/n/   Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    hf/g.
15336............  Aply acell grft f/n/hf/g  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add.
15340............  Apply cult skin           Y................  CH...............  G2...............  ...........       2.1051       $87.15       $87.15
                    substitute.
15341............  Apply cult skin sub add-  Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
                    on.
15360............  Apply cult derm sub, t/a/ Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
                    l.
15361............  Aply cult derm sub t/a/l  Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
                    add.
15365............  Apply cult derm sub f/n/  Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
                    hf/g.
15366............  Apply cult derm f/hf/g    Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
                    add.
15400............  Apply skin xenograft, t/  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    a/l.
15401............  Apply skn xenogrft t/a/l  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add.
15420............  Apply skin xgraft, f/n/   Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    hf/g.
15421............  Apply skn xgrft f/n/hf/g  Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add.
15430............  Apply acellular           Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    xenograft.
15431............  Apply acellular xgraft    Y................  .................  A2...............      $323.28       4.5263      $187.39      $289.31
                    add.
15570............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15572............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15574............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15576............  Form skin pedicle flap..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15600............  Skin graft..............  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15610............  Skin graft..............  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15620............  Skin graft..............  Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
15630............  Skin graft..............  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15650............  Transfer skin pedicle     Y................  .................  A2...............      $717.00      20.2069      $836.59      $746.90
                    flap.
15731............  Forehead flap w/vasc      Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    pedicle.
15732............  Muscle-skin graft, head/  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    neck.
15734............  Muscle-skin graft, trunk  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15736............  Muscle-skin graft, arm..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15738............  Muscle-skin graft, leg..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15740............  Island pedicle flap       Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    graft.
15750............  Neurovascular pedicle     Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
                    graft.
15760............  Composite skin graft....  Y................  .................  A2...............      $446.00      20.2069      $836.59      $543.65
15770............  Derma-fat-fascia graft..  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15775............  Hair transplant punch     Y................  .................  A2...............      $323.28       1.2792       $52.96      $255.70
                    grafts.
15776............  Hair transplant punch     Y................  .................  A2...............      $323.28       1.2792       $52.96      $255.70
                    grafts.
15780............  Abrasion treatment of     Y................  .................  P3...............  ...........       9.3645      $387.70      $387.70
                    skin.
15781............  Abrasion treatment of     Y................  .................  P2...............  ...........       4.3039      $178.19      $178.19
                    skin.
15782............  Abrasion treatment of     Y................  .................  P2...............  ...........       4.3039      $178.19      $178.19
                    skin.
15783............  Abrasion treatment of     Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    skin.
15786............  Abrasion, lesion, single  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
15787............  Abrasion, lesions, add-   Y................  .................  P3...............  ...........       0.7901       $32.71       $32.71
                    on.
15788............  Chemical peel, face,      Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
                    epiderm.
15789............  Chemical peel, face,      Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    dermal.
15792............  Chemical peel, nonfacial  Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
15793............  Chemical peel, nonfacial  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
15819............  Plastic surgery, neck...  Y................  .................  G2...............  ...........       2.1051       $87.15       $87.15
15820............  Revision of lower eyelid  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15821............  Revision of lower eyelid  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15822............  Revision of upper eyelid  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15823............  Revision of upper eyelid  Y................  .................  A2...............      $717.00      20.2069      $836.59      $746.90
15824............  Removal of forehead       Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    wrinkles.
15825............  Removal of neck wrinkles  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15826............  Removal of brow wrinkles  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15828............  Removal of face wrinkles  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15829............  Removal of skin wrinkles  Y................  .................  A2...............      $717.00      20.2069      $836.59      $746.90
15830............  Exc skin abd............  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
15832............  Excise excessive skin     Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    tissue.
15833............  Excise excessive skin     Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    tissue.
15834............  Excise excessive skin     Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    tissue.
15835............  Excise excessive skin     Y................  .................  A2...............      $323.28      21.1098      $873.97      $460.95
                    tissue.
15836............  Excise excessive skin     Y................  .................  A2...............      $510.00      16.1001      $666.56      $549.14
                    tissue.
15837............  Excise excessive skin     Y................  .................  G2...............  ...........      16.1001      $666.56      $666.56
                    tissue.
15838............  Excise excessive skin     Y................  .................  G2...............  ...........      16.1001      $666.56      $666.56
                    tissue.
15839............  Excise excessive skin     Y................  .................  A2...............      $510.00      16.1001      $666.56      $549.14
                    tissue.
15840............  Graft for face nerve      Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    palsy.
15841............  Graft for face nerve      Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    palsy.
15842............  Flap for face nerve       Y................  .................  G2...............  ...........      20.2069      $836.59      $836.59
                    palsy.
15845............  Skin and muscle repair,   Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    face.
15847............  Exc skin abd add-on.....  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
15850............  Removal of sutures......  Y................  .................  G2...............  ...........       2.6604      $110.14      $110.14
15851............  Removal of sutures......  Y................  .................  P3...............  ...........       1.2425       $51.44       $51.44
15852............  Dressing change not for   N................  .................  G2...............  ...........        0.631       $26.12       $26.12
                    burn.
15860............  Test for blood flow in    N................  .................  G2...............  ...........        0.631       $26.12       $26.12
                    graft.
15876............  Suction assisted          Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    lipectomy.
15877............  Suction assisted          Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    lipectomy.
15878............  Suction assisted          Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    lipectomy.

[[Page 9869]]

 
15879............  Suction assisted          Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    lipectomy.
15920............  Removal of tail bone      Y................  .................  A2...............      $251.52       4.3039      $178.19      $233.19
                    ulcer.
15922............  Removal of tail bone      Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    ulcer.
15931............  Remove sacrum pressure    Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    sore.
15933............  Remove sacrum pressure    Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    sore.
15934............  Remove sacrum pressure    Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    sore.
15935............  Remove sacrum pressure    Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    sore.
15936............  Remove sacrum pressure    Y................  .................  A2...............      $630.00      15.0458      $622.91      $628.23
                    sore.
15937............  Remove sacrum pressure    Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
                    sore.
15940............  Remove hip pressure sore  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
15941............  Remove hip pressure sore  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
15944............  Remove hip pressure sore  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
15945............  Remove hip pressure sore  Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
15946............  Remove hip pressure sore  Y................  .................  A2...............      $630.00      20.2069      $836.59      $681.65
15950............  Remove thigh pressure     Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    sore.
15951............  Remove thigh pressure     Y................  .................  A2...............      $630.00      21.1098      $873.97      $690.99
                    sore.
15952............  Remove thigh pressure     Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    sore.
15953............  Remove thigh pressure     Y................  .................  A2...............      $630.00      15.0458      $622.91      $628.23
                    sore.
15956............  Remove thigh pressure     Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    sore.
15958............  Remove thigh pressure     Y................  .................  A2...............      $630.00      15.0458      $622.91      $628.23
                    sore.
16000............  Initial treatment of      Y................  .................  P3...............  ...........         0.65       $26.91       $26.91
                    burn(s).
16020............  Dress/debrid p-thick      Y................  .................  P3...............  ...........       0.9874       $40.88       $40.88
                    burn, s.
16025............  Dress/debrid p-thick      Y................  .................  A2...............       $67.11       2.6604      $110.14       $77.87
                    burn, m.
16030............  Dress/debrid p-thick      Y................  .................  A2...............       $99.83       2.6604      $110.14      $102.41
                    burn, l.
16035............  Incision of burn scab,    Y................  .................  G2...............  ...........       2.6604      $110.14      $110.14
                    initi.
17000............  Destruct premalg lesion.  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
17003............  Destruct premalg les, 2-  Y................  .................  P3...............  ...........       0.0906        $3.75        $3.75
                    14.
17004............  Destroy premlg lesions    Y................  .................  P3...............  ...........       1.9502       $80.74       $80.74
                    15+.
17106............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17107............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17108............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17110............  Destruct b9 lesion, 1-14  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
17111............  Destruct lesion, 15 or    Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    more.
17250............  Chemical cautery, tissue  Y................  .................  P3...............  ...........       1.0451       $43.27       $43.27
17260............  Destruction of skin       Y................  .................  P3...............  ...........       1.1026       $45.65       $45.65
                    lesions.
17261............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17262............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17263............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17264............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17266............  Destruction of skin       Y................  .................  P3...............  ...........       2.4685      $102.20      $102.20
                    lesions.
17270............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17271............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17272............  Destruction of skin       Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17273............  Destruction of skin       Y................  CH...............  P3...............  ...........       2.2299       $92.32       $92.32
                    lesions.
17274............  Destruction of skin       Y................  .................  P3...............  ...........       2.5427      $105.27      $105.27
                    lesions.
17276............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17280............  Destruction of skin       Y................  CH...............  P2...............  ...........       1.4595       $60.42       $60.42
                    lesions.
17281............  Destruction of skin       Y................  CH...............  P3...............  ...........       1.9091       $79.04       $79.04
                    lesions.
17282............  Destruction of skin       Y................  CH...............  P3...............  ...........       2.1806       $90.28       $90.28
                    lesions.
17283............  Destruction of skin       Y................  CH...............  P3...............  ...........       2.5098      $103.91      $103.91
                    lesions.
17284............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17286............  Destruction of skin       Y................  .................  P2...............  ...........       2.6604      $110.14      $110.14
                    lesions.
17311............  Mohs, 1 stage, h/n/hf/g.  Y................  .................  P2...............  ...........       3.6321      $150.37      $150.37
17312............  Mohs addl stage.........  Y................  .................  P2...............  ...........       3.6321      $150.37      $150.37
17313............  Mohs, 1 stage, t/a/l....  Y................  .................  P2...............  ...........       3.6321      $150.37      $150.37
17314............  Mohs, addl stage, t/a/l.  Y................  .................  P2...............  ...........       3.6321      $150.37      $150.37
17315............  Mohs surg, addl block...  Y................  .................  P3...............  ...........       0.9381       $38.84       $38.84
17340............  Cryotherapy of skin.....  Y................  .................  P3...............  ...........       0.2961       $12.26       $12.26
17360............  Skin peel therapy.......  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
17380............  Hair removal by           Y................  .................  R2...............  ...........        0.793       $32.83       $32.83
                    electrolysis.
19000............  Drainage of breast        Y................  .................  P3...............  ...........       1.6046       $66.43       $66.43
                    lesion.
19001............  Drain breast lesion add-  Y................  .................  P3...............  ...........       0.2058        $8.52        $8.52
                    on.
19020............  Incision of breast        Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
                    lesion.
19030............  Injection for breast x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
19100............  Bx breast percut w/o      Y................  .................  A2...............      $240.00        4.327      $179.14      $224.79
                    image.
19101............  Biopsy of breast, open..  Y................  .................  A2...............      $446.00      20.6417      $854.59      $548.15
19102............  Bx breast percut w/image  Y................  .................  A2...............      $240.00       7.1147      $294.56      $253.64
19103............  Bx breast percut w/       Y................  .................  A2...............      $395.77      13.5764      $562.08      $437.35
                    device.
19105............  Cryosurg ablate fa, each  Y................  .................  G2...............  ...........      31.7134    $1,312.97    $1,312.97
19110............  Nipple exploration......  Y................  .................  A2...............      $446.00      20.6417      $854.59      $548.15
19112............  Excise breast duct        Y................  .................  A2...............      $510.00      20.6417      $854.59      $596.15
                    fistula.
19120............  Removal of breast lesion  Y................  .................  A2...............      $510.00      20.6417      $854.59      $596.15
19125............  Excision, breast lesion.  Y................  .................  A2...............      $510.00      20.6417      $854.59      $596.15
19126............  Excision, addl breast     Y................  .................  A2...............      $510.00      20.6417      $854.59      $596.15
                    lesion.
19290............  Place needle wire,        N................  .................  N1...............  ...........  ...........  ...........  ...........
                    breast.
19291............  Place needle wire,        N................  .................  N1...............  ...........  ...........  ...........  ...........
                    breast.
19295............  Place breast clip,        N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    percut.

[[Page 9870]]

 
19296............  Place po breast cath for  Y................  .................  A2...............    $1,339.00      56.5774    $2,342.36    $1,589.84
                    rad.
19297............  Place breast cath for     Y................  .................  A2...............    $1,339.00      56.5774    $2,342.36    $1,589.84
                    rad.
19298............  Place breast rad tube/    Y................  .................  A2...............    $1,339.00      56.5774    $2,342.36    $1,589.84
                    caths.
19300............  Removal of breast tissue  Y................  .................  A2...............      $630.00      20.6417      $854.59      $686.15
19301............  Partical mastectomy.....  Y................  .................  A2...............      $510.00      20.6417      $854.59      $596.15
19302............  P-mastectomy w/ln         Y................  .................  A2...............      $995.00      39.8191    $1,648.55    $1,158.39
                    removal.
19303............  Mast, simple, complete..  Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
19304............  Mast, subq..............  Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
19316............  Suspension of breast....  Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
19318............  Reduction of large        Y................  .................  A2...............      $630.00      39.8191    $1,648.55      $884.64
                    breast.
19324............  Enlarge breast..........  Y................  .................  A2...............      $630.00      39.8191    $1,648.55      $884.64
19325............  Enlarge breast with       Y................  .................  A2...............    $1,339.00      56.5774    $2,342.36    $1,589.84
                    implant.
19328............  Removal of breast         Y................  .................  A2...............      $333.00      31.7134    $1,312.97      $577.99
                    implant.
19330............  Removal of implant        Y................  .................  A2...............      $333.00      31.7134    $1,312.97      $577.99
                    material.
19340............  Immediate breast          Y................  .................  A2...............      $446.00      39.8191    $1,648.55      $746.64
                    prosthesis.
19342............  Delayed breast            Y................  .................  A2...............      $510.00      56.5774    $2,342.36      $968.09
                    prosthesis.
19350............  Breast reconstruction...  Y................  .................  A2...............      $630.00      20.6417      $854.59      $686.15
19355............  Correct inverted          Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
                    nipple(s).
19357............  Breast reconstruction...  Y................  .................  A2...............      $717.00      56.5774    $2,342.36    $1,123.34
19366............  Breast reconstruction...  Y................  .................  A2...............      $717.00      31.7134    $1,312.97      $865.99
19370............  Surgery of breast         Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
                    capsule.
19371............  Removal of breast         Y................  .................  A2...............      $630.00      31.7134    $1,312.97      $800.74
                    capsule.
19380............  Revise breast             Y................  .................  A2...............      $717.00      39.8191    $1,648.55      $949.89
                    reconstruction.
19396............  Design custom breast      Y................  .................  G2...............  ...........      31.7134    $1,312.97    $1,312.97
                    implant.
20000............  Incision of abscess.....  Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
20005............  Incision of deep abscess  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
20103............  Explore wound, extremity  Y................  .................  G2...............  ...........       9.6341      $398.86      $398.86
20150............  Excise epiphyseal bar...  Y................  .................  G2...............  ...........       42.985    $1,779.62    $1,779.62
20200............  Muscle biopsy...........  Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
20205............  Deep muscle biopsy......  Y................  .................  A2...............      $510.00      16.1001      $666.56      $549.14
20206............  Needle biopsy, muscle...  Y................  .................  A2...............      $240.00       7.1147      $294.56      $253.64
20220............  Bone biopsy, trocar/      Y................  .................  A2...............      $251.52        8.685      $359.57      $278.53
                    needle.
20225............  Bone biopsy, trocar/      Y................  .................  A2...............      $418.49        8.685      $359.57      $403.76
                    needle.
20240............  Bone biopsy, excisional.  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
20245............  Bone biopsy, excisional.  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
20250............  Open bone biopsy........  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
20251............  Open bone biopsy........  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
20500............  Injection of sinus tract  Y................  .................  P3...............  ...........       1.4811       $61.32       $61.32
20501............  Inject sinus tract for x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
20520............  Removal of foreign body.  Y................  .................  P3...............  ...........       2.2712       $94.03       $94.03
20525............  Removal of foreign body.  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
20526............  Ther injection, carp      Y................  .................  P3...............  ...........       0.7323       $30.32       $30.32
                    tunnel.
20550............  Inj tendon sheath/        Y................  .................  P3...............  ...........       0.5514       $22.83       $22.83
                    ligament.
20551............  Inj tendon origin/        Y................  .................  P3...............  ...........       0.5432       $22.49       $22.49
                    insertion.
20552............  Inj trigger point, 1/2    Y................  .................  P3...............  ...........       0.5348       $22.14       $22.14
                    muscl.
20553............  Inject trigger points, =/ Y................  .................  P3...............  ...........       0.6007       $24.87       $24.87
                    > 3.
20555............  Place ndl musc/tis for    Y................  NI...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    rt.
20600............  Drain/inject, joint/      Y................  .................  P3...............  ...........       0.5432       $22.49       $22.49
                    bursa.
20605............  Drain/inject, joint/      Y................  .................  P3...............  ...........       0.6171       $25.55       $25.55
                    bursa.
20610............  Drain/inject, joint/      Y................  .................  P3...............  ...........       0.8311       $34.41       $34.41
                    bursa.
20612............  Aspirate/inj ganglion     Y................  .................  P3...............  ...........       0.5761       $23.85       $23.85
                    cyst.
20615............  Treatment of bone cyst..  Y................  CH...............  P3...............  ...........       2.5591      $105.95      $105.95
20650............  Insert and remove bone    Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    pin.
20662............  Application of pelvis     Y................  .................  R2...............  ...........      21.2689      $880.55      $880.55
                    brace.
20663............  Application of thigh      Y................  .................  R2...............  ...........      21.2689      $880.55      $880.55
                    brace.
20665............  Removal of fixation       N................  .................  G2...............  ...........        0.631       $26.12       $26.12
                    device.
20670............  Removal of support        Y................  .................  A2...............      $333.00      16.1001      $666.56      $416.39
                    implant.
20680............  Removal of support        Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    implant.
20690............  Apply bone fixation       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    device.
20692............  Apply bone fixation       Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    device.
20693............  Adjust bone fixation      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    device.
20694............  Remove bone fixation      Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    device.
20822............  Replantation digit,       Y................  .................  G2...............  ...........      26.3105    $1,089.28    $1,089.28
                    complete.
20900............  Removal of bone for       Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    graft.
20902............  Removal of bone for       Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    graft.
20910............  Remove cartilage for      Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    graft.
20912............  Remove cartilage for      Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
                    graft.
20920............  Removal of fascia for     Y................  .................  A2...............      $630.00      15.0458      $622.91      $628.23
                    graft.
20922............  Removal of fascia for     Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    graft.
20924............  Removal of tendon for     Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    graft.
20926............  Removal of tissue for     Y................  .................  A2...............      $630.00       4.5263      $187.39      $519.35
                    graft.
20950............  Fluid pressure, muscle..  Y................  .................  G2...............  ...........       1.4066       $58.23       $58.23
20972............  Bone/skin graft,          Y................  .................  G2...............  ...........      44.2687    $1,832.77    $1,832.77
                    metatarsal.
20973............  Bone/skin graft, great    Y................  .................  R2...............  ...........      44.2687    $1,832.77    $1,832.77
                    toe.
20975............  Electrical bone           N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    stimulation.
20979............  Us bone stimulation.....  N................  .................  P3...............  ...........       0.5843       $24.19       $24.19
20982............  Ablate, bone tumor(s)     Y................  .................  G2...............  ...........       42.985    $1,779.62    $1,779.62
                    perq.

[[Page 9871]]

 
20985............  Cptr-asst dir ms px.....  N................  NI...............  N1...............  ...........  ...........  ...........  ...........
20986............  Cptr-asst dir ms px io    N................  NI...............  N1...............  ...........  ...........  ...........  ...........
                    img.
20987............  Cptr-asst dir ms px pre   N................  NI...............  N1...............  ...........  ...........  ...........  ...........
                    img.
21010............  Incision of jaw joint...  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
21015............  Resection of facial       Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    tumor.
21025............  Excision of bone, lower   Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    jaw.
21026............  Excision of facial        Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    bone(s).
21029............  Contour of face bone      Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    lesion.
21030............  Excise max/zygoma b9      Y................  .................  P3...............  ...........       5.5627      $230.30      $230.30
                    tumor.
21031............  Remove exostosis,         Y................  .................  P3...............  ...........       4.5588      $188.74      $188.74
                    mandible.
21032............  Remove exostosis,         Y................  .................  P3...............  ...........       4.6905      $194.19      $194.19
                    maxilla.
21034............  Excise max/zygoma mlg     Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
                    tumor.
21040............  Excise mandible lesion..  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
21044............  Removal of jaw bone       Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    lesion.
21046............  Remove mandible cyst      Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    complex.
21047............  Excise lwr jaw cyst w/    Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    repair.
21048............  Remove maxilla cyst       Y................  .................  R2...............  ...........      39.8776    $1,650.97    $1,650.97
                    complex.
21050............  Removal of jaw joint....  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
21060............  Remove jaw joint          Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    cartilage.
21070............  Remove coronoid process.  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
21073 *..........  Mnpj of tmj w/anesth....  Y................  NI...............  P3...............  ...........        4.526      $187.38      $187.38
21076............  Prepare face/oral         Y................  .................  P3...............  ...........       8.3851      $347.15      $347.15
                    prosthesis.
21077............  Prepare face/oral         Y................  .................  P3...............  ...........      20.4816      $847.96      $847.96
                    prosthesis.
21079............  Prepare face/oral         Y................  .................  P3...............  ...........       14.598      $604.37      $604.37
                    prosthesis.
21080............  Prepare face/oral         Y................  .................  P3...............  ...........      16.7293      $692.61      $692.61
                    prosthesis.
21081............  Prepare face/oral         Y................  .................  P3...............  ...........      15.3632      $636.05      $636.05
                    prosthesis.
21082............  Prepare face/oral         Y................  .................  P3...............  ...........       14.096      $583.59      $583.59
                    prosthesis.
21083............  Prepare face/oral         Y................  .................  P3...............  ...........      13.8738      $574.39      $574.39
                    prosthesis.
21084............  Prepare face/oral         Y................  .................  P3...............  ...........      16.1697      $669.44      $669.44
                    prosthesis.
21085............  Prepare face/oral         Y................  .................  P3...............  ...........       6.2622      $259.26      $259.26
                    prosthesis.
21086............  Prepare face/oral         Y................  .................  P3...............  ...........      15.0917      $624.81      $624.81
                    prosthesis.
21087............  Prepare face/oral         Y................  .................  P3...............  ...........      14.9518      $619.02      $619.02
                    prosthesis.
21088............  Prepare face/oral         Y................  .................  R2...............  ...........      39.8776    $1,650.97    $1,650.97
                    prosthesis.
21100............  Maxillofacial fixation..  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
21110............  Interdental fixation....  Y................  .................  P2...............  ...........       7.4474      $308.33      $308.33
21116............  Injection, jaw joint x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
21120............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21121............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21122............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21123............  Reconstruction of chin..  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21125............  Augmentation, lower jaw   Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
                    bone.
21127............  Augmentation, lower jaw   Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
                    bone.
21137............  Reduction of forehead...  Y................  .................  G2...............  ...........      23.9765      $992.65      $992.65
21138............  Reduction of forehead...  Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
21139............  Reduction of forehead...  Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
21150............  Reconstruct midface,      Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    lefort.
21181............  Contour cranial bone      Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
                    lesion.
21198............  Reconstr lwr jaw segment  Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
21199............  Reconstr lwr jaw w/       Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    advance.
21206............  Reconstruct upper jaw     Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    bone.
21208............  Augmentation of facial    Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    bones.
21209............  Reduction of facial       Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    bones.
21210............  Face bone graft.........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21215............  Lower jaw bone graft....  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21230............  Rib cartilage graft.....  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21235............  Ear cartilage graft.....  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21240............  Reconstruction of jaw     Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    joint.
21242............  Reconstruction of jaw     Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    joint.
21243............  Reconstruction of jaw     Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    joint.
21244............  Reconstruction of lower   Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    jaw.
21245............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21246............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21248............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21249............  Reconstruction of jaw...  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21260............  Revise eye sockets......  Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
21267............  Revise eye sockets......  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
21270............  Augmentation, cheek bone  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
21275............  Revision, orbitofacial    Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    bones.
21280............  Revision of eyelid......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
21282............  Revision of eyelid......  Y................  .................  A2...............      $717.00      16.3288      $676.03      $706.76
21295............  Revision of jaw muscle/   Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
                    bone.
21296............  Revision of jaw muscle/   Y................  .................  A2...............      $333.00      23.9765      $992.65      $497.91
                    bone.
21310............  Treatment of nose         Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    fracture.
21315............  Treatment of nose         Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    fracture.
21320............  Treatment of nose         Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    fracture.
21325............  Treatment of nose         Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
                    fracture.
21330............  Treatment of nose         Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
                    fracture.

[[Page 9872]]

 
21335............  Treatment of nose         Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
                    fracture.
21336............  Treat nasal septal        Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    fracture.
21337............  Treat nasal septal        Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    fracture.
21338............  Treat nasoethmoid         Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
                    fracture.
21339............  Treat nasoethmoid         Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
                    fracture.
21340............  Treatment of nose         Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    fracture.
21345............  Treat nose/jaw fracture.  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
21355............  Treat cheek bone          Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
                    fracture.
21356............  Treat cheek bone          Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
                    fracture.
21360............  Treat cheek bone          Y................  CH...............  G2...............  ...........      23.9765      $992.65      $992.65
                    fracture.
21390............  Treat eye socket          Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    fracture.
21400............  Treat eye socket          Y................  .................  A2...............      $446.00       7.4474      $308.33      $411.58
                    fracture.
21401............  Treat eye socket          Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    fracture.
21406............  Treat eye socket          Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    fracture.
21407............  Treat eye socket          Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    fracture.
21421............  Treat mouth roof          Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
                    fracture.
21440............  Treat dental ridge        Y................  .................  P3...............  ...........       7.0687      $292.65      $292.65
                    fracture.
21445............  Treat dental ridge        Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
                    fracture.
21450............  Treat lower jaw fracture  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
21451............  Treat lower jaw fracture  Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
21452............  Treat lower jaw fracture  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
21453............  Treat lower jaw fracture  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
21454............  Treat lower jaw fracture  Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
21461............  Treat lower jaw fracture  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
21462............  Treat lower jaw fracture  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
21465............  Treat lower jaw fracture  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
21480............  Reset dislocated jaw....  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
21485............  Reset dislocated jaw....  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
21490............  Repair dislocated jaw...  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
21495............  Treat hyoid bone          Y................  .................  G2...............  ...........      16.3288      $676.03      $676.03
                    fracture.
21497............  Interdental wiring......  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
21501............  Drain neck/chest lesion.  Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
21502............  Drain chest lesion......  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
21550............  Biopsy of neck/chest....  Y................  .................  G2...............  ...........        8.685      $359.57      $359.57
21555............  Remove lesion, neck/      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    chest.
21556............  Remove lesion, neck/      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    chest.
21557............  Remove tumor, neck/chest  Y................  .................  G2...............  ...........      21.1098      $873.97      $873.97
21600............  Partial removal of rib..  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
21610............  Partial removal of rib..  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
21685............  Hyoid myotomy &           Y................  .................  G2...............  ...........       7.4474      $308.33      $308.33
                    suspension.
21700............  Revision of neck muscle.  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
21720............  Revision of neck muscle.  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
21725............  Revision of neck muscle.  Y................  .................  A2...............       $88.46       1.4066       $58.23       $80.90
21800............  Treatment of rib          Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
21805............  Treatment of rib          Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
                    fracture.
21820............  Treat sternum fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
21920............  Biopsy soft tissue of     Y................  .................  P3...............  ...........       3.1763      $131.50      $131.50
                    back.
21925............  Biopsy soft tissue of     Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    back.
21930............  Remove lesion, back or    Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    flank.
21935............  Remove tumor, back......  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
22102............  Remove part, lumbar       Y................  .................  G2...............  ...........      46.7724    $1,936.42    $1,936.42
                    vertebra.
22103............  Remove extra spine        Y................  .................  G2...............  ...........      46.7724    $1,936.42    $1,936.42
                    segment.
22305............  Treat spine process       Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
22310............  Treat spine fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
22315............  Treat spine fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
22505............  Manipulation of spine...  Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
22520............  Percut vertebroplasty     Y................  .................  A2...............    $1,339.00        29.19    $1,208.50    $1,306.38
                    thor.
22521............  Percut vertebroplasty     Y................  .................  A2...............    $1,339.00        29.19    $1,208.50    $1,306.38
                    lumb.
22522............  Percut vertebroplasty     Y................  .................  A2...............    $1,339.00        29.19    $1,208.50    $1,306.38
                    add?l.
22523............  Percut kyphoplasty, thor  Y................  .................  G2...............  ...........      79.4244    $3,288.25    $3,288.25
22524............  Percut kyphoplasty,       Y................  .................  G2...............  ...........      79.4244    $3,288.25    $3,288.25
                    lumbar.
22525............  Percut kyphoplasty, add-  Y................  .................  G2...............  ...........      79.4244    $3,288.25    $3,288.25
                    on.
22526............  Idet, single level......  Y................  CH...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
22527............  Idet, 1 or more levels..  Y................  CH...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
22900............  Remove abdominal wall     Y................  .................  A2...............      $630.00      21.1098      $873.97      $690.99
                    lesion.
23000............  Removal of calcium        Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    deposits.
23020............  Release shoulder joint..  Y................  .................  A2...............      $446.00       42.985    $1,779.62      $779.41
23030............  Drain shoulder lesion...  Y................  .................  A2...............      $333.00      18.3197      $758.45      $439.36
23031............  Drain shoulder bursa....  Y................  .................  A2...............      $510.00      18.3197      $758.45      $572.11
23035............  Drain shoulder bone       Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    lesion.
23040............  Exploratory shoulder      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    surgery.
23044............  Exploratory shoulder      Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    surgery.
23065............  Biopsy shoulder tissues.  Y................  .................  P3...............  ...........       2.2384       $92.67       $92.67
23066............  Biopsy shoulder tissues.  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
23075............  Removal of shoulder       Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    lesion.
23076............  Removal of shoulder       Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    lesion.
23077............  Remove tumor of shoulder  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99

[[Page 9873]]

 
23100............  Biopsy of shoulder joint  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
23101............  Shoulder joint surgery..  Y................  .................  A2...............      $995.00        29.19    $1,208.50    $1,048.38
23105............  Remove shoulder joint     Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
23106............  Incision of collarbone    Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    joint.
23107............  Explore treat shoulder    Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    joint.
23120............  Partial removal, collar   Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    bone.
23125............  Removal of collar bone..  Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
23130............  Remove shoulder bone,     Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    part.
23140............  Removal of bone lesion..  Y................  .................  A2...............      $630.00      21.2689      $880.55      $692.64
23145............  Removal of bone lesion..  Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
23146............  Removal of bone lesion..  Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
23150............  Removal of humerus        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lesion.
23155............  Removal of humerus        Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    lesion.
23156............  Removal of humerus        Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    lesion.
23170............  Remove collar bone        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    lesion.
23172............  Remove shoulder blade     Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    lesion.
23174............  Remove humerus lesion...  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
23180............  Remove collar bone        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lesion.
23182............  Remove shoulder blade     Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lesion.
23184............  Remove humerus lesion...  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
23190............  Partial removal of        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    scapula.
23195............  Removal of head of        Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    humerus.
23330............  Remove shoulder foreign   Y................  .................  A2...............      $333.00        8.685      $359.57      $339.64
                    body.
23331............  Remove shoulder foreign   Y................  .................  A2...............      $333.00      21.1098      $873.97      $468.24
                    body.
23350............  Injection for shoulder x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
23395............  Muscle transfer,shoulder/ Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    arm.
23397............  Muscle transfers........  Y................  .................  A2...............      $995.00      79.4244    $3,288.25    $1,568.31
23400............  Fixation of shoulder      Y................  .................  A2...............      $995.00        29.19    $1,208.50    $1,048.38
                    blade.
23405............  Incision of tendon &      Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    muscle.
23406............  Incise tendon(s) &        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    muscle(s).
23410............  Repair rotator cuff,      Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    acute.
23412............  Repair rotator cuff,      Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
                    chronic.
23415............  Release of shoulder       Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    ligament.
23420............  Repair of shoulder......  Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
23430............  Repair biceps tendon....  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
23440............  Remove/transplant tendon  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
23450............  Repair shoulder capsule.  Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
23455............  Repair shoulder capsule.  Y................  .................  A2...............      $995.00      79.4244    $3,288.25    $1,568.31
23460............  Repair shoulder capsule.  Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
23462............  Repair shoulder capsule.  Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
23465............  Repair shoulder capsule.  Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
23466............  Repair shoulder capsule.  Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
23480............  Revision of collar bone.  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
23485............  Revision of collar bone.  Y................  .................  A2...............      $995.00      79.4244    $3,288.25    $1,568.31
23490............  Reinforce clavicle......  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
23491............  Reinforce shoulder bones  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
23500............  Treat clavicle fracture.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23505............  Treat clavicle fracture.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23515............  Treat clavicle fracture.  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
23520............  Treat clavicle            Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
23525............  Treat clavicle            Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
23530............  Treat clavicle            Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    dislocation.
23532............  Treat clavicle            Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    dislocation.
23540............  Treat clavicle            Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
23545............  Treat clavicle            Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
23550............  Treat clavicle            Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    dislocation.
23552............  Treat clavicle            Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
                    dislocation.
23570............  Treat shoulder blade fx.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23575............  Treat shoulder blade fx.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23585............  Treat scapula fracture..  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
23600............  Treat humerus fracture..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
23605............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23615............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
23616............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
23620............  Treat humerus fracture..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
23625............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
23630............  Treat humerus fracture..  Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
23650............  Treat shoulder            Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
23655............  Treat shoulder            Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
                    dislocation.
23660............  Treat shoulder            Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    dislocation.
23665............  Treat dislocation/        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
23670............  Treat dislocation/        Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
                    fracture.
23675............  Treat dislocation/        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
23680............  Treat dislocation/        Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
23700............  Fixation of shoulder....  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
23800............  Fusion of shoulder joint  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
23802............  Fusion of shoulder joint  Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16

[[Page 9874]]

 
23921............  Amputation follow-up      Y................  .................  A2...............      $323.28      15.0458      $622.91      $398.19
                    surgery.
23930............  Drainage of arm lesion..  Y................  .................  A2...............      $333.00      18.3197      $758.45      $439.36
23931............  Drainage of arm bursa...  Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
23935............  Drain arm/elbow bone      Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    lesion.
24000............  Exploratory elbow         Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    surgery.
24006............  Release elbow joint.....  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
24065............  Biopsy arm/elbow soft     Y................  .................  P3...............  ...........       3.0282      $125.37      $125.37
                    tissue.
24066............  Biopsy arm/elbow soft     Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    tissue.
24075............  Remove arm/elbow lesion.  Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
24076............  Remove arm/elbow lesion.  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
24077............  Remove tumor of arm/      Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    elbow.
24100............  Biopsy elbow joint        Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    lining.
24101............  Explore/treat elbow       Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    joint.
24102............  Remove elbow joint        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
24105............  Removal of elbow bursa..  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
24110............  Remove humerus lesion...  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
24115............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
24116............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
24120............  Remove elbow lesion.....  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
24125............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
24126............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
24130............  Removal of head of        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    radius.
24134............  Removal of arm bone       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    lesion.
24136............  Remove radius bone        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    lesion.
24138............  Remove elbow bone lesion  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
24140............  Partial removal of arm    Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    bone.
24145............  Partial removal of        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    radius.
24147............  Partial removal of elbow  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
24149............  Radical resection of      Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    elbow.
24152............  Extensive radius surgery  Y................  .................  G2...............  ...........       42.985    $1,779.62    $1,779.62
24153............  Extensive radius surgery  Y................  .................  G2...............  ...........      79.4244    $3,288.25    $3,288.25
24155............  Removal of elbow joint..  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24160............  Remove elbow joint        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    implant.
24164............  Remove radius head        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    implant.
24200............  Removal of arm foreign    Y................  .................  P3...............  ...........       2.5345      $104.93      $104.93
                    body.
24201............  Removal of arm foreign    Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    body.
24220............  Injection for elbow x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
24300............  Manipulate elbow w/       Y................  .................  G2...............  ...........      14.7658      $611.32      $611.32
                    anesth.
24301............  Muscle/tendon transfer..  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
24305............  Arm tendon lengthening..  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
24310............  Revision of arm tendon..  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
24320............  Repair of arm tendon....  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24330............  Revision of arm muscles.  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
24331............  Revision of arm muscles.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24332............  Tenolysis, triceps......  Y................  .................  G2...............  ...........      21.2689      $880.55      $880.55
24340............  Repair of biceps tendon.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24341............  Repair arm tendon/muscle  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24342............  Repair of ruptured        Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendon.
24343............  Repr elbow lat ligmnt w/  Y................  .................  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    tiss.
24344............  Reconstruct elbow lat     Y................  .................  G2...............  ...........      79.4244    $3,288.25    $3,288.25
                    ligmnt.
24345............  Repr elbw med ligmnt w/   Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    tissu.
24346............  Reconstruct elbow med     Y................  .................  G2...............  ...........       42.985    $1,779.62    $1,779.62
                    ligmnt.
24350............  Repair of tennis elbow..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
24351............  Repair of tennis elbow..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
24352............  Repair of tennis elbow..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
24354............  Repair of tennis elbow..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
24356............  Revision of tennis elbow  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
24357............  Repair elbow, perc......  Y................  NI...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
24358............  Repair elbow w/deb, open  Y................  NI...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
24359............  Repair elbow deb/attch    Y................  NI...............  G2...............  ...........        29.19    $1,208.50    $1,208.50
                    open.
24360............  Reconstruct elbow joint.  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
24361............  Reconstruct elbow joint.  Y................  .................  A2...............      $717.00     122.2057    $5,059.44    $1,802.61
24362............  Reconstruct elbow joint.  Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
24363............  Replace elbow joint.....  Y................  .................  A2...............      $995.00     122.2057    $5,059.44    $2,011.11
24365............  Reconstruct head of       Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
                    radius.
24366............  Reconstruct head of       Y................  .................  A2...............      $717.00     122.2057    $5,059.44    $1,802.61
                    radius.
24400............  Revision of humerus.....  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
24410............  Revision of humerus.....  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
24420............  Revision of humerus.....  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24430............  Repair of humerus.......  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
24435............  Repair humerus with       Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
                    graft.
24470............  Revision of elbow joint.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
24495............  Decompression of forearm  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
24498............  Reinforce humerus.......  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
24500............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24505............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24515............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48

[[Page 9875]]

 
24516............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
24530............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24535............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24538............  Treat humerus fracture..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
24545............  Treat humerus fracture..  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
24546............  Treat humerus fracture..  Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
24560............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24565............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24566............  Treat humerus fracture..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
24575............  Treat humerus fracture..  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
24576............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24577............  Treat humerus fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24579............  Treat humerus fracture..  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
24582............  Treat humerus fracture..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
24586............  Treat elbow fracture....  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
24587............  Treat elbow fracture....  Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
24600............  Treat elbow dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24605............  Treat elbow dislocation.  Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
24615............  Treat elbow dislocation.  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
24620............  Treat elbow fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24635............  Treat elbow fracture....  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
24640............  Treat elbow dislocation.  Y................  CH...............  P3...............  ...........       1.3908       $57.58       $57.58
24650............  Treat radius fracture...  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
24655............  Treat radius fracture...  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24665............  Treat radius fracture...  Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
24666............  Treat radius fracture...  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
24670............  Treat ulnar fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24675............  Treat ulnar fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
24685............  Treat ulnar fracture....  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
24800............  Fusion of elbow joint...  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
24802............  Fusion/graft of elbow     Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    joint.
24925............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    surgery.
25000............  Incision of tendon        Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    sheath.
25001............  Incise flexor carpi       Y................  .................  G2...............  ...........      21.2689      $880.55      $880.55
                    radialis.
25020............  Decompress forearm 1      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    space.
25023............  Decompress forearm 1      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    space.
25024............  Decompress forearm 2      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    spaces.
25025............  Decompress forearm 2      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    spaces.
25028............  Drainage of forearm       Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    lesion.
25031............  Drainage of forearm       Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    bursa.
25035............  Treat forearm bone        Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    lesion.
25040............  Explore/treat wrist       Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    joint.
25065............  Biopsy forearm soft       Y................  .................  P3...............  ...........       3.1106      $128.78      $128.78
                    tissues.
25066............  Biopsy forearm soft       Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    tissues.
25075............  Removal forearm lesion    Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    subcu.
25076............  Removal forearm lesion    Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    deep.
25077............  Remove tumor, forearm/    Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    wrist.
25085............  Incision of wrist         Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    capsule.
25100............  Biopsy of wrist joint...  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
25101............  Explore/treat wrist       Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    joint.
25105............  Remove wrist joint        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
25107............  Remove wrist joint        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    cartilage.
25109............  Excise tendon forearm/    Y................  .................  G2...............  ...........      21.2689      $880.55      $880.55
                    wrist.
25110............  Remove wrist tendon       Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    lesion.
25111............  Remove wrist tendon       Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    lesion.
25112............  Reremove wrist tendon     Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    lesion.
25115............  Remove wrist/forearm      Y................  .................  A2...............      $630.00      21.2689      $880.55      $692.64
                    lesion.
25116............  Remove wrist/forearm      Y................  .................  A2...............      $630.00      21.2689      $880.55      $692.64
                    lesion.
25118............  Excise wrist tendon       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    sheath.
25119............  Partial removal of ulna.  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25120............  Removal of forearm        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
25125............  Remove/graft forearm      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
25126............  Remove/graft forearm      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
25130............  Removal of wrist lesion.  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25135............  Remove & graft wrist      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
25136............  Remove & graft wrist      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
25145............  Remove forearm bone       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    lesion.
25150............  Partial removal of ulna.  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
25151............  Partial removal of        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    radius.
25210............  Removal of wrist bone...  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
25215............  Removal of wrist bones..  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
25230............  Partial removal of        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    radius.
25240............  Partial removal of ulna.  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
25246............  Injection for wrist x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
25248............  Remove forearm foreign    Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    body.
25250............  Removal of wrist          Y................  .................  A2...............      $333.00        29.19    $1,208.50      $551.88
                    prosthesis.
25251............  Removal of wrist          Y................  .................  A2...............      $333.00        29.19    $1,208.50      $551.88
                    prosthesis.

[[Page 9876]]

 
25259............  Manipulate wrist w/       Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
                    anesthes.
25260............  Repair forearm tendon/    Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    muscle.
25263............  Repair forearm tendon/    Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    muscle.
25265............  Repair forearm tendon/    Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    muscle.
25270............  Repair forearm tendon/    Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    muscle.
25272............  Repair forearm tendon/    Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    muscle.
25274............  Repair forearm tendon/    Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    muscle.
25275............  Repair forearm tendon     Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    sheath.
25280............  Revise wrist/forearm      Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    tendon.
25290............  Incise wrist/forearm      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    tendon.
25295............  Release wrist/forearm     Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    tendon.
25300............  Fusion of tendons at      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    wrist.
25301............  Fusion of tendons at      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    wrist.
25310............  Transplant forearm        Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendon.
25312............  Transplant forearm        Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    tendon.
25315............  Revise palsy hand         Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendon(s).
25316............  Revise palsy hand         Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
                    tendon(s).
25320............  Repair/revise wrist       Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    joint.
25332............  Revise wrist joint......  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
25335............  Realignment of hand.....  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25337............  Reconstruct ulna/         Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    radioulnar.
25350............  Revision of radius......  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
25355............  Revision of radius......  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25360............  Revision of ulna........  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25365............  Revise radius & ulna....  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25370............  Revise radius or ulna...  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25375............  Revise radius & ulna....  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
25390............  Shorten radius or ulna..  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25391............  Lengthen radius or ulna.  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
25392............  Shorten radius & ulna...  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
25393............  Lengthen radius & ulna..  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
25394............  Repair carpal bone,       Y................  .................  G2...............  ...........      16.4637      $681.61      $681.61
                    shorten.
25400............  Repair radius or ulna...  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
25405............  Repair/graft radius or    Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
                    ulna.
25415............  Repair radius & ulna....  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
25420............  Repair/graft radius &     Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
                    ulna.
25425............  Repair/graft radius or    Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    ulna.
25426............  Repair/graft radius &     Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    ulna.
25430............  Vasc graft into carpal    Y................  .................  G2...............  ...........      26.3105    $1,089.28    $1,089.28
                    bone.
25431............  Repair nonunion carpal    Y................  .................  G2...............  ...........      26.3105    $1,089.28    $1,089.28
                    bone.
25440............  Repair/graft wrist bone.  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
25441............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00     122.2057    $5,059.44    $1,802.61
25442............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00     122.2057    $5,059.44    $1,802.61
25443............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
25444............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
25445............  Reconstruct wrist joint.  Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
25446............  Wrist replacement.......  Y................  .................  A2...............      $995.00     122.2057    $5,059.44    $2,011.11
25447............  Repair wrist joint(s)...  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
25449............  Remove wrist joint        Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
                    implant.
25450............  Revision of wrist joint.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25455............  Revision of wrist joint.  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25490............  Reinforce radius........  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25491............  Reinforce ulna..........  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
25492............  Reinforce radius and      Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    ulna.
25500............  Treat fracture of radius  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
25505............  Treat fracture of radius  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25515............  Treat fracture of radius  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
25520............  Treat fracture of radius  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25525............  Treat fracture of radius  Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
25526............  Treat fracture of radius  Y................  .................  A2...............      $717.00      41.1091    $1,701.96      $963.24
25530............  Treat fracture of ulna..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
25535............  Treat fracture of ulna..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25545............  Treat fracture of ulna..  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
25560............  Treat fracture radius &   Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    ulna.
25565............  Treat fracture radius &   Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    ulna.
25574............  Treat fracture radius &   Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
                    ulna.
25575............  Treat fracture radius/    Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
                    ulna.
25600............  Treat fracture radius/    Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    ulna.
25605............  Treat fracture radius/    Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    ulna.
25606............  Treat fx distal radial..  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
25607............  Treat fx rad extra-       Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
                    articul.
25608............  Treat fx rad intra-       Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
                    articul.
25609............  Treat fx radial 3+ frag.  Y................  .................  A2...............      $717.00      59.2233    $2,451.90    $1,150.73
25622............  Treat wrist bone          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
25624............  Treat wrist bone          Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
25628............  Treat wrist bone          Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
25630............  Treat wrist bone          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.

[[Page 9877]]

 
25635............  Treat wrist bone          Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
25645............  Treat wrist bone          Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
25650............  Treat wrist bone          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
25651............  Pin ulnar styloid         Y................  .................  G2...............  ...........      26.1592    $1,083.02    $1,083.02
                    fracture.
25652............  Treat fracture ulnar      Y................  .................  G2...............  ...........      41.1091    $1,701.96    $1,701.96
                    styloid.
25660............  Treat wrist dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25670............  Treat wrist dislocation.  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
25671............  Pin radioulnar            Y................  .................  A2...............      $333.00      26.1592    $1,083.02      $520.51
                    dislocation.
25675............  Treat wrist dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25676............  Treat wrist dislocation.  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
25680............  Treat wrist fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25685............  Treat wrist fracture....  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
25690............  Treat wrist dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
25695............  Treat wrist dislocation.  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
25800............  Fusion of wrist joint...  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
25805............  Fusion/graft of wrist     Y................  .................  A2...............      $717.00       42.985    $1,779.62      $982.66
                    joint.
25810............  Fusion/graft of wrist     Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
                    joint.
25820............  Fusion of hand bones....  Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
25825............  Fuse hand bones with      Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
                    graft.
25830............  Fusion, radioulnar jnt/   Y................  .................  A2...............      $717.00      79.4244    $3,288.25    $1,359.81
                    ulna.
25907............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    surgery.
25922............  Amputate hand at wrist..  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
25929............  Amputation follow-up      Y................  .................  A2...............      $510.00      15.0458      $622.91      $538.23
                    surgery.
25931............  Amputation follow-up      Y................  CH...............  G2...............  ...........      21.2689      $880.55      $880.55
                    surgery.
26010............  Drainage of finger        Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
                    abscess.
26011............  Drainage of finger        Y................  .................  A2...............      $333.00      11.5594      $478.57      $369.39
                    abscess.
26020............  Drain hand tendon sheath  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26025............  Drainage of palm bursa..  Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
26030............  Drainage of palm          Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    bursa(s).
26034............  Treat hand bone lesion..  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26035............  Decompress fingers/hand.  Y................  .................  G2...............  ...........      16.4637      $681.61      $681.61
26040............  Release palm contracture  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26045............  Release palm contracture  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26055............  Incise finger tendon      Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    sheath.
26060............  Incision of finger        Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    tendon.
26070............  Explore/treat hand joint  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26075............  Explore/treat finger      Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    joint.
26080............  Explore/treat finger      Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    joint.
26100............  Biopsy hand joint lining  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26105............  Biopsy finger joint       Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
                    lining.
26110............  Biopsy finger joint       Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
                    lining.
26115............  Removal hand lesion       Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    subcut.
26116............  Removal hand lesion,      Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    deep.
26117............  Remove tumor, hand/       Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
                    finger.
26121............  Release palm contracture  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26123............  Release palm contracture  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26125............  Release palm contracture  Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
26130............  Remove wrist joint        Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    lining.
26135............  Revise finger joint,      Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    each.
26140............  Revise finger joint,      Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    each.
26145............  Tendon excision, palm/    Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    finger.
26160............  Remove tendon sheath      Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    lesion.
26170............  Removal of palm tendon,   Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    each.
26180............  Removal of finger tendon  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26185............  Remove finger bone......  Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
26200............  Remove hand bone lesion.  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26205............  Remove/graft bone lesion  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26210............  Removal of finger lesion  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26215............  Remove/graft finger       Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    lesion.
26230............  Partial removal of hand   Y................  .................  A2...............      $992.95      16.4637      $681.61      $915.12
                    bone.
26235............  Partial removal, finger   Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    bone.
26236............  Partial removal, finger   Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    bone.
26250............  Extensive hand surgery..  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26255............  Extensive hand surgery..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26260............  Extensive finger surgery  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26261............  Extensive finger surgery  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26262............  Partial removal of        Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    finger.
26320............  Removal of implant from   Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    hand.
26340............  Manipulate finger w/      Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
                    anesth.
26350............  Repair finger/hand        Y................  .................  A2...............      $333.00      26.3105    $1,089.28      $522.07
                    tendon.
26352............  Repair/graft hand tendon  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26356............  Repair finger/hand        Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26357............  Repair finger/hand        Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26358............  Repair/graft hand tendon  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26370............  Repair finger/hand        Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26372............  Repair/graft hand tendon  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26373............  Repair finger/hand        Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.

[[Page 9878]]

 
26390............  Revise hand/finger        Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26392............  Repair/graft hand tendon  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26410............  Repair hand tendon......  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26412............  Repair/graft hand tendon  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26415............  Excision, hand/finger     Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26416............  Graft hand or finger      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26418............  Repair finger tendon....  Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
26420............  Repair/graft finger       Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    tendon.
26426............  Repair finger/hand        Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26428............  Repair/graft finger       Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26432............  Repair finger tendon....  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26433............  Repair finger tendon....  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26434............  Repair/graft finger       Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26437............  Realignment of tendons..  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26440............  Release palm/finger       Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    tendon.
26442............  Release palm & finger     Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26445............  Release hand/finger       Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    tendon.
26449............  Release forearm/hand      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26450............  Incision of palm tendon.  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26455............  Incision of finger        Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    tendon.
26460............  Incise hand/finger        Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    tendon.
26471............  Fusion of finger tendons  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26474............  Fusion of finger tendons  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26476............  Tendon lengthening......  Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
26477............  Tendon shortening.......  Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
26478............  Lengthening of hand       Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
                    tendon.
26479............  Shortening of hand        Y................  .................  A2...............      $333.00      16.4637      $681.61      $420.15
                    tendon.
26480............  Transplant hand tendon..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26483............  Transplant/graft hand     Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26485............  Transplant palm tendon..  Y................  .................  A2...............      $446.00      26.3105    $1,089.28      $606.82
26489............  Transplant/graft palm     Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    tendon.
26490............  Revise thumb tendon.....  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26492............  Tendon transfer with      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    graft.
26494............  Hand tendon/muscle        Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    transfer.
26496............  Revise thumb tendon.....  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26497............  Finger tendon transfer..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26498............  Finger tendon transfer..  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26499............  Revision of finger......  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26500............  Hand tendon               Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    reconstruction.
26502............  Hand tendon               Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    reconstruction.
26508............  Release thumb             Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    contracture.
26510............  Thumb tendon transfer...  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26516............  Fusion of knuckle joint.  Y................  .................  A2...............      $333.00      26.3105    $1,089.28      $522.07
26517............  Fusion of knuckle joints  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26518............  Fusion of knuckle joints  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26520............  Release knuckle           Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    contracture.
26525............  Release finger            Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
                    contracture.
26530............  Revise knuckle joint....  Y................  .................  A2...............      $510.00       35.904    $1,486.46      $754.12
26531............  Revise knuckle with       Y................  .................  A2...............      $995.00      50.8876    $2,106.80    $1,272.95
                    implant.
26535............  Revise finger joint.....  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
26536............  Revise/implant finger     Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
                    joint.
26540............  Repair hand joint.......  Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
26541............  Repair hand joint with    Y................  .................  A2...............      $995.00      26.3105    $1,089.28    $1,018.57
                    graft.
26542............  Repair hand joint with    Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    graft.
26545............  Reconstruct finger joint  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26546............  Repair nonunion hand....  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26548............  Reconstruct finger joint  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26550............  Construct thumb           Y................  .................  A2...............      $446.00      26.3105    $1,089.28      $606.82
                    replacement.
26555............  Positional change of      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    finger.
26560............  Repair of web finger....  Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
26561............  Repair of web finger....  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26562............  Repair of web finger....  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26565............  Correct metacarpal flaw.  Y................  .................  A2...............      $717.00      26.3105    $1,089.28      $810.07
26567............  Correct finger deformity  Y................  .................  A2...............      $717.00      26.3105    $1,089.28      $810.07
26568............  Lengthen metacarpal/      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    finger.
26580............  Repair hand deformity...  Y................  .................  A2...............      $717.00      16.4637      $681.61      $708.15
26587............  Reconstruct extra finger  Y................  .................  A2...............      $717.00      16.4637      $681.61      $708.15
26590............  Repair finger deformity.  Y................  .................  A2...............      $717.00      16.4637      $681.61      $708.15
26591............  Repair muscles of hand..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26593............  Release muscles of hand.  Y................  .................  A2...............      $510.00      16.4637      $681.61      $552.90
26596............  Excision constricting     Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    tissue.
26600............  Treat metacarpal          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
26605............  Treat metacarpal          Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
26607............  Treat metacarpal          Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
26608............  Treat metacarpal          Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    fracture.
26615............  Treat metacarpal          Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
                    fracture.
26641............  Treat thumb dislocation.  Y................  CH...............  P2...............  ...........       1.7682       $73.21       $73.21

[[Page 9879]]

 
26645............  Treat thumb fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
26650............  Treat thumb fracture....  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
26665............  Treat thumb fracture....  Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
26670............  Treat hand dislocation..  Y................  CH...............  P2...............  ...........       1.7682       $73.21       $73.21
26675............  Treat hand dislocation..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
26676............  Pin hand dislocation....  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
26685............  Treat hand dislocation..  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
26686............  Treat hand dislocation..  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
26700............  Treat knuckle             Y................  CH...............  P2...............  ...........       1.7682       $73.21       $73.21
                    dislocation.
26705............  Treat knuckle             Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
26706............  Pin knuckle dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
26715............  Treat knuckle             Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    dislocation.
26720............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
26725............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
26727............  Treat finger fracture,    Y................  .................  A2...............      $995.00      26.1592    $1,083.02    $1,017.01
                    each.
26735............  Treat finger fracture,    Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    each.
26740............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
26742............  Treat finger fracture,    Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    each.
26746............  Treat finger fracture,    Y................  .................  A2...............      $717.00      26.1592    $1,083.02      $808.51
                    each.
26750............  Treat finger fracture,    Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
26755............  Treat finger fracture,    Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
                    each.
26756............  Pin finger fracture,      Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
                    each.
26765............  Treat finger fracture,    Y................  .................  A2...............      $630.00      26.1592    $1,083.02      $743.26
                    each.
26770............  Treat finger dislocation  Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
26775............  Treat finger dislocation  Y................  CH...............  P3...............  ...........       4.0402      $167.27      $167.27
26776............  Pin finger dislocation..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
26785............  Treat finger dislocation  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
26820............  Thumb fusion with graft.  Y................  .................  A2...............      $717.00      26.3105    $1,089.28      $810.07
26841............  Fusion of thumb.........  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26842............  Thumb fusion with graft.  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26843............  Fusion of hand joint....  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26844............  Fusion/graft of hand      Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
                    joint.
26850............  Fusion of knuckle.......  Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
26852............  Fusion of knuckle with    Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    graft.
26860............  Fusion of finger joint..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26861............  Fusion of finger jnt,     Y................  .................  A2...............      $446.00      26.3105    $1,089.28      $606.82
                    add-on.
26862............  Fusion/graft of finger    Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    joint.
26863............  Fuse/graft added joint..  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26910............  Amputate metacarpal bone  Y................  .................  A2...............      $510.00      26.3105    $1,089.28      $654.82
26951............  Amputation of finger/     Y................  .................  A2...............      $446.00      16.4637      $681.61      $504.90
                    thumb.
26952............  Amputation of finger/     Y................  .................  A2...............      $630.00      16.4637      $681.61      $642.90
                    thumb.
26990............  Drainage of pelvis        Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    lesion.
26991............  Drainage of pelvis bursa  Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
27000............  Incision of hip tendon..  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27001............  Incision of hip tendon..  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27003............  Incision of hip tendon..  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27033............  Exploration of hip joint  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
27035............  Denervation of hip joint  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27040............  Biopsy of soft tissues..  Y................  .................  A2...............      $333.00        8.685      $359.57      $339.64
27041............  Biopsy of soft tissues..  Y................  .................  A2...............      $418.49        8.685      $359.57      $403.76
27047............  Remove hip/pelvis lesion  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
27048............  Remove hip/pelvis lesion  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
27049............  Remove tumor, hip/pelvis  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
27050............  Biopsy of sacroiliac      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    joint.
27052............  Biopsy of hip joint.....  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27060............  Removal of ischial bursa  Y................  .................  A2...............      $717.00      21.2689      $880.55      $757.89
27062............  Remove femur lesion/      Y................  .................  A2...............      $717.00      21.2689      $880.55      $757.89
                    bursa.
27065............  Removal of hip bone       Y................  .................  A2...............      $717.00      21.2689      $880.55      $757.89
                    lesion.
27066............  Removal of hip bone       Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    lesion.
27067............  Remove/graft hip bone     Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    lesion.
27080............  Removal of tail bone....  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
27086............  Remove hip foreign body.  Y................  .................  A2...............      $333.00        8.685      $359.57      $339.64
27087............  Remove hip foreign body.  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27093............  Injection for hip x-ray.  N................  .................  N1...............  ...........  ...........  ...........  ...........
27095............  Injection for hip x-ray.  N................  .................  N1...............  ...........  ...........  ...........  ...........
27097............  Revision of hip tendon..  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27098............  Transfer tendon to        Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    pelvis.
27100............  Transfer of abdominal     Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    muscle.
27105............  Transfer of spinal        Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    muscle.
27110............  Transfer of iliopsoas     Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    muscle.
27111............  Transfer of iliopsoas     Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    muscle.
27193............  Treat pelvic ring         Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27194............  Treat pelvic ring         Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
                    fracture.
27200............  Treat tail bone fracture  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
27202............  Treat tail bone fracture  Y................  .................  A2...............      $446.00      41.1091    $1,701.96      $759.99
27220............  Treat hip socket          Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
27230............  Treat thigh fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02

[[Page 9880]]

 
27238............  Treat thigh fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27246............  Treat thigh fracture....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27250............  Treat hip dislocation...  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27252............  Treat hip dislocation...  Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
27256............  Treat hip dislocation...  Y................  .................  G2...............  ...........       1.7682       $73.21       $73.21
27257............  Treat hip dislocation...  Y................  .................  A2...............      $510.00      14.7658      $611.32      $535.33
27265............  Treat hip dislocation...  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27266............  Treat hip dislocation...  Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
27267............  Cltx thigh fx...........  Y................  NI...............  G2...............  ...........       1.7682       $73.21       $73.21
27275............  Manipulation of hip       Y................  .................  A2...............      $446.00      14.7658      $611.32      $487.33
                    joint.
27301............  Drain thigh/knee lesion.  Y................  .................  A2...............      $510.00      18.3197      $758.45      $572.11
27305............  Incise thigh tendon &     Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    fascia.
27306............  Incision of thigh tendon  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27307............  Incision of thigh         Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    tendons.
27310............  Exploration of knee       Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    joint.
27323............  Biopsy, thigh soft        Y................  .................  A2...............      $333.00        8.685      $359.57      $339.64
                    tissues.
27324............  Biopsy, thigh soft        Y................  .................  A2...............      $333.00      21.1098      $873.97      $468.24
                    tissues.
27325............  Neurectomy, hamstring...  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
27326............  Neurectomy, popliteal...  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
27327............  Removal of thigh lesion.  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
27328............  Removal of thigh lesion.  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
27329............  Remove tumor, thigh/knee  Y................  .................  A2...............      $630.00      21.1098      $873.97      $690.99
27330............  Biopsy, knee joint        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
27331............  Explore/treat knee joint  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
27332............  Removal of knee           Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    cartilage.
27333............  Removal of knee           Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    cartilage.
27334............  Remove knee joint lining  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
27335............  Remove knee joint lining  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
27340............  Removal of kneecap bursa  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27345............  Removal of knee cyst....  Y................  .................  A2...............      $630.00      21.2689      $880.55      $692.64
27347............  Remove knee cyst........  Y................  .................  A2...............      $630.00      21.2689      $880.55      $692.64
27350............  Removal of kneecap......  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
27355............  Remove femur lesion.....  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27356............  Remove femur lesion/      Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    graft.
27357............  Remove femur lesion/      Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    graft.
27358............  Remove femur lesion/      Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    fixation.
27360............  Partial removal, leg      Y................  .................  A2...............      $717.00        29.19    $1,208.50      $839.88
                    bone(s).
27370............  Injection for knee x-ray  N................  .................  N1...............  ...........  ...........  ...........  ...........
27372............  Removal of foreign body.  Y................  .................  A2...............      $995.00      21.1098      $873.97      $964.74
27380............  Repair of kneecap tendon  Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
27381............  Repair/graft kneecap      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    tendon.
27385............  Repair of thigh muscle..  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27386............  Repair/graft of thigh     Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    muscle.
27390............  Incision of thigh tendon  Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
27391............  Incision of thigh         Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    tendons.
27392............  Incision of thigh         Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    tendons.
27393............  Lengthening of thigh      Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    tendon.
27394............  Lengthening of thigh      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    tendons.
27395............  Lengthening of thigh      Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendons.
27396............  Transplant of thigh       Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    tendon.
27397............  Transplants of thigh      Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendons.
27400............  Revise thigh muscles/     Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendons.
27403............  Repair of knee cartilage  Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
27405............  Repair of knee ligament.  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27407............  Repair of knee ligament.  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
27409............  Repair of knee ligaments  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27416............  Osteochondral knee        Y................  NI...............  G2...............  ...........       42.985    $1,779.62    $1,779.62
                    autograft.
27418............  Repair degenerated        Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    kneecap.
27420............  Revision of unstable      Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    kneecap.
27422............  Revision of unstable      Y................  .................  A2...............      $995.00       42.985    $1,779.62    $1,191.16
                    kneecap.
27424............  Revision/removal of       Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    kneecap.
27425............  Lat retinacular release   Y................  .................  A2...............      $995.00        29.19    $1,208.50    $1,048.38
                    open.
27427............  Reconstruction, knee....  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
27428............  Reconstruction, knee....  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
27429............  Reconstruction, knee....  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
27430............  Revision of thigh         Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
                    muscles.
27435............  Incision of knee joint..  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27437............  Revise kneecap..........  Y................  .................  A2...............      $630.00       35.904    $1,486.46      $844.12
27438............  Revise kneecap with       Y................  .................  A2...............      $717.00      50.8876    $2,106.80    $1,064.45
                    implant.
27440............  Revision of knee joint..  Y................  .................  G2...............  ...........       35.904    $1,486.46    $1,486.46
27441............  Revision of knee joint..  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
27442............  Revision of knee joint..  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
27443............  Revision of knee joint..  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
27446............  Revision of knee joint..  Y................  .................  G2...............  ...........     274.6715   $11,371.67   $11,371.67
27496............  Decompression of thigh/   Y................  .................  A2...............      $717.00      21.2689      $880.55      $757.89
                    knee.
27497............  Decompression of thigh/   Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    knee.
27498............  Decompression of thigh/   Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    knee.

[[Page 9881]]

 
27499............  Decompression of thigh/   Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    knee.
27500............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27501............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27502............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27503............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27508............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27509............  Treatment of thigh        Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
                    fracture.
27510............  Treatment of thigh        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27516............  Treat thigh fx growth     Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    plate.
27517............  Treat thigh fx growth     Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    plate.
27520............  Treat kneecap fracture..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27530............  Treat knee fracture.....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27532............  Treat knee fracture.....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27538............  Treat knee fracture(s)..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27550............  Treat knee dislocation..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27552............  Treat knee dislocation..  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
27560............  Treat kneecap             Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
27562............  Treat kneecap             Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
                    dislocation.
27566............  Treat kneecap             Y................  .................  A2...............      $446.00      41.1091    $1,701.96      $759.99
                    dislocation.
27570............  Fixation of knee joint..  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
27594............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    surgery.
27600............  Decompression of lower    Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    leg.
27601............  Decompression of lower    Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    leg.
27602............  Decompression of lower    Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    leg.
27603............  Drain lower leg lesion..  Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
27604............  Drain lower leg bursa...  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27605............  Incision of achilles      Y................  .................  A2...............      $333.00      20.8284      $862.32      $465.33
                    tendon.
27606............  Incision of achilles      Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    tendon.
27607............  Treat lower leg bone      Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    lesion.
27610............  Explore/treat ankle       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    joint.
27612............  Exploration of ankle      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    joint.
27613............  Biopsy lower leg soft     Y................  .................  P3...............  ...........       2.9376      $121.62      $121.62
                    tissue.
27614............  Biopsy lower leg soft     Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
                    tissue.
27615............  Remove tumor, lower leg.  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27618............  Remove lower leg lesion.  Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
27619............  Remove lower leg lesion.  Y................  .................  A2...............      $510.00      21.1098      $873.97      $600.99
27620............  Explore/treat ankle       Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    joint.
27625............  Remove ankle joint        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
27626............  Remove ankle joint        Y................  .................  A2...............      $630.00        29.19    $1,208.50      $774.63
                    lining.
27630............  Removal of tendon lesion  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27635............  Remove lower leg bone     Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
27637............  Remove/graft leg bone     Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
27638............  Remove/graft leg bone     Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    lesion.
27640............  Partial removal of tibia  Y................  .................  A2...............      $446.00       42.985    $1,779.62      $779.41
27641............  Partial removal of        Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    fibula.
27647............  Extensive ankle/heel      Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    surgery.
27648............  Injection for ankle x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
27650............  Repair achilles tendon..  Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
27652............  Repair/graft achilles     Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
                    tendon.
27654............  Repair of achilles        Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendon.
27656............  Repair leg fascia defect  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27658............  Repair of leg tendon,     Y................  .................  A2...............      $333.00      21.2689      $880.55      $469.89
                    each.
27659............  Repair of leg tendon,     Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    each.
27664............  Repair of leg tendon,     Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
                    each.
27665............  Repair of leg tendon,     Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    each.
27675............  Repair lower leg tendons  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27676............  Repair lower leg tendons  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27680............  Release of lower leg      Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    tendon.
27681............  Release of lower leg      Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    tendons.
27685............  Revision of lower leg     Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    tendon.
27686............  Revise lower leg tendons  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27687............  Revision of calf tendon.  Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
27690............  Revise lower leg tendon.  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27691............  Revise lower leg tendon.  Y................  .................  A2...............      $630.00       42.985    $1,779.62      $917.41
27692............  Revise additional leg     Y................  .................  A2...............      $510.00       42.985    $1,779.62      $827.41
                    tendon.
27695............  Repair of ankle ligament  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
27696............  Repair of ankle           Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    ligaments.
27698............  Repair of ankle ligament  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
27700............  Revision of ankle joint.  Y................  .................  A2...............      $717.00       35.904    $1,486.46      $909.37
27704............  Removal of ankle implant  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27705............  Incision of tibia.......  Y................  .................  A2...............      $446.00       42.985    $1,779.62      $779.41
27707............  Incision of fibula......  Y................  .................  A2...............      $446.00      21.2689      $880.55      $554.64
27709............  Incision of tibia &       Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    fibula.
27726............  Repair fibula nonunion..  Y................  NI...............  G2...............  ...........      26.1592    $1,083.02    $1,083.02
27730............  Repair of tibia           Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    epiphysis.
27732............  Repair of fibula          Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    epiphysis.
27734............  Repair lower leg          Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
                    epiphyses.

[[Page 9882]]

 
27740............  Repair of leg epiphyses.  Y................  .................  A2...............      $446.00        29.19    $1,208.50      $636.63
27742............  Repair of leg epiphyses.  Y................  .................  A2...............      $446.00       42.985    $1,779.62      $779.41
27745............  Reinforce tibia.........  Y................  .................  A2...............      $510.00      79.4244    $3,288.25    $1,204.56
27750............  Treatment of tibia        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27752............  Treatment of tibia        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27756............  Treatment of tibia        Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
                    fracture.
27758............  Treatment of tibia        Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
                    fracture.
27759............  Treatment of tibia        Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
                    fracture.
27760............  Cltx medial ankle fx....  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27762............  Cltx med ankle fx w/mnpj  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27766............  Optx medial ankle fx....  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
27767............  Cltx post ankle fx......  Y................  NI...............  G2...............  ...........       1.7682       $73.21       $73.21
27768............  Cltx post ankle fx w/     Y................  NI...............  G2...............  ...........       1.7682       $73.21       $73.21
                    mnpj.
27769............  Optx post ankle fx......  Y................  NI...............  G2...............  ...........      41.1091    $1,701.96    $1,701.96
27780............  Treatment of fibula       Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27781............  Treatment of fibula       Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27784............  Treatment of fibula       Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
27786............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27788............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27792............  Treatment of ankle        Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
27808............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27810............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27814............  Treatment of ankle        Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
27816............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27818............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
27822............  Treatment of ankle        Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    fracture.
27823............  Treatment of ankle        Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
                    fracture.
27824............  Treat lower leg fracture  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27825............  Treat lower leg fracture  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27826............  Treat lower leg fracture  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
27827............  Treat lower leg fracture  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
27828............  Treat lower leg fracture  Y................  .................  A2...............      $630.00      59.2233    $2,451.90    $1,085.48
27829............  Treat lower leg joint...  Y................  .................  A2...............      $446.00      41.1091    $1,701.96      $759.99
27830............  Treat lower leg           Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
27831............  Treat lower leg           Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    dislocation.
27832............  Treat lower leg           Y................  .................  A2...............      $446.00      41.1091    $1,701.96      $759.99
                    dislocation.
27840............  Treat ankle dislocation.  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
27842............  Treat ankle dislocation.  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
27846............  Treat ankle dislocation.  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
27848............  Treat ankle dislocation.  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
27860............  Fixation of ankle joint.  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
27870............  Fusion of ankle joint,    Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
                    open.
27871............  Fusion of tibiofibular    Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
                    joint.
27884............  Amputation follow-up      Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    surgery.
27889............  Amputation of foot at     Y................  .................  A2...............      $510.00        29.19    $1,208.50      $684.63
                    ankle.
27892............  Decompression of leg....  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27893............  Decompression of leg....  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
27894............  Decompression of leg....  Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
28001............  Drainage of bursa of      Y................  .................  P3...............  ...........       2.8719      $118.90      $118.90
                    foot.
28002............  Treatment of foot         Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    infection.
28003............  Treatment of foot         Y................  .................  A2...............      $510.00      21.2689      $880.55      $602.64
                    infection.
28005............  Treat foot bone lesion..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28008............  Incision of foot fascia.  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28010............  Incision of toe tendon..  Y................  .................  P3...............  ...........        2.156       $89.26       $89.26
28011............  Incision of toe tendons.  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28020............  Exploration of foot       Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    joint.
28022............  Exploration of foot       Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    joint.
28024............  Exploration of toe joint  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28035............  Decompression of tibia    Y................  .................  A2...............      $630.00      18.0518      $747.36      $659.34
                    nerve.
28043............  Excision of foot lesion.  Y................  .................  A2...............      $446.00      21.1098      $873.97      $552.99
28045............  Excision of foot lesion.  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28046............  Resection of tumor, foot  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28050............  Biopsy of foot joint      Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    lining.
28052............  Biopsy of foot joint      Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    lining.
28054............  Biopsy of toe joint       Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    lining.
28055............  Neurectomy, foot........  Y................  .................  A2...............      $630.00      18.0518      $747.36      $659.34
28060............  Partial removal, foot     Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    fascia.
28062............  Removal of foot fascia..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28070............  Removal of foot joint     Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    lining.
28072............  Removal of foot joint     Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    lining.
28080............  Removal of foot lesion..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28086............  Excise foot tendon        Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    sheath.
28088............  Excise foot tendon        Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    sheath.
28090............  Removal of foot lesion..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28092............  Removal of toe lesions..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28100............  Removal of ankle/heel     Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    lesion.
28102............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69

[[Page 9883]]

 
28103............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
28104............  Removal of foot lesion..  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28106............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
28107............  Remove/graft foot lesion  Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
28108............  Removal of toe lesions..  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28110............  Part removal of           Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    metatarsal.
28111............  Part removal of           Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    metatarsal.
28112............  Part removal of           Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    metatarsal.
28113............  Part removal of           Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    metatarsal.
28114............  Removal of metatarsal     Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    heads.
28116............  Revision of foot........  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28118............  Removal of heel bone....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28119............  Removal of heel spur....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28120............  Part removal of ankle/    Y................  .................  A2...............      $995.00      20.8284      $862.32      $961.83
                    heel.
28122............  Partial removal of foot   Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    bone.
28124............  Partial removal of toe..  Y................  .................  P3...............  ...........       4.8385      $200.32      $200.32
28126............  Partial removal of toe..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28130............  Removal of ankle bone...  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28140............  Removal of metatarsal...  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28150............  Removal of toe..........  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28153............  Partial removal of toe..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28160............  Partial removal of toe..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28171............  Extensive foot surgery..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28173............  Extensive foot surgery..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28175............  Extensive foot surgery..  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28190............  Removal of foot foreign   Y................  .................  P3...............  ...........       3.0446      $126.05      $126.05
                    body.
28192............  Removal of foot foreign   Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    body.
28193............  Removal of foot foreign   Y................  .................  A2...............      $418.49        8.685      $359.57      $403.76
                    body.
28200............  Repair of foot tendon...  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28202............  Repair/graft of foot      Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    tendon.
28208............  Repair of foot tendon...  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28210............  Repair/graft of foot      Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
                    tendon.
28220............  Release of foot tendon..  Y................  .................  P3...............  ...........       4.5588      $188.74      $188.74
28222............  Release of foot tendons.  Y................  .................  A2...............      $333.00      20.8284      $862.32      $465.33
28225............  Release of foot tendon..  Y................  .................  A2...............      $333.00      20.8284      $862.32      $465.33
28226............  Release of foot tendons.  Y................  .................  A2...............      $333.00      20.8284      $862.32      $465.33
28230............  Incision of foot          Y................  .................  P3...............  ...........       4.5011      $186.35      $186.35
                    tendon(s).
28232............  Incision of toe tendon..  Y................  .................  P3...............  ...........       4.3038      $178.18      $178.18
28234............  Incision of foot tendon.  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28238............  Revision of foot tendon.  Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
28240............  Release of big toe......  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28250............  Revision of foot fascia.  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28260............  Release of midfoot joint  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28261............  Revision of foot tendon.  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28262............  Revision of foot and      Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
                    ankle.
28264............  Release of midfoot joint  Y................  .................  A2...............      $333.00      44.2687    $1,832.77      $707.94
28270............  Release of foot           Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    contracture.
28272............  Release of toe joint,     Y................  .................  P3...............  ...........       4.1226      $170.68      $170.68
                    each.
28280............  Fusion of toes..........  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28285............  Repair of hammertoe.....  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28286............  Repair of hammertoe.....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28288............  Partial removal of foot   Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
                    bone.
28289............  Repair hallux rigidus...  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28290............  Correction of bunion....  Y................  .................  A2...............      $446.00      29.4167    $1,217.88      $638.97
28292............  Correction of bunion....  Y................  .................  A2...............      $446.00      29.4167    $1,217.88      $638.97
28293............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.4167    $1,217.88      $686.97
28294............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.4167    $1,217.88      $686.97
28296............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.4167    $1,217.88      $686.97
28297............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.4167    $1,217.88      $686.97
28298............  Correction of bunion....  Y................  .................  A2...............      $510.00      29.4167    $1,217.88      $686.97
28299............  Correction of bunion....  Y................  .................  A2...............      $717.00      29.4167    $1,217.88      $842.22
28300............  Incision of heel bone...  Y................  .................  A2...............      $446.00      44.2687    $1,832.77      $792.69
28302............  Incision of ankle bone..  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28304............  Incision of midfoot       Y................  .................  A2...............      $446.00      44.2687    $1,832.77      $792.69
                    bones.
28305............  Incise/graft midfoot      Y................  .................  A2...............      $510.00      44.2687    $1,832.77      $840.69
                    bones.
28306............  Incision of metatarsal..  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28307............  Incision of metatarsal..  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28308............  Incision of metatarsal..  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28309............  Incision of metatarsals.  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28310............  Revision of big toe.....  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28312............  Revision of toe.........  Y................  .................  A2...............      $510.00      20.8284      $862.32      $598.08
28313............  Repair deformity of toe.  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28315............  Removal of sesamoid bone  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28320............  Repair of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28322............  Repair of metatarsals...  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28340............  Resect enlarged toe       Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
                    tissue.
28341............  Resect enlarged toe.....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08

[[Page 9884]]

 
28344............  Repair extra toe(s).....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28345............  Repair webbed toe(s)....  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28400............  Treatment of heel         Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
28405............  Treatment of heel         Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
28406............  Treatment of heel         Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
                    fracture.
28415............  Treat heel fracture.....  Y................  .................  A2...............      $510.00      59.2233    $2,451.90      $995.48
28420............  Treat/graft heel          Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
                    fracture.
28430............  Treatment of ankle        Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
28435............  Treatment of ankle        Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
                    fracture.
28436............  Treatment of ankle        Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
                    fracture.
28445............  Treat ankle fracture....  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
28446............  Osteochondral talus       Y................  NI...............  G2...............  ...........      44.2687    $1,832.77    $1,832.77
                    autogrft.
28450............  Treat midfoot fracture,   Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
28455............  Treat midfoot fracture,   Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    each.
28456............  Treat midfoot fracture..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
28465............  Treat midfoot fracture,   Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
                    each.
28470............  Treat metatarsal          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
28475............  Treat metatarsal          Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
                    fracture.
28476............  Treat metatarsal          Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
                    fracture.
28485............  Treat metatarsal          Y................  .................  A2...............      $630.00      41.1091    $1,701.96      $897.99
                    fracture.
28490............  Treat big toe fracture..  Y................  .................  P3...............  ...........       1.6869       $69.84       $69.84
28495............  Treat big toe fracture..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
28496............  Treat big toe fracture..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
28505............  Treat big toe fracture..  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28510............  Treatment of toe          Y................  .................  P3...............  ...........       1.3248       $54.85       $54.85
                    fracture.
28515............  Treatment of toe          Y................  .................  P3...............  ...........       1.6951       $70.18       $70.18
                    fracture.
28525............  Treat toe fracture......  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28530............  Treat sesamoid bone       Y................  .................  P3...............  ...........       1.2589       $52.12       $52.12
                    fracture.
28531............  Treat sesamoid bone       Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
                    fracture.
28540............  Treat foot dislocation..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
28545............  Treat foot dislocation..  Y................  .................  A2...............      $333.00      26.1592    $1,083.02      $520.51
28546............  Treat foot dislocation..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
28555............  Repair foot dislocation.  Y................  .................  A2...............      $446.00      41.1091    $1,701.96      $759.99
28570............  Treat foot dislocation..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
28575............  Treat foot dislocation..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
28576............  Treat foot dislocation..  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28585............  Repair foot dislocation.  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28600............  Treat foot dislocation..  Y................  .................  P2...............  ...........       1.7682       $73.21       $73.21
28605............  Treat foot dislocation..  Y................  .................  A2...............      $103.62       1.7682       $73.21       $96.02
28606............  Treat foot dislocation..  Y................  .................  A2...............      $446.00      26.1592    $1,083.02      $605.26
28615............  Repair foot dislocation.  Y................  .................  A2...............      $510.00      41.1091    $1,701.96      $807.99
28630............  Treat toe dislocation...  Y................  CH...............  P3...............  ...........       1.4072       $58.26       $58.26
28635............  Treat toe dislocation...  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
28636............  Treat toe dislocation...  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28645............  Repair toe dislocation..  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28660............  Treat toe dislocation...  Y................  CH...............  P3...............  ...........       1.0534       $43.61       $43.61
28665............  Treat toe dislocation...  Y................  .................  A2...............      $333.00      14.7658      $611.32      $402.58
28666............  Treat toe dislocation...  Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
28675............  Repair of toe             Y................  .................  A2...............      $510.00      26.1592    $1,083.02      $653.26
                    dislocation.
28705............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28715............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      79.4244    $3,288.25    $1,294.56
28725............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28730............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28735............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28737............  Revision of foot bones..  Y................  .................  A2...............      $717.00      44.2687    $1,832.77      $995.94
28740............  Fusion of foot bones....  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28750............  Fusion of big toe joint.  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28755............  Fusion of big toe joint.  Y................  .................  A2...............      $630.00      20.8284      $862.32      $688.08
28760............  Fusion of big toe joint.  Y................  .................  A2...............      $630.00      44.2687    $1,832.77      $930.69
28810............  Amputation toe &          Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    metatarsal.
28820............  Amputation of toe.......  Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
28825............  Partial amputation of     Y................  .................  A2...............      $446.00      20.8284      $862.32      $550.08
                    toe.
28890 *..........  High energy eswt,         Y................  CH...............  P3...............  ...........       4.2296      $175.11      $175.11
                    plantar f.
29000............  Application of body cast  N................  .................  G2...............  ...........       1.0931       $45.26       $45.26
29010............  Application of body cast  N................  .................  P2...............  ...........        2.291       $94.85       $94.85
29015............  Application of body cast  N................  .................  P2...............  ...........        2.291       $94.85       $94.85
29020............  Application of body cast  N................  .................  G2...............  ...........       1.0931       $45.26       $45.26
29025............  Application of body cast  N................  .................  P2...............  ...........       1.0931       $45.26       $45.26
29035............  Application of body cast  N................  CH...............  P2...............  ...........        2.291       $94.85       $94.85
29040............  Application of body cast  N................  .................  G2...............  ...........       1.0931       $45.26       $45.26
29044............  Application of body cast  N................  .................  P2...............  ...........        2.291       $94.85       $94.85
29046............  Application of body cast  N................  .................  G2...............  ...........        2.291       $94.85       $94.85
29049............  Application of figure     N................  .................  P3...............  ...........       0.9956       $41.22       $41.22
                    eight.
29055............  Application of shoulder   N................  .................  P2...............  ...........        2.291       $94.85       $94.85
                    cast.
29058............  Application of shoulder   N................  .................  P2...............  ...........       1.0931       $45.26       $45.26
                    cast.
29065............  Application of long arm   N................  .................  P3...............  ...........       1.0698       $44.29       $44.29
                    cast.
29075............  Application of forearm    N................  .................  P3...............  ...........       1.0287       $42.59       $42.59
                    cast.

[[Page 9885]]

 
29085............  Apply hand/wrist cast...  N................  .................  P3...............  ...........       1.0451       $43.27       $43.27
29086............  Apply finger cast.......  N................  .................  P3...............  ...........       0.8394       $34.75       $34.75
29105............  Apply long arm splint...  N................  .................  P3...............  ...........       0.9546       $39.52       $39.52
29125............  Apply forearm splint....  N................  .................  P3...............  ...........       0.8147       $33.73       $33.73
29126............  Apply forearm splint....  N................  .................  P3...............  ...........       0.9135       $37.82       $37.82
29130............  Application of finger     N................  .................  P3...............  ...........       0.3703       $15.33       $15.33
                    splint.
29131............  Application of finger     N................  .................  P3...............  ...........       0.5432       $22.49       $22.49
                    splint.
29200............  Strapping of chest......  N................  .................  P3...............  ...........       0.5432       $22.49       $22.49
29220............  Strapping of low back...  N................  .................  P3...............  ...........       0.5679       $23.51       $23.51
29240............  Strapping of shoulder...  N................  .................  P3...............  ...........       0.6253       $25.89       $25.89
29260............  Strapping of elbow or     N................  .................  P3...............  ...........       0.5843       $24.19       $24.19
                    wrist.
29280............  Strapping of hand or      N................  .................  P3...............  ...........       0.6007       $24.87       $24.87
                    finger.
29305............  Application of hip cast.  N................  CH...............  P2...............  ...........        2.291       $94.85       $94.85
29325............  Application of hip casts  N................  CH...............  P2...............  ...........        2.291       $94.85       $94.85
29345............  Application of long leg   N................  .................  P3...............  ...........       1.4154       $58.60       $58.60
                    cast.
29355............  Application of long leg   N................  .................  P3...............  ...........       1.3659       $56.55       $56.55
                    cast.
29358............  Apply long leg cast       N................  .................  P3...............  ...........       1.6787       $69.50       $69.50
                    brace.
29365............  Application of long leg   N................  .................  P3...............  ...........       1.3331       $55.19       $55.19
                    cast.
29405............  Apply short leg cast....  N................  .................  P3...............  ...........       0.9956       $41.22       $41.22
29425............  Apply short leg cast....  N................  .................  P3...............  ...........       1.0121       $41.90       $41.90
29435............  Apply short leg cast....  N................  .................  P3...............  ...........       1.2674       $52.47       $52.47
29440............  Addition of walker to     N................  .................  P3...............  ...........       0.5514       $22.83       $22.83
                    cast.
29445............  Apply rigid leg cast....  N................  .................  P3...............  ...........       1.3823       $57.23       $57.23
29450............  Application of leg cast.  N................  .................  P2...............  ...........       1.0931       $45.26       $45.26
29505............  Application, long leg     N................  CH...............  P3...............  ...........       0.9299       $38.50       $38.50
                    splint.
29515............  Application lower leg     N................  CH...............  P3...............  ...........       0.7488       $31.00       $31.00
                    splint.
29520............  Strapping of hip........  N................  .................  P3...............  ...........       0.6171       $25.55       $25.55
29530............  Strapping of knee.......  N................  .................  P3...............  ...........       0.5925       $24.53       $24.53
29540............  Strapping of ankle and/   N................  .................  P3...............  ...........       0.3949       $16.35       $16.35
                    or ft.
29550............  Strapping of toes.......  N................  .................  P3...............  ...........       0.4031       $16.69       $16.69
29580............  Application of paste      N................  .................  P3...............  ...........       0.5596       $23.17       $23.17
                    boot.
29590............  Application of foot       N................  .................  P3...............  ...........       0.4526       $18.74       $18.74
                    splint.
29700............  Removal/revision of cast  N................  .................  P3...............  ...........        0.757       $31.34       $31.34
29705............  Removal/revision of cast  N................  .................  P3...............  ...........         0.65       $26.91       $26.91
29710............  Removal/revision of cast  N................  .................  P3...............  ...........       1.1768       $48.72       $48.72
29715............  Removal/revision of cast  N................  .................  P3...............  ...........       0.9792       $40.54       $40.54
29720............  Repair of body cast.....  N................  .................  P3...............  ...........       0.9546       $39.52       $39.52
29730............  Windowing of cast.......  N................  .................  P3...............  ...........       0.6336       $26.23       $26.23
29740............  Wedging of cast.........  N................  .................  P3...............  ...........       0.8968       $37.13       $37.13
29750............  Wedging of clubfoot cast  N................  .................  P3...............  ...........       0.8722       $36.11       $36.11
29800............  Jaw arthroscopy/surgery.  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29804............  Jaw arthroscopy/surgery.  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29805............  Shoulder arthroscopy, dx  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29806............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29807............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29819............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29820............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29821............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29822............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29823............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29824............  Shoulder arthroscopy/     Y................  .................  A2...............      $717.00      28.7803    $1,191.53      $835.63
                    surgery.
29825............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29826............  Shoulder arthroscopy/     Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29827............  Arthroscop rotator cuff   Y................  .................  A2...............      $717.00      45.7072    $1,892.32    $1,010.83
                    repr.
29828............  Arthroscopy biceps        Y................  NI...............  G2...............  ...........      45.7072    $1,892.32    $1,892.32
                    tenodesis.
29830............  Elbow arthroscopy.......  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29834............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29835............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29836............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29837............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29838............  Elbow arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29840............  Wrist arthroscopy.......  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29843............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29844............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29845............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29846............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29847............  Wrist arthroscopy/        Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29848............  Wrist endoscopy/surgery.  Y................  .................  A2...............    $1,339.00      28.7803    $1,191.53    $1,302.13
29850............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29851............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
29855............  Tibial arthroscopy/       Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
                    surgery.
29856............  Tibial arthroscopy/       Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
                    surgery.
29860............  Hip arthroscopy, dx.....  Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
29861............  Hip arthroscopy/surgery.  Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
29862............  Hip arthroscopy/surgery.  Y................  .................  A2...............    $1,339.00      45.7072    $1,892.32    $1,477.33
29863............  Hip arthroscopy/surgery.  Y................  .................  A2...............      $630.00      45.7072    $1,892.32      $945.58
29866............  Autgrft implnt, knee w/   Y................  CH...............  G2...............  ...........      45.7072    $1,892.32    $1,892.32
                    scope.

[[Page 9886]]

 
29870............  Knee arthroscopy, dx....  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29871............  Knee arthroscopy/         Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    drainage.
29873............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29874............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29875............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29876............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29877............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29879............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29880............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29881............  Knee arthroscopy/surgery  Y................  .................  A2...............      $630.00      28.7803    $1,191.53      $770.38
29882............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29883............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29884............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29885............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
29886............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29887............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
29888............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
29889............  Knee arthroscopy/surgery  Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
29891............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29892............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29893............  Scope, plantar            Y................  .................  A2...............    $1,255.56      20.8284      $862.32    $1,157.25
                    fasciotomy.
29894............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29895............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29897............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29898............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surgery.
29899............  Ankle arthroscopy/        Y................  .................  A2...............      $510.00      45.7072    $1,892.32      $855.58
                    surgery.
29900............  Mcp joint arthroscopy,    Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    dx.
29901............  Mcp joint arthroscopy,    Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surg.
29902............  Mcp joint arthroscopy,    Y................  .................  A2...............      $510.00      28.7803    $1,191.53      $680.38
                    surg.
29904............  Subtalar arthro w/fb      Y................  NI...............  G2...............  ...........      28.7803    $1,191.53    $1,191.53
                    rmvl.
29905............  Subtalar arthro w/exc...  Y................  NI...............  G2...............  ...........      28.7803    $1,191.53    $1,191.53
29906............  Subtalar arthro w/deb...  Y................  NI...............  G2...............  ...........      28.7803    $1,191.53    $1,191.53
29907............  Subtalar arthro w/fusion  Y................  NI...............  G2...............  ...........      45.7072    $1,892.32    $1,892.32
30000............  Drainage of nose lesion.  Y................  .................  P2...............  ...........       2.5002      $103.51      $103.51
30020............  Drainage of nose lesion.  Y................  .................  P2...............  ...........       2.5002      $103.51      $103.51
30100............  Intranasal biopsy.......  Y................  .................  P3...............  ...........       1.8763       $77.68       $77.68
30110............  Removal of nose polyp(s)  Y................  .................  P3...............  ...........       2.9376      $121.62      $121.62
30115............  Removal of nose polyp(s)  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
30117............  Removal of intranasal     Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    lesion.
30118............  Removal of intranasal     Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
                    lesion.
30120............  Revision of nose........  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
30124............  Removal of nose lesion..  Y................  .................  R2...............  ...........       7.4474      $308.33      $308.33
30125............  Removal of nose lesion..  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
30130............  Excise inferior           Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    turbinate.
30140............  Resect inferior           Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    turbinate.
30150............  Partial removal of nose.  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
30160............  Removal of nose.........  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
30200............  Injection treatment of    Y................  .................  P3...............  ...........       1.4975       $62.00       $62.00
                    nose.
30210............  Nasal sinus therapy.....  Y................  .................  P3...............  ...........       1.9009       $78.70       $78.70
30220............  Insert nasal septal       Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
                    button.
30300............  Remove nasal foreign      N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    body.
30310............  Remove nasal foreign      Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    body.
30320............  Remove nasal foreign      Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    body.
30400............  Reconstruction of nose..  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
30410............  Reconstruction of nose..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
30420............  Reconstruction of nose..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
30430............  Revision of nose........  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
30435............  Revision of nose........  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
30450............  Revision of nose........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
30460............  Revision of nose........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
30462............  Revision of nose........  Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
30465............  Repair nasal stenosis...  Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
30520............  Repair of nasal septum..  Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
30540............  Repair nasal defect.....  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
30545............  Repair nasal defect.....  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
30560............  Release of nasal          Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    adhesions.
30580............  Repair upper jaw fistula  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
30600............  Repair mouth/nose         Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    fistula.
30620............  Intranasal                Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    reconstruction.
30630............  Repair nasal septum       Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
                    defect.
30801............  Ablate inf turbinate,     Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
                    superf.
30802............  Cauterization, inner      Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
                    nose.
30901............  Control of nosebleed....  Y................  .................  P3...............  ...........       1.0862       $44.97       $44.97
30903............  Control of nosebleed....  Y................  .................  A2...............       $72.48       1.1251       $46.58       $66.01
30905............  Control of nosebleed....  Y................  .................  A2...............       $72.48       1.1251       $46.58       $66.01
30906............  Repeat control of         Y................  .................  A2...............       $72.48       1.1251       $46.58       $66.01
                    nosebleed.
30915............  Ligation, nasal sinus     Y................  .................  A2...............      $446.00       25.841    $1,069.84      $601.96
                    artery.

[[Page 9887]]

 
30920............  Ligation, upper jaw       Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
                    artery.
30930............  Ther fx, nasal inf        Y................  .................  A2...............      $630.00      16.3288      $676.03      $641.51
                    turbinate.
31000............  Irrigation, maxillary     Y................  .................  P3...............  ...........       2.4934      $103.23      $103.23
                    sinus.
31002............  Irrigation, sphenoid      Y................  .................  R2...............  ...........       7.4474      $308.33      $308.33
                    sinus.
31020............  Exploration, maxillary    Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    sinus.
31030............  Exploration, maxillary    Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
                    sinus.
31032............  Explore sinus, remove     Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    polyps.
31040............  Exploration behind upper  Y................  .................  R2...............  ...........      23.9765      $992.65      $992.65
                    jaw.
31050............  Exploration, sphenoid     Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    sinus.
31051............  Sphenoid sinus surgery..  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31070............  Exploration of frontal    Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    sinus.
31075............  Exploration of frontal    Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    sinus.
31080............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31081............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31084............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31085............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31086............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31087............  Removal of frontal sinus  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
31090............  Exploration of sinuses..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31200............  Removal of ethmoid sinus  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31201............  Removal of ethmoid sinus  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31205............  Removal of ethmoid sinus  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
31231............  Nasal endoscopy, dx.....  Y................  .................  P2...............  ...........       1.6115       $66.72       $66.72
31233............  Nasal/sinus endoscopy,    Y................  .................  A2...............       $86.39       1.6115       $66.72       $81.47
                    dx.
31235............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $333.00       17.016      $704.48      $425.87
                    dx.
31237............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
                    surg.
31238............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $333.00       17.016      $704.48      $425.87
                    surg.
31239............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $630.00      22.7191      $940.59      $707.65
                    surg.
31240............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
                    surg.
31254............  Revision of ethmoid       Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    sinus.
31255............  Removal of ethmoid sinus  Y................  .................  A2...............      $717.00      22.7191      $940.59      $772.90
31256............  Exploration maxillary     Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    sinus.
31267............  Endoscopy, maxillary      Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    sinus.
31276............  Sinus endoscopy,          Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    surgical.
31287............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    surg.
31288............  Nasal/sinus endoscopy,    Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    surg.
31300............  Removal of larynx lesion  Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
31320............  Diagnostic incision,      Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    larynx.
31400............  Revision of larynx......  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31420............  Removal of epiglottis...  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31500............  Insert emergency airway.  N................  .................  G2...............  ...........        2.459      $101.81      $101.81
31502............  Change of windpipe        N................  .................  G2...............  ...........       1.3362       $55.32       $55.32
                    airway.
31505............  Diagnostic laryngoscopy.  Y................  .................  P2...............  ...........       0.8224       $34.05       $34.05
31510............  Laryngoscopy with biopsy  Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
31511............  Remove foreign body,      Y................  .................  A2...............       $86.39       1.6115       $66.72       $81.47
                    larynx.
31512............  Removal of larynx lesion  Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
31513............  Injection into vocal      Y................  .................  A2...............       $86.39       1.6115       $66.72       $81.47
                    cord.
31515............  Laryngoscopy for          Y................  .................  A2...............      $333.00       17.016      $704.48      $425.87
                    aspiration.
31520............  Dx laryngoscopy, newborn  Y................  .................  G2...............  ...........       1.6115       $66.72       $66.72
31525............  Dx laryngoscopy excl nb.  Y................  .................  A2...............      $333.00       17.016      $704.48      $425.87
31526............  Dx laryngoscopy w/oper    Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
                    scope.
31527............  Laryngoscopy for          Y................  .................  A2...............      $333.00      22.7191      $940.59      $484.90
                    treatment.
31528............  Laryngoscopy and          Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
                    dilation.
31529............  Laryngoscopy and          Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
                    dilation.
31530............  Laryngoscopy w/fb         Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
                    removal.
31531............  Laryngoscopy w/fb & op    Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    scope.
31535............  Laryngoscopy w/biopsy...  Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
31536............  Laryngoscopy w/bx & op    Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    scope.
31540............  Laryngoscopy w/exc of     Y................  .................  A2...............      $510.00      22.7191      $940.59      $617.65
                    tumor.
31541............  Larynscop w/tumr exc +    Y................  .................  A2...............      $630.00      22.7191      $940.59      $707.65
                    scope.
31545............  Remove vc lesion w/scope  Y................  .................  A2...............      $630.00      22.7191      $940.59      $707.65
31546............  Remove vc lesion scope/   Y................  .................  A2...............      $630.00      22.7191      $940.59      $707.65
                    graft.
31560............  Laryngoscop w/            Y................  .................  A2...............      $717.00      22.7191      $940.59      $772.90
                    arytenoidectom.
31561............  Larynscop, remve cart +   Y................  .................  A2...............      $717.00      22.7191      $940.59      $772.90
                    scop.
31570............  Laryngoscope w/vc inj...  Y................  .................  A2...............      $446.00       17.016      $704.48      $510.62
31571............  Laryngoscop w/vc inj +    Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
                    scope.
31575............  Diagnostic laryngoscopy.  Y................  .................  P3...............  ...........       1.4811       $61.32       $61.32
31576............  Laryngoscopy with biopsy  Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
31577............  Remove foreign body,      Y................  .................  A2...............      $236.42        3.994      $165.36      $218.66
                    larynx.
31578............  Removal of larynx lesion  Y................  .................  A2...............      $446.00      22.7191      $940.59      $569.65
31579............  Diagnostic laryngoscopy.  Y................  .................  P3...............  ...........       2.7321      $113.11      $113.11
31580............  Revision of larynx......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31582............  Revision of larynx......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31588............  Revision of larynx......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31590............  Reinnervate larynx......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31595............  Larynx nerve surgery....  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31603............  Incision of windpipe....  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83

[[Page 9888]]

 
31605............  Incision of windpipe....  Y................  .................  G2...............  ...........       7.4474      $308.33      $308.33
31611............  Surgery/speech            Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
                    prosthesis.
31612............  Puncture/clear windpipe.  Y................  .................  A2...............      $333.00      23.9765      $992.65      $497.91
31613............  Repair windpipe opening.  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
31614............  Repair windpipe opening.  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31615............  Visualization of          Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
                    windpipe.
31620............  Endobronchial us add-on.  N................  CH...............  N1...............  ...........  ...........  ...........  ...........
31622............  Dx bronchoscope/wash....  Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
31623............  Dx bronchoscope/brush...  Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
31624............  Dx bronchoscope/lavage..  Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
31625............  Bronchoscopy w/biopsy(s)  Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
31628............  Bronchoscopy/lung bx,     Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
                    each.
31629............  Bronchoscopy/needle bx,   Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
                    each.
31630............  Bronchoscopy dilate/fx    Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    repr.
31631............  Bronchoscopy, dilate w/   Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    stent.
31632............  Bronchoscopy/lung bx,     Y................  .................  G2...............  ...........       9.9575      $412.25      $412.25
                    add?l.
31633............  Bronchoscopy/needle bx    Y................  .................  G2...............  ...........       9.9575      $412.25      $412.25
                    add?l.
31635............  Bronchoscopy w/fb         Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
                    removal.
31636............  Bronchoscopy, bronch      Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    stents.
31637............  Bronchoscopy, stent add-  Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
                    on.
31638............  Bronchoscopy, revise      Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    stent.
31640............  Bronchoscopy w/tumor      Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    excise.
31641............  Bronchoscopy, treat       Y................  .................  A2...............      $446.00      24.0654      $996.33      $583.58
                    blockage.
31643............  Diag bronchoscope/        Y................  .................  A2...............      $446.00       9.9575      $412.25      $437.56
                    catheter.
31645............  Bronchoscopy, clear       Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
                    airways.
31646............  Bronchoscopy, reclear     Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
                    airway.
31656............  Bronchoscopy, inj for x-  Y................  .................  A2...............      $333.00       9.9575      $412.25      $352.81
                    ray.
31715............  Injection for bronchus x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
31717............  Bronchial brush biopsy..  Y................  .................  A2...............      $236.42        3.994      $165.36      $218.66
31720............  Clearance of airways....  N................  .................  A2...............       $47.32       0.3877       $16.05       $39.50
31730............  Intro, windpipe wire/     Y................  .................  A2...............      $236.42        3.994      $165.36      $218.66
                    tube.
31750............  Repair of windpipe......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
31755............  Repair of windpipe......  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
31820............  Closure of windpipe       Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    lesion.
31825............  Repair of windpipe        Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    defect.
31830............  Revise windpipe scar....  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
32000............  Drainage of chest.......  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
32002............  Treatment of collapsed    N................  CH...............  D5...............  ...........  ...........  ...........  ...........
                    lung.
32019............  Insert pleural catheter.  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
32400............  Needle biopsy chest       Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
                    lining.
32405............  Biopsy, lung or           Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
                    mediastinum.
32420............  Puncture/clear lung.....  Y................  .................  A2...............      $222.78       5.2024      $215.38      $220.93
32421............  Thoracentesis for         Y................  NI...............  A2...............      $222.78       5.2024      $215.38      $220.93
                    aspiration.
32422............  Thoracentesis w/tube      Y................  NI...............  G2...............  ...........       5.2024      $215.38      $215.38
                    insert.
32550............  Insert pleural cath.....  Y................  NI...............  G2...............  ...........      30.7096    $1,271.41    $1,271.41
32960............  Therapeutic pneumothorax  Y................  .................  G2...............  ...........       5.2024      $215.38      $215.38
32998............  Perq rf ablate tx, pul    Y................  CH...............  G2...............  ...........       42.998    $1,780.16    $1,780.16
                    tumor.
33010............  Drainage of heart sac...  Y................  .................  A2...............      $222.78       5.2024      $215.38      $220.93
33011............  Repeat drainage of heart  Y................  .................  A2...............      $222.78       5.2024      $215.38      $220.93
                    sac.
33206............  Insertion of heart        Y................  .................  J8...............  ...........     169.4628    $7,015.93    $7,015.93
                    pacemaker.
33207............  Insertion of heart        Y................  .................  J8...............  ...........     169.4628    $7,015.93    $7,015.93
                    pacemaker.
33208............  Insertion of heart        Y................  .................  J8...............  ...........     196.2967    $8,126.88    $8,126.88
                    pacemaker.
33210............  Insertion of heart        Y................  CH...............  J8...............  ...........       90.579    $3,750.06    $3,750.06
                    electrode.
33211............  Insertion of heart        Y................  CH...............  J8...............  ...........       90.579    $3,750.06    $3,750.06
                    electrode.
33212............  Insertion of pulse        Y................  .................  H8...............      $510.00     142.1043    $5,883.26    $5,514.64
                    generator.
33213............  Insertion of pulse        Y................  .................  H8...............      $510.00     154.6733    $6,403.63    $6,010.06
                    generator.
33214............  Upgrade of pacemaker      Y................  .................  J8...............  ...........     196.2967    $8,126.88    $8,126.88
                    system.
33215............  Reposition pacing-defib   Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    lead.
33216............  Insert lead pace-defib,   Y................  CH...............  J8...............  ...........       90.579    $3,750.06    $3,750.06
                    one.
33217............  Insert lead pace-defib,   Y................  CH...............  J8...............  ...........       90.579    $3,750.06    $3,750.06
                    dual.
33218............  Repair lead pace-defib,   Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    one.
33220............  Repair lead pace-defib,   Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    dual.
33222............  Revise pocket, pacemaker  Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
33223............  Revise pocket, pacing-    Y................  .................  A2...............      $446.00      15.0458      $622.91      $490.23
                    defib.
33224............  Insert pacing lead &      Y................  .................  J8...............  ...........     375.1658   $15,532.24   $15,532.24
                    connect.
33225............  L ventric pacing lead     Y................  .................  J8...............  ...........     375.1658   $15,532.24   $15,532.24
                    add-on.
33226............  Reposition l ventric      Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    lead.
33233............  Removal of pacemaker      Y................  .................  A2...............      $446.00      23.9802      $992.80      $582.70
                    system.
33234............  Removal of pacemaker      Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    system.
33235............  Removal pacemaker         Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
                    electrode.
33240............  Insert pulse generator..  Y................  CH...............  J8...............  ...........     493.9803   $20,451.28   $20,451.28
33241............  Remove pulse generator..  Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
33249............  Eltrd/insert pace-defib.  Y................  CH...............  J8...............  ...........     599.3974   $24,815.65   $24,815.65
33282............  Implant pat-active ht     N................  .................  J8...............  ...........      98.4186    $4,074.63    $4,074.63
                    record.
33284............  Remove pat-active ht      Y................  .................  G2...............  ...........        8.685      $359.57      $359.57
                    record.
33508............  Endoscopic vein harvest.  N................  .................  N1...............  ...........  ...........  ...........  ...........
35188............  Repair blood vessel       Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
                    lesion.

[[Page 9889]]

 
35207............  Repair blood vessel       Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
                    lesion.
35473............  Repair arterial blockage  Y................  .................  G2...............  ...........      45.3845    $1,878.96    $1,878.96
35476............  Repair venous blockage..  Y................  .................  G2...............  ...........      45.3845    $1,878.96    $1,878.96
35492............  Atherectomy,              Y................  .................  G2...............  ...........      87.5137    $3,623.15    $3,623.15
                    percutaneous.
35572............  Harvest femoropopliteal   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
35761............  Exploration of artery/    Y................  .................  G2...............  ...........      29.6965    $1,229.46    $1,229.46
                    vein.
35875............  Removal of clot in graft  Y................  .................  A2...............    $1,339.00      38.7673    $1,605.00    $1,405.50
35876............  Removal of clot in graft  Y................  .................  A2...............    $1,339.00      38.7673    $1,605.00    $1,405.50
36000............  Place needle in vein....  N................  .................  N1...............  ...........  ...........  ...........  ...........
36002............  Pseudoaneurysm injection  N................  .................  G2...............  ...........       2.3792       $98.50       $98.50
                    trt.
36005............  Injection ext venography  N................  .................  N1...............  ...........  ...........  ...........  ...........
36010............  Place catheter in vein..  N................  .................  N1...............  ...........  ...........  ...........  ...........
36011............  Place catheter in vein..  N................  .................  N1...............  ...........  ...........  ...........  ...........
36012............  Place catheter in vein..  N................  .................  N1...............  ...........  ...........  ...........  ...........
36013............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36014............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36015............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36100............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36120............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36140............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36145............  Artery to vein shunt....  N................  .................  N1...............  ...........  ...........  ...........  ...........
36160............  Establish access to       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    aorta.
36200............  Place catheter in aorta.  N................  .................  N1...............  ...........  ...........  ...........  ...........
36215............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36216............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36217............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36218............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36245............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36246............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36247............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36248............  Place catheter in artery  N................  .................  N1...............  ...........  ...........  ...........  ...........
36260............  Insertion of infusion     Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
                    pump.
36261............  Revision of infusion      Y................  .................  A2...............      $446.00      23.9802      $992.80      $582.70
                    pump.
36262............  Removal of infusion pump  Y................  .................  A2...............      $333.00      23.9802      $992.80      $497.95
36400............  Bl draw < 3 yrs fem/      N................  .................  N1...............  ...........  ...........  ...........  ...........
                    jugular.
36405............  Bl draw < 3 yrs scalp     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36406............  Bl draw < 3 yrs other     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36410............  Non-routine bl draw > 3   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    yrs.
36416............  Capillary blood draw....  N................  .................  N1...............  ...........  ...........  ...........  ...........
36420............  Vein access cutdown < 1   Y................  .................  G2...............  ...........       0.2143        $8.87        $8.87
                    yr.
36425............  Vein access cutdown > 1   Y................  .................  R2...............  ...........       0.2143        $8.87        $8.87
                    yr.
36430............  Blood transfusion         N................  .................  P3...............  ...........       0.7983       $33.05       $33.05
                    service.
36440............  Bl push transfuse, 2 yr   N................  .................  R2...............  ...........       3.3967      $140.63      $140.63
                    or <.
36450............  Bl exchange/transfuse,    N................  .................  R2...............  ...........       3.3967      $140.63      $140.63
                    nb.
36468............  Injection(s), spider      Y................  .................  R2...............  ...........        0.793       $32.83       $32.83
                    veins.
36469............  Injection(s), spider      Y................  CH...............  R2...............  ...........        0.793       $32.83       $32.83
                    veins.
36470............  Injection therapy of      Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
                    vein.
36471............  Injection therapy of      Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
                    veins.
36475............  Endovenous rf, 1st vein.  Y................  .................  A2...............    $1,339.00      42.6114    $1,764.15    $1,445.29
36476............  Endovenous rf, vein add-  Y................  .................  A2...............    $1,339.00       25.841    $1,069.84    $1,271.71
                    on.
36478............  Endovenous laser, 1st     Y................  .................  A2...............    $1,339.00       25.841    $1,069.84    $1,271.71
                    vein.
36479............  Endovenous laser vein     Y................  .................  A2...............    $1,339.00       25.841    $1,069.84    $1,271.71
                    addon.
36481............  Insertion of catheter,    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36500............  Insertion of catheter,    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36510............  Insertion of catheter,    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    vein.
36511............  Apheresis wbc...........  N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
36512............  Apheresis rbc...........  N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
36513............  Apheresis platelets.....  N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
36514............  Apheresis plasma........  N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
36515............  Apheresis, adsorp/        N................  .................  G2...............  ...........      30.6035    $1,267.02    $1,267.02
                    reinfuse.
36516............  Apheresis, selective....  N................  .................  G2...............  ...........      30.6035    $1,267.02    $1,267.02
36522............  Photopheresis...........  N................  .................  G2...............  ...........      30.6035    $1,267.02    $1,267.02
36540............  Collect blood venous      N................  CH...............  D5...............  ...........  ...........  ...........  ...........
                    device.
36550............  Declot vascular device..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
36555............  Insert non-tunnel cv      Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
                    cath.
36556............  Insert non-tunnel cv      Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
                    cath.
36557............  Insert tunneled cv cath.  Y................  .................  A2...............      $446.00      24.1069      $998.05      $584.01
36558............  Insert tunneled cv cath.  Y................  .................  A2...............      $446.00      24.1069      $998.05      $584.01
36560............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36561............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36563............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36565............  Insert tunneled cv cath.  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36566............  Insert tunneled cv cath.  Y................  .................  H8...............      $510.00     107.6665    $4,457.50    $3,796.23
36568............  Insert picc cath........  Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
36569............  Insert picc cath........  Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
36570............  Insert picvad cath......  Y................  .................  A2...............      $510.00      24.1069      $998.05      $632.01
36571............  Insert picvad cath......  Y................  .................  A2...............      $510.00      24.1069      $998.05      $632.01

[[Page 9890]]

 
36575............  Repair tunneled cv cath.  Y................  .................  A2...............      $446.00       5.6614      $234.39      $393.10
36576............  Repair tunneled cv cath.  Y................  .................  A2...............      $446.00      10.9092      $451.65      $447.41
36578............  Replace tunneled cv cath  Y................  .................  A2...............      $446.00      24.1069      $998.05      $584.01
36580............  Replace cvad cath.......  Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
36581............  Replace tunneled cv cath  Y................  .................  A2...............      $446.00      24.1069      $998.05      $584.01
36582............  Replace tunneled cv cath  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36583............  Replace tunneled cv cath  Y................  .................  A2...............      $510.00      28.8743    $1,195.42      $681.36
36584............  Replace picc cath.......  Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
36585............  Replace picvad cath.....  Y................  .................  A2...............      $510.00      24.1069      $998.05      $632.01
36589............  Removal tunneled cv cath  Y................  .................  A2...............      $333.00       5.6614      $234.39      $308.35
36590............  Removal tunneled cv cath  Y................  .................  A2...............      $333.00      10.9092      $451.65      $362.66
36591............  Draw blood off venous     N................  NI...............  N1...............  ...........  ...........  ...........  ...........
                    device.
36592............  Collect blood from picc.  N................  NI...............  N1...............  ...........  ...........  ...........  ...........
36593............  Declot vascular device..  Y................  NI...............  P3...............  ...........       0.4937       $20.44       $20.44
36595............  Mech remov tunneled cv    Y................  .................  G2...............  ...........      24.1069      $998.05      $998.05
                    cath.
36596............  Mech remov tunneled cv    Y................  .................  G2...............  ...........      10.9092      $451.65      $451.65
                    cath.
36597............  Reposition venous         Y................  .................  G2...............  ...........      10.9092      $451.65      $451.65
                    catheter.
36598............  Inj w/fluor, eval cv      Y................  CH...............  P3...............  ...........       1.9997       $82.79       $82.79
                    device.
36600............  Withdrawal of arterial    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    blood.
36620............  Insertion catheter,       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36625............  Insertion catheter,       N................  .................  N1...............  ...........  ...........  ...........  ...........
                    artery.
36640............  Insertion catheter,       Y................  .................  A2...............      $333.00      28.8743    $1,195.42      $548.61
                    artery.
36680............  Insert needle, bone       Y................  .................  G2...............  ...........       1.1097       $45.94       $45.94
                    cavity.
36800............  Insertion of cannula....  Y................  .................  A2...............      $510.00      29.6965    $1,229.46      $689.87
36810............  Insertion of cannula....  Y................  .................  A2...............      $510.00      29.6965    $1,229.46      $689.87
36815............  Insertion of cannula....  Y................  .................  A2...............      $510.00      29.6965    $1,229.46      $689.87
36818............  Av fuse, uppr arm,        Y................  .................  A2...............      $510.00      38.7673    $1,605.00      $783.75
                    cephalic.
36819............  Av fuse, uppr arm,        Y................  .................  A2...............      $510.00      38.7673    $1,605.00      $783.75
                    basilic.
36820............  Av fusion/forearm vein..  Y................  .................  A2...............      $510.00      38.7673    $1,605.00      $783.75
36821............  Av fusion direct any      Y................  .................  A2...............      $510.00      38.7673    $1,605.00      $783.75
                    site.
36825............  Artery-vein autograft...  Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
36830............  Artery-vein nonautograft  Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
36831............  Open thrombect av         Y................  .................  A2...............    $1,339.00      38.7673    $1,605.00    $1,405.50
                    fistula.
36832............  Av fistula revision,      Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
                    open.
36833............  Av fistula revision.....  Y................  .................  A2...............      $630.00      38.7673    $1,605.00      $873.75
36834............  Repair a-v aneurysm.....  Y................  .................  A2...............      $510.00      38.7673    $1,605.00      $783.75
36835............  Artery to vein shunt....  Y................  .................  A2...............      $630.00      29.6965    $1,229.46      $779.87
36860............  External cannula          Y................  .................  A2...............      $127.40       2.4824      $102.77      $121.24
                    declotting.
36861............  Cannula declotting......  Y................  .................  A2...............      $510.00      29.6965    $1,229.46      $689.87
36870............  Percut thrombect av       Y................  .................  A2...............    $1,339.00      40.4667    $1,675.36    $1,423.09
                    fistula.
37184............  Prim art mech             Y................  .................  G2...............  ...........      38.7673    $1,605.00    $1,605.00
                    thrombectomy.
37185............  Prim art m-thrombect add- Y................  .................  G2...............  ...........      38.7673    $1,605.00    $1,605.00
                    on.
37186............  Sec art m-thrombect add-  Y................  .................  G2...............  ...........      38.7673    $1,605.00    $1,605.00
                    on.
37187............  Venous mech thrombectomy  Y................  .................  G2...............  ...........      38.7673    $1,605.00    $1,605.00
37188............  Venous m-thrombectomy     Y................  .................  G2...............  ...........      38.7673    $1,605.00    $1,605.00
                    add-on.
37200............  Transcatheter biopsy....  Y................  .................  G2...............  ...........      28.8743    $1,195.42    $1,195.42
37203............  Transcatheter retrieval.  Y................  .................  G2...............  ...........      28.8743    $1,195.42    $1,195.42
37250............  Iv us first vessel add-   N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    on.
37251............  Iv us each add vessel     N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    add-on.
37500............  Endoscopy ligate perf     Y................  .................  A2...............      $510.00      42.6114    $1,764.15      $823.54
                    veins.
37607............  Ligation of a-v fistula.  Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
37609............  Temporal artery           Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    procedure.
37650............  Revision of major vein..  Y................  .................  A2...............      $446.00       25.841    $1,069.84      $601.96
37700............  Revise leg vein.........  Y................  .................  A2...............      $446.00       25.841    $1,069.84      $601.96
37718............  Ligate/strip short leg    Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
                    vein.
37722............  Ligate/strip long leg     Y................  .................  A2...............      $510.00      42.6114    $1,764.15      $823.54
                    vein.
37735............  Removal of leg veins/     Y................  .................  A2...............      $510.00      42.6114    $1,764.15      $823.54
                    lesion.
37760............  Ligation, leg veins,      Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
                    open.
37765............  Phleb veins extrem 10-20  Y................  .................  R2...............  ...........       25.841    $1,069.84    $1,069.84
37766............  Phleb veins extrem 20+..  Y................  .................  R2...............  ...........       25.841    $1,069.84    $1,069.84
37780............  Revision of leg vein....  Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
37785............  Ligate/divide/excise      Y................  .................  A2...............      $510.00       25.841    $1,069.84      $649.96
                    vein.
37790............  Penile venous occlusion.  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
38200............  Injection for spleen x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
38204............  Bl donor search           N................  .................  N1...............  ...........  ...........  ...........  ...........
                    management.
38205............  Harvest allogenic stem    N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
                    cells.
38206............  Harvest auto stem cells.  N................  .................  G2...............  ...........      11.5058      $476.35      $476.35
38220............  Bone marrow aspiration..  Y................  CH...............  P3...............  ...........       2.6333      $109.02      $109.02
38221............  Bone marrow biopsy......  Y................  CH...............  P3...............  ...........       2.7649      $114.47      $114.47
38230............  Bone marrow collection..  N................  .................  G2...............  ...........      30.6035    $1,267.02    $1,267.02
38241............  Bone marrow/stem          N................  .................  G2...............  ...........      30.6035    $1,267.02    $1,267.02
                    transplant.
38242............  Lymphocyte infuse         N................  .................  R2...............  ...........      11.5058      $476.35      $476.35
                    transplant.
38300............  Drainage, lymph node      Y................  .................  A2...............      $333.00      11.5594      $478.57      $369.39
                    lesion.
38305............  Drainage, lymph node      Y................  .................  A2...............      $446.00      18.3197      $758.45      $524.11
                    lesion.
38308............  Incision of lymph         Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    channels.
38500............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    nodes.
38505............  Needle biopsy, lymph      Y................  .................  A2...............      $240.00       7.1147      $294.56      $253.64
                    nodes.

[[Page 9891]]

 
38510............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    nodes.
38520............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    nodes.
38525............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    nodes.
38530............  Biopsy/removal, lymph     Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
                    nodes.
38542............  Explore deep node(s),     Y................  .................  A2...............      $446.00       44.324    $1,835.06      $793.27
                    neck.
38550............  Removal, neck/armpit      Y................  .................  A2...............      $510.00      22.9584      $950.50      $620.13
                    lesion.
38555............  Removal, neck/armpit      Y................  .................  A2...............      $630.00      22.9584      $950.50      $710.13
                    lesion.
38570............  Laparoscopy, lymph node   Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    biop.
38571............  Laparoscopy,              Y................  .................  A2...............    $1,339.00      69.6652    $2,884.21    $1,725.30
                    lymphadenectomy.
38572............  Laparoscopy,              Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    lymphadenectomy.
38700............  Removal of lymph nodes,   Y................  .................  G2...............  ...........      22.9584      $950.50      $950.50
                    neck.
38740............  Remove armpit lymph       Y................  .................  A2...............      $446.00       44.324    $1,835.06      $793.27
                    nodes.
38745............  Remove armpit lymph       Y................  .................  A2...............      $630.00       44.324    $1,835.06      $931.27
                    nodes.
38760............  Remove groin lymph nodes  Y................  .................  A2...............      $446.00      22.9584      $950.50      $572.13
38790............  Inject for lymphatic x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
38792............  Identify sentinel node..  N................  .................  N1...............  ...........  ...........  ...........  ...........
38794............  Access thoracic lymph     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    duct.
40490............  Biopsy of lip...........  Y................  .................  P3...............  ...........       1.5224       $63.03       $63.03
40500............  Partial excision of lip.  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
40510............  Partial excision of lip.  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
40520............  Partial excision of lip.  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
40525............  Reconstruct lip with      Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    flap.
40527............  Reconstruct lip with      Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    flap.
40530............  Partial removal of lip..  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
40650............  Repair lip..............  Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
40652............  Repair lip..............  Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
40654............  Repair lip..............  Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
40700............  Repair cleft lip/nasal..  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
40701............  Repair cleft lip/nasal..  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
40702............  Repair cleft lip/nasal..  Y................  .................  R2...............  ...........      39.8776    $1,650.97    $1,650.97
40720............  Repair cleft lip/nasal..  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
40761............  Repair cleft lip/nasal..  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
40800............  Drainage of mouth lesion  Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
40801............  Drainage of mouth lesion  Y................  .................  A2...............      $446.00       7.4474      $308.33      $411.58
40804............  Removal, foreign body,    N................  .................  P2...............  ...........        0.631       $26.12       $26.12
                    mouth.
40805............  Removal, foreign body,    Y................  .................  P3...............  ...........       3.9581      $163.87      $163.87
                    mouth.
40806............  Incision of lip fold....  Y................  .................  P3...............  ...........       1.7529       $72.57       $72.57
40808............  Biopsy of mouth lesion..  Y................  .................  P2...............  ...........       2.5002      $103.51      $103.51
40810............  Excision of mouth lesion  Y................  .................  P3...............  ...........       2.7072      $112.08      $112.08
40812............  Excise/repair mouth       Y................  .................  P3...............  ...........       3.3985      $140.70      $140.70
                    lesion.
40814............  Excise/repair mouth       Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    lesion.
40816............  Excision of mouth lesion  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
40818............  Excise oral mucosa for    Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    graft.
40819............  Excise lip or cheek fold  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
40820............  Treatment of mouth        Y................  .................  P3...............  ...........       3.8018      $157.40      $157.40
                    lesion.
40830............  Repair mouth laceration.  Y................  .................  G2...............  ...........       2.5002      $103.51      $103.51
40831............  Repair mouth laceration.  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
40840............  Reconstruction of mouth.  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
40842............  Reconstruction of mouth.  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
40843............  Reconstruction of mouth.  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
40844............  Reconstruction of mouth.  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
40845............  Reconstruction of mouth.  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
41000............  Drainage of mouth lesion  Y................  .................  P3...............  ...........       2.0079       $83.13       $83.13
41005............  Drainage of mouth lesion  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
41006............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00      23.9765      $992.65      $497.91
41007............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
41008............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
41009............  Drainage of mouth lesion  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
41010............  Incision of tongue fold.  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
41015............  Drainage of mouth lesion  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
41016............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
41017............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
41018............  Drainage of mouth lesion  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
41019............  Place needles h&n for rt  Y................  NI...............  G2...............  ...........      23.9765      $992.65      $992.65
41100............  Biopsy of tongue........  Y................  .................  P3...............  ...........       2.0983       $86.87       $86.87
41105............  Biopsy of tongue........  Y................  .................  P3...............  ...........        2.049       $84.83       $84.83
41108............  Biopsy of floor of mouth  Y................  .................  P3...............  ...........       1.8927       $78.36       $78.36
41110............  Excision of tongue        Y................  .................  P3...............  ...........       2.7321      $113.11      $113.11
                    lesion.
41112............  Excision of tongue        Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    lesion.
41113............  Excision of tongue        Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    lesion.
41114............  Excision of tongue        Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    lesion.
41115............  Excision of tongue fold.  Y................  .................  P3...............  ...........       3.0777      $127.42      $127.42
41116............  Excision of mouth lesion  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
41120............  Partial removal of        Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
                    tongue.
41250............  Repair tongue laceration  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
41251............  Repair tongue laceration  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
41252............  Repair tongue laceration  Y................  .................  A2...............      $446.00       7.4474      $308.33      $411.58

[[Page 9892]]

 
41500............  Fixation of tongue......  Y................  .................  A2...............      $333.00      23.9765      $992.65      $497.91
41510............  Tongue to lip surgery...  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
41520............  Reconstruction, tongue    Y................  .................  A2...............      $446.00       7.4474      $308.33      $411.58
                    fold.
41800............  Drainage of gum lesion..  Y................  .................  A2...............       $88.46       1.4066       $58.23       $80.90
41805............  Removal foreign body,     Y................  .................  P3...............  ...........       3.0118      $124.69      $124.69
                    gum.
41806............  Removal foreign           Y................  .................  P3...............  ...........       3.8758      $160.46      $160.46
                    body,jawbone.
41820............  Excision, gum, each       Y................  .................  R2...............  ...........       7.4474      $308.33      $308.33
                    quadrant.
41821............  Excision of gum flap....  Y................  .................  G2...............  ...........       7.4474      $308.33      $308.33
41822............  Excision of gum lesion..  Y................  .................  P3...............  ...........       3.5796      $148.20      $148.20
41823............  Excision of gum lesion..  Y................  .................  P3...............  ...........       4.9455      $204.75      $204.75
41825............  Excision of gum lesion..  Y................  .................  P3...............  ...........       2.7813      $115.15      $115.15
41826............  Excision of gum lesion..  Y................  .................  P3...............  ...........       3.0941      $128.10      $128.10
41827............  Excision of gum lesion..  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
41828............  Excision of gum lesion..  Y................  .................  P3...............  ...........       3.2504      $134.57      $134.57
41830............  Removal of gum tissue...  Y................  .................  P3...............  ...........       4.5011      $186.35      $186.35
41850............  Treatment of gum lesion.  Y................  .................  R2...............  ...........      16.3288      $676.03      $676.03
41870............  Gum graft...............  Y................  .................  G2...............  ...........      23.9765      $992.65      $992.65
41872............  Repair gum..............  Y................  .................  P3...............  ...........       4.5506      $188.40      $188.40
41874............  Repair tooth socket.....  Y................  .................  P3...............  ...........       4.3202      $178.86      $178.86
42000............  Drainage mouth roof       Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    lesion.
42100............  Biopsy roof of mouth....  Y................  .................  P3...............  ...........       1.7939       $74.27       $74.27
42104............  Excision lesion, mouth    Y................  .................  P3...............  ...........       2.5181      $104.25      $104.25
                    roof.
42106............  Excision lesion, mouth    Y................  .................  P3...............  ...........       3.1598      $130.82      $130.82
                    roof.
42107............  Excision lesion, mouth    Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    roof.
42120............  Remove palate/lesion....  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
42140............  Excision of uvula.......  Y................  .................  A2...............      $446.00       7.4474      $308.33      $411.58
42145............  Repair palate, pharynx/   Y................  .................  A2...............      $717.00      23.9765      $992.65      $785.91
                    uvula.
42160............  Treatment mouth roof      Y................  .................  P3...............  ...........       3.2997      $136.61      $136.61
                    lesion.
42180............  Repair palate...........  Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
42182............  Repair palate...........  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
42200............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42205............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42210............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42215............  Reconstruct cleft palate  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
42220............  Reconstruct cleft palate  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42226............  Lengthening of palate...  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42235............  Repair palate...........  Y................  .................  A2...............      $717.00      16.3288      $676.03      $706.76
42260............  Repair nose to lip        Y................  .................  A2...............      $630.00      23.9765      $992.65      $720.66
                    fistula.
42280............  Preparation, palate mold  Y................  .................  P3...............  ...........        1.728       $71.54       $71.54
42281............  Insertion, palate         Y................  .................  G2...............  ...........      16.3288      $676.03      $676.03
                    prosthesis.
42300............  Drainage of salivary      Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    gland.
42305............  Drainage of salivary      Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    gland.
42310............  Drainage of salivary      Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    gland.
42320............  Drainage of salivary      Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    gland.
42330............  Removal of salivary       Y................  .................  P3...............  ...........        2.699      $111.74      $111.74
                    stone.
42335............  Removal of salivary       Y................  .................  P3...............  ...........       4.3941      $181.92      $181.92
                    stone.
42340............  Removal of salivary       Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
                    stone.
42400............  Biopsy of salivary gland  Y................  .................  P3...............  ...........       1.4975       $62.00       $62.00
42405............  Biopsy of salivary gland  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
42408............  Excision of salivary      Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    cyst.
42409............  Drainage of salivary      Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    cyst.
42410............  Excise parotid gland/     Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
                    lesion.
42415............  Excise parotid gland/     Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    lesion.
42420............  Excise parotid gland/     Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    lesion.
42425............  Excise parotid gland/     Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    lesion.
42440............  Excise submaxillary       Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
                    gland.
42450............  Excise sublingual gland.  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
42500............  Repair salivary duct....  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
42505............  Repair salivary duct....  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
42507............  Parotid duct diversion..  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
42508............  Parotid duct diversion..  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
42509............  Parotid duct diversion..  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
42510............  Parotid duct diversion..  Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
42550............  Injection for salivary x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
42600............  Closure of salivary       Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    fistula.
42650............  Dilation of salivary      Y................  .................  P3...............  ...........       0.9792       $40.54       $40.54
                    duct.
42660............  Dilation of salivary      Y................  .................  P3...............  ...........       1.1521       $47.70       $47.70
                    duct.
42665............  Ligation of salivary      Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
                    duct.
42700............  Drainage of tonsil        Y................  .................  A2...............      $150.72       2.5002      $103.51      $138.92
                    abscess.
42720............  Drainage of throat        Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    abscess.
42725............  Drainage of throat        Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
                    abscess.
42800............  Biopsy of throat........  Y................  .................  P3...............  ...........       1.9173       $79.38       $79.38
42802............  Biopsy of throat........  Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
42804............  Biopsy of upper nose/     Y................  .................  A2...............      $333.00      16.3288      $676.03      $418.76
                    throat.
42806............  Biopsy of upper nose/     Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    throat.
42808............  Excise pharynx lesion...  Y................  .................  A2...............      $446.00      16.3288      $676.03      $503.51
42809............  Remove pharynx foreign    N................  .................  G2...............  ...........        0.631       $26.12       $26.12
                    body.

[[Page 9893]]

 
42810............  Excision of neck cyst...  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
42815............  Excision of neck cyst...  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
42820............  Remove tonsils and        Y................  .................  A2...............      $510.00      22.2557      $921.41      $612.85
                    adenoids.
42821............  Remove tonsils and        Y................  .................  A2...............      $717.00      22.2557      $921.41      $768.10
                    adenoids.
42825............  Removal of tonsils......  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42826............  Removal of tonsils......  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42830............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42831............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42835............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42836............  Removal of adenoids.....  Y................  .................  A2...............      $630.00      22.2557      $921.41      $702.85
42860............  Excision of tonsil tags.  Y................  .................  A2...............      $510.00      22.2557      $921.41      $612.85
42870............  Excision of lingual       Y................  .................  A2...............      $510.00      22.2557      $921.41      $612.85
                    tonsil.
42890............  Partial removal of        Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    pharynx.
42892............  Revision of pharyngeal    Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    walls.
42900............  Repair throat wound.....  Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
42950............  Reconstruction of throat  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
42955............  Surgical opening of       Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    throat.
42960............  Control throat bleeding.  Y................  .................  A2...............       $72.48       1.1251       $46.58       $66.01
42962............  Control throat bleeding.  Y................  .................  A2...............      $446.00      39.8776    $1,650.97      $747.24
42970............  Control nose/throat       Y................  .................  R2...............  ...........       1.1251       $46.58       $46.58
                    bleeding.
42972............  Control nose/throat       Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
                    bleeding.
43030............  Throat muscle surgery...  Y................  .................  G2...............  ...........      16.3288      $676.03      $676.03
43200............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43201............  Esoph scope w/submucous   Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    inj.
43202............  Esophagus endoscopy,      Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    biopsy.
43204............  Esoph scope w/sclerosis   Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    inj.
43205............  Esophagus endoscopy/      Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    ligation.
43215............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43216............  Esophagus endoscopy/      Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    lesion.
43217............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43219............  Esophagus endoscopy.....  Y................  .................  A2...............      $333.00      24.9814    $1,034.25      $508.31
43220............  Esoph endoscopy,          Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    dilation.
43226............  Esoph endoscopy,          Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    dilation.
43227............  Esoph endoscopy, repair.  Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
43228............  Esoph endoscopy,          Y................  .................  A2...............      $446.00      25.3233    $1,048.41      $596.60
                    ablation.
43231............  Esoph endoscopy w/us      Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    exam.
43232............  Esoph endoscopy w/us fn   Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    bx.
43234............  Upper gi endoscopy, exam  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43235............  Uppr gi endoscopy,        Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    diagnosis.
43236............  Uppr gi scope w/submuc    Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    inj.
43237............  Endoscopic us exam,       Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    esoph.
43238............  Uppr gi endoscopy w/us    Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    fn bx.
43239............  Upper gi endoscopy,       Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    biopsy.
43240............  Esoph endoscope w/drain   Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    cyst.
43241............  Upper gi endoscopy with   Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    tube.
43242............  Uppr gi endoscopy w/us    Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    fn bx.
43243............  Upper gi endoscopy &      Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    inject.
43244............  Upper gi endoscopy/       Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    ligation.
43245............  Uppr gi scope dilate      Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    strictr.
43246............  Place gastrostomy tube..  Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
43247............  Operative upper gi        Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    endoscopy.
43248............  Uppr gi endoscopy/guide   Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    wire.
43249............  Esoph endoscopy,          Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    dilation.
43250............  Upper gi endoscopy/tumor  Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
43251............  Operative upper gi        Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    endoscopy.
43255............  Operative upper gi        Y................  .................  A2...............      $446.00        8.503      $352.03      $422.51
                    endoscopy.
43256............  Uppr gi endoscopy w/      Y................  .................  A2...............      $510.00      24.9814    $1,034.25      $641.06
                    stent.
43257............  Uppr gi scope w/thrml     Y................  .................  A2...............      $510.00      25.3233    $1,048.41      $644.60
                    txmnt.
43258............  Operative upper gi        Y................  .................  A2...............      $510.00        8.503      $352.03      $470.51
                    endoscopy.
43259............  Endoscopic ultrasound     Y................  .................  A2...............      $510.00        8.503      $352.03      $470.51
                    exam.
43260............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43261............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43262............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43263............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43264............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43265............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43267............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43268............  Endo                      Y................  .................  A2...............      $446.00      24.9814    $1,034.25      $593.06
                    cholangiopancreatograph.
43269............  Endo                      Y................  .................  A2...............      $446.00      24.9814    $1,034.25      $593.06
                    cholangiopancreatograph.
43271............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43272............  Endo                      Y................  .................  A2...............      $446.00       20.951      $867.39      $551.35
                    cholangiopancreatograph.
43450............  Dilate esophagus........  Y................  .................  A2...............      $333.00       5.8431      $241.91      $310.23
43453............  Dilate esophagus........  Y................  .................  A2...............      $333.00       5.8431      $241.91      $310.23
43456............  Dilate esophagus........  Y................  .................  A2...............      $335.41       5.8431      $241.91      $312.04
43458............  Dilate esophagus........  Y................  .................  A2...............      $335.41        8.503      $352.03      $339.57
43600............  Biopsy of stomach.......  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43653............  Laparoscopy, gastrostomy  Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52

[[Page 9894]]

 
43750............  Place gastrostomy tube..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
43760............  Change gastrostomy tube.  Y................  .................  A2...............      $144.98       3.2383      $134.07      $142.25
43761............  Reposition gastrostomy    Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
                    tube.
43870............  Repair stomach opening..  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
43886............  Revise gastric port,      Y................  .................  G2...............  ...........      20.2069      $836.59      $836.59
                    open.
43887............  Remove gastric port,      Y................  .................  G2...............  ...........       4.5263      $187.39      $187.39
                    open.
43888............  Change gastric port,      Y................  .................  G2...............  ...........      20.2069      $836.59      $836.59
                    open.
44100............  Biopsy of bowel.........  Y................  .................  A2...............      $333.00        8.503      $352.03      $337.76
44312............  Revision of ileostomy...  Y................  .................  A2...............      $333.00      20.2069      $836.59      $458.90
44340............  Revision of colostomy...  Y................  .................  A2...............      $510.00      20.2069      $836.59      $591.65
44360............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44361............  Small bowel endoscopy/    Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
                    biopsy.
44363............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44364............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44365............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44366............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44369............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44370............  Small bowel endoscopy/    Y................  .................  A2...............    $1,339.00      24.9814    $1,034.25    $1,262.81
                    stent.
44372............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44373............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44376............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44377............  Small bowel endoscopy/    Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
                    biopsy.
44378............  Small bowel endoscopy...  Y................  .................  A2...............      $446.00       9.5292      $394.52      $433.13
44379............  S bowel endoscope w/      Y................  .................  A2...............    $1,339.00      24.9814    $1,034.25    $1,262.81
                    stent.
44380............  Small bowel endoscopy...  Y................  .................  A2...............      $333.00       9.5292      $394.52      $348.38
44382............  Small bowel endoscopy...  Y................  .................  A2...............      $333.00       9.5292      $394.52      $348.38
44383............  Ileoscopy w/stent.......  Y................  .................  A2...............    $1,339.00      24.9814    $1,034.25    $1,262.81
44385............  Endoscopy of bowel pouch  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
44386............  Endoscopy, bowel pouch/   Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
                    biop.
44388............  Colonoscopy.............  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
44389............  Colonoscopy with biopsy.  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
44390............  Colonoscopy for foreign   Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
                    body.
44391............  Colonoscopy for bleeding  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
44392............  Colonoscopy &             Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
                    polypectomy.
44393............  Colonoscopy, lesion       Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
                    removal.
44394............  Colonoscopy w/snare.....  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
44397............  Colonoscopy w/stent.....  Y................  .................  A2...............      $333.00      24.9814    $1,034.25      $508.31
44500............  Intro, gastrointestinal   Y................  CH...............  G2...............  ...........       3.2383      $134.07      $134.07
                    tube.
44701............  Intraop colon lavage add- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    on.
45000............  Drainage of pelvic        Y................  .................  A2...............      $312.07      10.9132      $451.82      $347.01
                    abscess.
45005............  Drainage of rectal        Y................  .................  A2...............      $446.00      10.9132      $451.82      $447.46
                    abscess.
45020............  Drainage of rectal        Y................  .................  A2...............      $446.00      10.9132      $451.82      $447.46
                    abscess.
45100............  Biopsy of rectum........  Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
45108............  Removal of anorectal      Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    lesion.
45150............  Excision of rectal        Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    stricture.
45160............  Excision of rectal        Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    lesion.
45170............  Excision of rectal        Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    lesion.
45190............  Destruction, rectal       Y................  .................  A2...............    $1,339.00      22.7451      $941.67    $1,239.67
                    tumor.
45300............  Proctosigmoidoscopy dx..  Y................  .................  P3...............  ...........       1.4318       $59.28       $59.28
45303............  Proctosigmoidoscopy       Y................  .................  P2...............  ...........       8.7031      $360.32      $360.32
                    dilate.
45305............  Proctosigmoidoscopy w/bx  Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
45307............  Proctosigmoidoscopy fb..  Y................  .................  A2...............      $333.00      21.4632      $888.60      $471.90
45308............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    removal.
45309............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    removal.
45315............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    removal.
45317............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    bleed.
45320............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00      21.4632      $888.60      $471.90
                    ablate.
45321............  Proctosigmoidoscopy       Y................  .................  A2...............      $333.00      21.4632      $888.60      $471.90
                    volvul.
45327............  Proctosigmoidoscopy w/    Y................  .................  A2...............      $333.00      24.9814    $1,034.25      $508.31
                    stent.
45330............  Diagnostic sigmoidoscopy  Y................  .................  P3...............  ...........       1.9748       $81.76       $81.76
45331............  Sigmoidoscopy and biopsy  Y................  .................  A2...............      $299.24       5.0972      $211.03      $277.19
45332............  Sigmoidoscopy w/fb        Y................  .................  A2...............      $299.24       5.0972      $211.03      $277.19
                    removal.
45333............  Sigmoidoscopy &           Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    polypectomy.
45334............  Sigmoidoscopy for         Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    bleeding.
45335............  Sigmoidoscopy w/submuc    Y................  .................  A2...............      $299.24       5.0972      $211.03      $277.19
                    inj.
45337............  Sigmoidoscopy &           Y................  .................  A2...............      $299.24       5.0972      $211.03      $277.19
                    decompress.
45338............  Sigmoidoscopy w/tumr      Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    remove.
45339............  Sigmoidoscopy w/ablate    Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    tumr.
45340............  Sig w/balloon dilation..  Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
45341............  Sigmoidoscopy w/          Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    ultrasound.
45342............  Sigmoidoscopy w/us guide  Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    bx.
45345............  Sigmoidoscopy w/stent...  Y................  .................  A2...............      $333.00      24.9814    $1,034.25      $508.31
45355............  Surgical colonoscopy....  Y................  .................  A2...............      $333.00       8.8486      $366.34      $341.34
45378............  Diagnostic colonoscopy..  Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
45379............  Colonoscopy w/fb removal  Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
45380............  Colonoscopy and biopsy..  Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
45381............  Colonoscopy, submucous    Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    inj.

[[Page 9895]]

 
45382............  Colonoscopy/control       Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    bleeding.
45383............  Lesion removal            Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    colonoscopy.
45384............  Lesion remove             Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    colonoscopy.
45385............  Lesion removal            Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    colonoscopy.
45386............  Colonoscopy dilate        Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    stricture.
45387............  Colonoscopy w/stent.....  Y................  .................  A2...............      $333.00      24.9814    $1,034.25      $508.31
45391............  Colonoscopy w/endoscope   Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    us.
45392............  Colonoscopy w/endoscopic  Y................  .................  A2...............      $446.00       8.8486      $366.34      $426.09
                    fnb.
45500............  Repair of rectum........  Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
45505............  Repair of rectum........  Y................  .................  A2...............      $446.00      30.1606    $1,248.68      $646.67
45520............  Treatment of rectal       Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
                    prolapse.
45560............  Repair of rectocele.....  Y................  .................  A2...............      $446.00      30.1606    $1,248.68      $646.67
45900............  Reduction of rectal       Y................  .................  A2...............      $312.07       4.7935      $198.46      $283.67
                    prolapse.
45905............  Dilation of anal          Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
                    sphincter.
45910............  Dilation of rectal        Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
                    narrowing.
45915............  Remove rectal             Y................  .................  A2...............      $312.07      10.9132      $451.82      $347.01
                    obstruction.
45990............  Surg dx exam, anorectal.  Y................  .................  A2...............      $312.07      22.7451      $941.67      $469.47
46020............  Placement of seton......  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46030............  Removal of rectal marker  Y................  .................  A2...............      $312.07       4.7935      $198.46      $283.67
46040............  Incision of rectal        Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
                    abscess.
46045............  Incision of rectal        Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    abscess.
46050............  Incision of anal abscess  Y................  .................  A2...............      $312.07      10.9132      $451.82      $347.01
46060............  Incision of rectal        Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    abscess.
46070............  Incision of anal septum.  Y................  .................  G2...............  ...........      10.9132      $451.82      $451.82
46080............  Incision of anal          Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
                    sphincter.
46083............  Incise external           Y................  .................  P2...............  ...........       2.0077       $83.12       $83.12
                    hemorrhoid.
46200............  Removal of anal fissure.  Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
46210............  Removal of anal crypt...  Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
46211............  Removal of anal crypts..  Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
46220............  Removal of anal tag.....  Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
46221............  Ligation of               Y................  .................  P3...............  ...........       2.6251      $108.68      $108.68
                    hemorrhoid(s).
46230............  Removal of anal tags....  Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
46250............  Hemorrhoidectomy........  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46255............  Hemorrhoidectomy........  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46257............  Remove hemorrhoids &      Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
                    fissure.
46258............  Remove hemorrhoids &      Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
                    fistula.
46260............  Hemorrhoidectomy........  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46261............  Remove hemorrhoids &      Y................  .................  A2...............      $630.00      22.7451      $941.67      $707.92
                    fissure.
46262............  Remove hemorrhoids &      Y................  .................  A2...............      $630.00      22.7451      $941.67      $707.92
                    fistula.
46270............  Removal of anal fistula.  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46275............  Removal of anal fistula.  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46280............  Removal of anal fistula.  Y................  .................  A2...............      $630.00      22.7451      $941.67      $707.92
46285............  Removal of anal fistula.  Y................  .................  A2...............      $333.00      22.7451      $941.67      $485.17
46288............  Repair anal fistula.....  Y................  .................  A2...............      $630.00      22.7451      $941.67      $707.92
46320............  Removal of hemorrhoid     Y................  .................  P3...............  ...........       1.8678       $77.33       $77.33
                    clot.
46500............  Injection into            Y................  .................  P3...............  ...........       2.3536       $97.44       $97.44
                    hemorrhoid(s).
46505............  Chemodenervation anal     Y................  .................  G2...............  ...........       4.7935      $198.46      $198.46
                    musc.
46600............  Diagnostic anoscopy.....  N................  .................  P2...............  ...........        0.631       $26.12       $26.12
46604............  Anoscopy and dilation...  Y................  .................  P2...............  ...........       8.7031      $360.32      $360.32
46606............  Anoscopy and biopsy.....  Y................  .................  P3...............  ...........       3.1516      $130.48      $130.48
46608............  Anoscopy, remove for      Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
                    body.
46610............  Anoscopy, remove lesion.  Y................  .................  A2...............      $333.00      21.4632      $888.60      $471.90
46611............  Anoscopy................  Y................  .................  A2...............      $333.00       8.7031      $360.32      $339.83
46612............  Anoscopy, remove lesions  Y................  .................  A2...............      $333.00      21.4632      $888.60      $471.90
46614............  Anoscopy, control         Y................  .................  P3...............  ...........       1.7529       $72.57       $72.57
                    bleeding.
46615............  Anoscopy................  Y................  .................  A2...............      $446.00      21.4632      $888.60      $556.65
46700............  Repair of anal stricture  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46706............  Repr of anal fistula w/   Y................  .................  A2...............      $333.00      30.1606    $1,248.68      $561.92
                    glue.
46750............  Repair of anal sphincter  Y................  .................  A2...............      $510.00      30.1606    $1,248.68      $694.67
46753............  Reconstruction of anus..  Y................  .................  A2...............      $510.00      22.7451      $941.67      $617.92
46754............  Removal of suture from    Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    anus.
46760............  Repair of anal sphincter  Y................  .................  A2...............      $446.00      30.1606    $1,248.68      $646.67
46761............  Repair of anal sphincter  Y................  .................  A2...............      $510.00      30.1606    $1,248.68      $694.67
46762............  Implant artificial        Y................  .................  A2...............      $995.00      30.1606    $1,248.68    $1,058.42
                    sphincter.
46900............  Destruction, anal         Y................  .................  P3...............  ...........       2.5673      $106.29      $106.29
                    lesion(s).
46910............  Destruction, anal         Y................  .................  P3...............  ...........       2.7895      $115.49      $115.49
                    lesion(s).
46916............  Cryosurgery, anal         Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesion(s).
46917............  Laser surgery, anal       Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesions.
46922............  Excision of anal          Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesion(s).
46924............  Destruction, anal         Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesion(s).
46934............  Destruction of            Y................  .................  P3...............  ...........       4.3777      $181.24      $181.24
                    hemorrhoids.
46935............  Destruction of            Y................  .................  P3...............  ...........       3.0118      $124.69      $124.69
                    hemorrhoids.
46936............  Destruction of            Y................  .................  P3...............  ...........       4.5753      $189.42      $189.42
                    hemorrhoids.
46937............  Cryotherapy of rectal     Y................  .................  A2...............      $446.00      22.7451      $941.67      $569.92
                    lesion.
46938............  Cryotherapy of rectal     Y................  .................  A2...............      $446.00      30.1606    $1,248.68      $646.67
                    lesion.
46940............  Treatment of anal         Y................  .................  P3...............  ...........       1.9915       $82.45       $82.45
                    fissure.
46942............  Treatment of anal         Y................  .................  P3...............  ...........       1.9091       $79.04       $79.04
                    fissure.

[[Page 9896]]

 
46945............  Ligation of hemorrhoids.  Y................  .................  P3...............  ...........       3.3161      $137.29      $137.29
46946............  Ligation of hemorrhoids.  Y................  .................  A2...............      $333.00      10.9132      $451.82      $362.71
46947............  Hemorrhoidopexy by        Y................  .................  A2...............      $995.00      30.1606    $1,248.68    $1,058.42
                    stapling.
47000............  Needle biopsy of liver..  Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
47001............  Needle biopsy, liver add- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    on.
47382............  Percut ablate liver rf..  Y................  .................  G2...............  ...........       42.998    $1,780.16    $1,780.16
47500............  Injection for liver x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    rays.
47505............  Injection for liver x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    rays.
47510............  Insert catheter, bile     Y................  .................  A2...............      $446.00      28.6884    $1,187.73      $631.43
                    duct.
47511............  Insert bile duct drain..  Y................  .................  A2...............    $1,245.85      28.6884    $1,187.73    $1,231.32
47525............  Change bile duct          Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
                    catheter.
47530............  Revise/reinsert bile      Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
                    tube.
47552............  Biliary endoscopy thru    Y................  .................  A2...............      $446.00      28.6884    $1,187.73      $631.43
                    skin.
47553............  Biliary endoscopy thru    Y................  .................  A2...............      $510.00      28.6884    $1,187.73      $679.43
                    skin.
47554............  Biliary endoscopy thru    Y................  .................  A2...............      $510.00      28.6884    $1,187.73      $679.43
                    skin.
47555............  Biliary endoscopy thru    Y................  .................  A2...............      $510.00      28.6884    $1,187.73      $679.43
                    skin.
47556............  Biliary endoscopy thru    Y................  .................  A2...............    $1,245.85      28.6884    $1,187.73    $1,231.32
                    skin.
47560............  Laparoscopy w/cholangio.  Y................  .................  A2...............      $510.00      34.3958    $1,424.02      $738.51
47561............  Laparo w/cholangio/       Y................  .................  A2...............      $510.00      34.3958    $1,424.02      $738.51
                    biopsy.
47562............  Laparoscopic              Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
                    cholecystectomy.
47563............  Laparo cholecystectomy/   Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
                    graph.
47564............  Laparo cholecystectomy/   Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
                    explr.
47630............  Remove bile duct stone..  Y................  .................  A2...............      $510.00      28.6884    $1,187.73      $679.43
48102............  Needle biopsy, pancreas.  Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
49080............  Puncture, peritoneal      Y................  .................  A2...............      $222.78       5.2024      $215.38      $220.93
                    cavity.
49081............  Removal of abdominal      Y................  .................  A2...............      $222.78       5.2024      $215.38      $220.93
                    fluid.
49180............  Biopsy, abdominal mass..  Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
49250............  Excision of umbilicus...  Y................  .................  A2...............      $630.00      25.6947    $1,063.79      $738.45
49320............  Diag laparo separate      Y................  .................  A2...............      $510.00      34.3958    $1,424.02      $738.51
                    proc.
49321............  Laparoscopy, biopsy.....  Y................  .................  A2...............      $630.00      34.3958    $1,424.02      $828.51
49322............  Laparoscopy, aspiration.  Y................  .................  A2...............      $630.00      34.3958    $1,424.02      $828.51
49400............  Air injection into        N................  .................  N1...............  ...........  ...........  ...........  ...........
                    abdomen.
49402............  Remove foreign body,      Y................  .................  A2...............      $446.00      25.6947    $1,063.79      $600.45
                    adbomen.
49419............  Insrt abdom cath for      Y................  .................  A2...............      $333.00      29.6965    $1,229.46      $557.12
                    chemotx.
49420............  Insert abdom drain, temp  Y................  .................  A2...............      $333.00      30.7096    $1,271.41      $567.60
49421............  Insert abdom drain, perm  Y................  .................  A2...............      $333.00      30.7096    $1,271.41      $567.60
49422............  Remove perm cannula/      Y................  .................  A2...............      $333.00      23.9802      $992.80      $497.95
                    catheter.
49423............  Exchange drainage         Y................  .................  G2...............  ...........      15.3545      $635.69      $635.69
                    catheter.
49424............  Assess cyst, contrast     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    inject.
49426............  Revise abdomen-venous     Y................  .................  A2...............      $446.00      25.6947    $1,063.79      $600.45
                    shunt.
49427............  Injection, abdominal      N................  .................  N1...............  ...........  ...........  ...........  ...........
                    shunt.
49429............  Removal of shunt........  Y................  .................  G2...............  ...........      23.9802      $992.80      $992.80
49440............  Place gastrostomy tube    Y................  NI...............  G2...............  ...........        8.503      $352.03      $352.03
                    perc.
49441............  Place duod/jej tube perc  Y................  NI...............  G2...............  ...........        8.503      $352.03      $352.03
49446............  Change g-tube to g-j      Y................  NI...............  G2...............  ...........        8.503      $352.03      $352.03
                    perc.
49450............  Replace g/c tube perc...  Y................  NI...............  G2...............  ...........       3.2383      $134.07      $134.07
49451............  Replace duod/jej tube     Y................  NI...............  G2...............  ...........       3.2383      $134.07      $134.07
                    perc.
49452............  Replace g-j tube perc...  Y................  NI...............  G2...............  ...........       3.2383      $134.07      $134.07
49460............  Fix g/colon tube w/       Y................  NI...............  G2...............  ...........       3.2383      $134.07      $134.07
                    device.
49465............  Fluoro exam of g/colon    N................  NI...............  N1...............  ...........  ...........  ...........  ...........
                    tube.
49495............  Rpr ing hernia baby,      Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    reduc.
49496............  Rpr ing hernia baby,      Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    blocked.
49500............  Rpr ing hernia, init,     Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    reduce.
49501............  Rpr ing hernia, init      Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    blocked.
49505............  Prp i/hern init reduc >5  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    yr.
49507............  Prp i/hern init block >5  Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    yr.
49520............  Rerepair ing hernia,      Y................  .................  A2...............      $995.00      30.6788    $1,270.13    $1,063.78
                    reduce.
49521............  Rerepair ing hernia,      Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    blocked.
49525............  Repair ing hernia,        Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    sliding.
49540............  Repair lumbar hernia....  Y................  .................  A2...............      $446.00      30.6788    $1,270.13      $652.03
49550............  Rpr rem hernia, init,     Y................  .................  A2...............      $717.00      30.6788    $1,270.13      $855.28
                    reduce.
49553............  Rpr fem hernia, init      Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    blocked.
49555............  Rerepair fem hernia,      Y................  .................  A2...............      $717.00      30.6788    $1,270.13      $855.28
                    reduce.
49557............  Rerepair fem hernia,      Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    blocked.
49560............  Rpr ventral hern init,    Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    reduc.
49561............  Rpr ventral hern init,    Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    block.
49565............  Rerepair ventrl hern,     Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    reduce.
49566............  Rerepair ventrl hern,     Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    block.
49568............  Hernia repair w/mesh....  Y................  .................  A2...............      $995.00      30.6788    $1,270.13    $1,063.78
49570............  Rpr epigastric hern,      Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    reduce.
49572............  Rpr epigastric hern,      Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    blocked.
49580............  Rpr umbil hern, reduc <   Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    5 yr.
49582............  Rpr umbil hern, block <   Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    5 yr.
49585............  Rpr umbil hern, reduc >   Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    5 yr.
49587............  Rpr umbil hern, block >   Y................  .................  A2...............    $1,339.00      30.6788    $1,270.13    $1,321.78
                    5 yr.
49590............  Repair spigelian hernia.  Y................  .................  A2...............      $510.00      30.6788    $1,270.13      $700.03
49600............  Repair umbilical lesion.  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03

[[Page 9897]]

 
49650............  Laparo hernia repair      Y................  .................  A2...............      $630.00      45.5317    $1,885.06      $943.77
                    initial.
49651............  Laparo hernia repair      Y................  .................  A2...............      $995.00      45.5317    $1,885.06    $1,217.52
                    recur.
50200............  Biopsy of kidney........  Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
50382............  Change ureter stent,      Y................  .................  G2...............  ...........      24.7749    $1,025.71    $1,025.71
                    percut.
50384............  Remove ureter stent,      Y................  .................  G2...............  ...........       17.942      $742.82      $742.82
                    percut.
50385............  Change stent via          Y................  NI...............  G2...............  ...........       17.942      $742.82      $742.82
                    transureth.
50386............  Remove stent via          Y................  NI...............  G2...............  ...........       5.9735      $247.31      $247.31
                    transureth.
50387............  Change ext/int ureter     Y................  .................  G2...............  ...........      15.3545      $635.69      $635.69
                    stent.
50389............  Remove renal tube w/      Y................  .................  G2...............  ...........       5.9735      $247.31      $247.31
                    fluoro.
50390............  Drainage of kidney        Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
                    lesion.
50391............  Instll rx agnt into rnal  Y................  .................  P2...............  ...........       1.0356       $42.87       $42.87
                    tub.
50392............  Insert kidney drain.....  Y................  .................  A2...............      $333.00       17.942      $742.82      $435.46
50393............  Insert ureteral tube....  Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
50394............  Injection for kidney x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
50395............  Create passage to kidney  Y................  .................  A2...............      $333.00       17.942      $742.82      $435.46
50396............  Measure kidney pressure.  Y................  .................  A2...............      $131.50       2.0077       $83.12      $119.41
50398............  Change kidney tube......  Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
50551............  Kidney endoscopy........  Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
50553............  Kidney endoscopy........  Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
50555............  Kidney endoscopy &        Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
                    biopsy.
50557............  Kidney endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    treatment.
50561............  Kidney endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    treatment.
50562............  Renal scope w/tumor       Y................  .................  G2...............  ...........       5.9735      $247.31      $247.31
                    resect.
50570............  Kidney endoscopy........  Y................  .................  G2...............  ...........       5.9735      $247.31      $247.31
50572............  Kidney endoscopy........  Y................  .................  G2...............  ...........       5.9735      $247.31      $247.31
50574............  Kidney endoscopy &        Y................  .................  G2...............  ...........       5.9735      $247.31      $247.31
                    biopsy.
50575............  Kidney endoscopy........  Y................  .................  G2...............  ...........      36.0774    $1,493.64    $1,493.64
50576............  Kidney endoscopy &        Y................  .................  G2...............  ...........       17.942      $742.82      $742.82
                    treatment.
50580............  Kidney endoscopy &        Y................  CH...............  G2...............  ...........       17.942      $742.82      $742.82
                    treatment.
50590............  Fragmenting of kidney     Y................  .................  G2...............  ...........      41.5299    $1,719.38    $1,719.38
                    stone.
50592............  Perc rf ablate renal      Y................  .................  G2...............  ...........       42.998    $1,780.16    $1,780.16
                    tumor.
50684............  Injection for ureter x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
50686............  Measure ureter pressure.  Y................  .................  P2...............  ...........       1.0356       $42.87       $42.87
50688............  Change of ureter tube/    Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
                    stent.
50690............  Injection for ureter x-   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
50947............  Laparo new ureter/        Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    bladder.
50948............  Laparo new ureter/        Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    bladder.
50951............  Endoscopy of ureter.....  Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
50953............  Endoscopy of ureter.....  Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
50955............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    biopsy.
50957............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    treatment.
50961............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    treatment.
50970............  Ureter endoscopy........  Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
50972............  Ureter endoscopy &        Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
                    catheter.
50974............  Ureter endoscopy &        Y................  .................  A2...............      $333.00       17.942      $742.82      $435.46
                    biopsy.
50976............  Ureter endoscopy &        Y................  .................  A2...............      $333.00       17.942      $742.82      $435.46
                    treatment.
50980............  Ureter endoscopy &        Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    treatment.
51000............  Drainage of bladder.....  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
51005............  Drainage of bladder.....  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
51010............  Drainage of bladder.....  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
51020............  Incise & treat bladder..  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
51030............  Incise & treat bladder..  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
51040............  Incise & drain bladder..  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
51045............  Incise bladder/drain      Y................  .................  A2...............      $399.24       5.9735      $247.31      $361.26
                    ureter.
51050............  Removal of bladder stone  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
51065............  Remove ureter calculus..  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
51080............  Drainage of bladder       Y................  .................  A2...............      $333.00      18.3197      $758.45      $439.36
                    abscess.
51100............  Drain bladder by needle.  Y................  NI...............  P3...............  ...........        0.757       $31.34       $31.34
51101............  Drain bladder by trocar/  Y................  NI...............  P2...............  ...........       1.0356       $42.87       $42.87
                    cath.
51102............  Drain bl w/cath           Y................  NI...............  A2...............      $333.00      19.3414      $800.75      $449.94
                    insertion.
51500............  Removal of bladder cyst.  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
51520............  Removal of bladder        Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
                    lesion.
51600............  Injection for bladder x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
51605............  Preparation for bladder   N................  .................  N1...............  ...........  ...........  ...........  ...........
                    xray.
51610............  Injection for bladder x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
51700............  Irrigation of bladder...  Y................  .................  P3...............  ...........       1.2756       $52.81       $52.81
51701............  Insert bladder catheter.  N................  .................  P2...............  ...........        0.631       $26.12       $26.12
51702............  Insert temp bladder cath  N................  .................  P2...............  ...........        0.631       $26.12       $26.12
51703............  Insert bladder cath,      Y................  .................  P2...............  ...........       1.0356       $42.87       $42.87
                    complex.
51705............  Change of bladder tube..  Y................  .................  P3...............  ...........       1.7693       $73.25       $73.25
51710............  Change of bladder tube..  Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
51715............  Endoscopic injection/     Y................  .................  A2...............      $510.00      29.7864    $1,233.19      $690.80
                    implant.
51720............  Treatment of bladder      Y................  .................  P3...............  ...........       1.3823       $57.23       $57.23
                    lesion.
51725............  Simple cystometrogram...  Y................  .................  P2...............  ...........       3.0469      $126.14      $126.14
51726............  Complex cystometrogram..  Y................  .................  A2...............      $209.48       3.0469      $126.14      $188.65
51736............  Urine flow measurement..  Y................  .................  P3...............  ...........       0.4444       $18.40       $18.40
51741............  Electro-uroflowmetry,     Y................  .................  P3...............  ...........       0.5101       $21.12       $21.12
                    first.

[[Page 9898]]

 
51772............  Urethra pressure profile  Y................  .................  A2...............      $131.50       2.0077       $83.12      $119.41
51784............  Anal/urinary muscle       Y................  .................  P2...............  ...........       1.0356       $42.87       $42.87
                    study.
51785............  Anal/urinary muscle       Y................  .................  A2...............       $66.92       2.0077       $83.12       $70.97
                    study.
51792............  Urinary reflex study....  Y................  .................  P2...............  ...........       1.0356       $42.87       $42.87
51795............  Urine voiding pressure    Y................  .................  P2...............  ...........       2.0077       $83.12       $83.12
                    study.
51797............  Intraabdominal pressure   Y................  .................  P2...............  ...........       2.0077       $83.12       $83.12
                    test.
51798............  Us urine capacity         N................  .................  P3...............  ...........       0.3867       $16.01       $16.01
                    measure.
51880............  Repair of bladder         Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    opening.
51992............  Laparo sling operation..  Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
52000............  Cystoscopy..............  Y................  .................  A2...............      $333.00       5.9735      $247.31      $311.58
52001............  Cystoscopy, removal of    Y................  .................  A2...............      $399.24       17.942      $742.82      $485.14
                    clots.
52005............  Cystoscopy & ureter       Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
                    catheter.
52007............  Cystoscopy and biopsy...  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52010............  Cystoscopy & duct         Y................  .................  A2...............      $399.24       5.9735      $247.31      $361.26
                    catheter.
52204............  Cystoscopy w/biopsy(s)..  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
52214............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52224............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52234............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52235............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52240............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52250............  Cystoscopy and            Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
                    radiotracer.
52260............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
52265............  Cystoscopy and treatment  Y................  .................  P2...............  ...........       5.9735      $247.31      $247.31
52270............  Cystoscopy & revise       Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
                    urethra.
52275............  Cystoscopy & revise       Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
                    urethra.
52276............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52277............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52281............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
52282............  Cystoscopy, implant       Y................  .................  A2...............    $1,339.00      36.0774    $1,493.64    $1,377.66
                    stent.
52283............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52285............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
52290............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
52300............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52301............  Cystoscopy and treatment  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52305............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52310............  Cystoscopy and treatment  Y................  .................  A2...............      $399.24       17.942      $742.82      $485.14
52315............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52317............  Remove bladder stone....  Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
52318............  Remove bladder stone....  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52320............  Cystoscopy and treatment  Y................  .................  A2...............      $717.00      24.7749    $1,025.71      $794.18
52325............  Cystoscopy, stone         Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
                    removal.
52327............  Cystoscopy, inject        Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
                    material.
52330............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52332............  Cystoscopy and treatment  Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
52334............  Create passage to kidney  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52341............  Cysto w/ureter stricture  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    tx.
52342............  Cysto w/up stricture tx.  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52343............  Cysto w/renal stricture   Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    tx.
52344............  Cysto/uretero, stricture  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    tx.
52345............  Cysto/uretero w/up        Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    stricture.
52346............  Cystouretero w/renal      Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    strict.
52351............  Cystouretero & or         Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    pyeloscope.
52352............  Cystouretero w/stone      Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
                    remove.
52353............  Cystouretero w/           Y................  .................  A2...............      $630.00      36.0774    $1,493.64      $845.91
                    lithotripsy.
52354............  Cystouretero w/biopsy...  Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
52355............  Cystouretero w/excise     Y................  .................  A2...............      $630.00      24.7749    $1,025.71      $728.93
                    tumor.
52400............  Cystouretero w/congen     Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    repr.
52402............  Cystourethro cut ejacul   Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
                    duct.
52450............  Incision of prostate....  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52500............  Revision of bladder neck  Y................  .................  A2...............      $510.00      24.7749    $1,025.71      $638.93
52510............  Dilation prostatic        N................  CH...............  D5...............  ...........  ...........  ...........  ...........
                    urethra.
52601............  Prostatectomy (turp)....  Y................  .................  A2...............      $630.00      36.0774    $1,493.64      $845.91
52606............  Control postop bleeding.  Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
52612............  Prostatectomy, first      Y................  .................  A2...............      $446.00      36.0774    $1,493.64      $707.91
                    stage.
52614............  Prostatectomy, second     Y................  .................  A2...............      $333.00      36.0774    $1,493.64      $623.16
                    stage.
52620............  Remove residual prostate  Y................  .................  A2...............      $333.00      36.0774    $1,493.64      $623.16
52630............  Remove prostate regrowth  Y................  .................  A2...............      $446.00      36.0774    $1,493.64      $707.91
52640............  Relieve bladder           Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
                    contracture.
52647............  Laser surgery of          Y................  .................  A2...............    $1,339.00      45.2042    $1,871.50    $1,472.13
                    prostate.
52648............  Laser surgery of          Y................  .................  A2...............    $1,339.00      45.2042    $1,871.50    $1,472.13
                    prostate.
52700............  Drainage of prostate      Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
                    abscess.
53000............  Incision of urethra.....  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53010............  Incision of urethra.....  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53020............  Incision of urethra.....  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53025............  Incision of urethra.....  Y................  .................  R2...............  ...........      19.1505      $792.85      $792.85
53040............  Drainage of urethra       Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
                    abscess.
53060............  Drainage of urethra       Y................  .................  P3...............  ...........       1.7198       $71.20       $71.20
                    abscess.

[[Page 9899]]

 
53080............  Drainage of urinary       Y................  .................  A2...............      $510.00      19.1505      $792.85      $580.71
                    leakage.
53085............  Drainage of urinary       Y................  .................  G2...............  ...........      19.1505      $792.85      $792.85
                    leakage.
53200............  Biopsy of urethra.......  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53210............  Removal of urethra......  Y................  .................  A2...............      $717.00      29.7864    $1,233.19      $846.05
53215............  Removal of urethra......  Y................  .................  A2...............      $717.00      19.1505      $792.85      $735.96
53220............  Treatment of urethra      Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    lesion.
53230............  Removal of urethra        Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    lesion.
53235............  Removal of urethra        Y................  .................  A2...............      $510.00      19.1505      $792.85      $580.71
                    lesion.
53240............  Surgery for urethra       Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    pouch.
53250............  Removal of urethra gland  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
53260............  Treatment of urethra      Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
                    lesion.
53265............  Treatment of urethra      Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
                    lesion.
53270............  Removal of urethra gland  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
53275............  Repair of urethra defect  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
53400............  Revise urethra, stage 1.  Y................  .................  A2...............      $510.00      29.7864    $1,233.19      $690.80
53405............  Revise urethra, stage 2.  Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
53410............  Reconstruction of         Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    urethra.
53420............  Reconstruct urethra,      Y................  .................  A2...............      $510.00      29.7864    $1,233.19      $690.80
                    stage 1.
53425............  Reconstruct urethra,      Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    stage 2.
53430............  Reconstruction of         Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    urethra.
53431............  Reconstruct urethra/      Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
                    bladder.
53440............  Male sling procedure....  N................  CH...............  H8...............      $446.00     106.8568    $4,423.98    $3,500.50
53442............  Remove/revise male sling  Y................  .................  A2...............      $333.00      29.7864    $1,233.19      $558.05
53444............  Insert tandem cuff......  N................  CH...............  H8...............      $446.00     106.8568    $4,423.98    $3,500.50
53445............  Insert uro/ves nck        N................  .................  H8...............      $333.00     193.4277    $8,008.10    $6,625.75
                    sphincter.
53446............  Remove uro sphincter....  Y................  .................  A2...............      $333.00      29.7864    $1,233.19      $558.05
53447............  Remove/replace ur         N................  .................  H8...............      $333.00     193.4277    $8,008.10    $6,625.75
                    sphincter.
53449............  Repair uro sphincter....  Y................  .................  A2...............      $333.00      29.7864    $1,233.19      $558.05
53450............  Revision of urethra.....  Y................  .................  A2...............      $333.00      29.7864    $1,233.19      $558.05
53460............  Revision of urethra.....  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53502............  Repair of urethra injury  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
53505............  Repair of urethra injury  Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
53510............  Repair of urethra injury  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
53515............  Repair of urethra injury  Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
53520............  Repair of urethra defect  Y................  .................  A2...............      $446.00      29.7864    $1,233.19      $642.80
53600............  Dilate urethra stricture  Y................  .................  P3...............  ...........       0.9381       $38.84       $38.84
53601............  Dilate urethra stricture  Y................  CH...............  P2...............  ...........       1.0356       $42.87       $42.87
53605............  Dilate urethra stricture  Y................  .................  A2...............      $446.00       17.942      $742.82      $520.21
53620............  Dilate urethra stricture  Y................  .................  P3...............  ...........       1.5224       $63.03       $63.03
53621............  Dilate urethra stricture  Y................  .................  P3...............  ...........       1.5963       $66.09       $66.09
53660............  Dilation of urethra.....  Y................  CH...............  P2...............  ...........       1.0356       $42.87       $42.87
53661............  Dilation of urethra.....  Y................  CH...............  P2...............  ...........       1.0356       $42.87       $42.87
53665............  Dilation of urethra.....  Y................  .................  A2...............      $333.00      19.1505      $792.85      $447.96
53850............  Prostatic microwave       Y................  .................  P2...............  ...........      45.2042    $1,871.50    $1,871.50
                    thermotx.
53852............  Prostatic rf thermotx...  Y................  .................  P2...............  ...........      45.2042    $1,871.50    $1,871.50
53853............  Prostatic water           Y................  .................  P2...............  ...........      24.7749    $1,025.71    $1,025.71
                    thermother.
54000............  Slitting of prepuce.....  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
54001............  Slitting of prepuce.....  Y................  .................  A2...............      $446.00      19.1505      $792.85      $532.71
54015............  Drain penis lesion......  Y................  .................  A2...............      $630.00      18.3197      $758.45      $662.11
54050............  Destruction, penis        Y................  .................  P2...............  ...........       1.4595       $60.42       $60.42
                    lesion(s).
54055............  Destruction, penis        Y................  .................  P3...............  ...........       1.4565       $60.30       $60.30
                    lesion(s).
54056............  Cryosurgery, penis        Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
                    lesion(s).
54057............  Laser surg, penis         Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesion(s).
54060............  Excision of penis         Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesion(s).
54065............  Destruction, penis        Y................  .................  A2...............      $333.00      19.9041      $824.05      $455.76
                    lesion(s).
54100............  Biopsy of penis.........  Y................  .................  A2...............      $333.00      16.1001      $666.56      $416.39
54105............  Biopsy of penis.........  Y................  .................  A2...............      $333.00      21.1098      $873.97      $468.24
54110............  Treatment of penis        Y................  .................  A2...............      $446.00      33.9306    $1,404.76      $685.69
                    lesion.
54111............  Treat penis lesion,       Y................  .................  A2...............      $446.00      33.9306    $1,404.76      $685.69
                    graft.
54112............  Treat penis lesion,       Y................  .................  A2...............      $446.00      33.9306    $1,404.76      $685.69
                    graft.
54115............  Treatment of penis        Y................  .................  A2...............      $333.00      18.3197      $758.45      $439.36
                    lesion.
54120............  Partial removal of penis  Y................  .................  A2...............      $446.00      33.9306    $1,404.76      $685.69
54150............  Circumcision w/regionl    Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
                    block.
54160............  Circumcision, neonate...  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54161............  Circum 28 days or older.  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54162............  Lysis penil circumic      Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
                    lesion.
54163............  Repair of circumcision..  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54164............  Frenulotomy of penis....  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54200............  Treatment of penis        Y................  .................  P3...............  ...........       1.5717       $65.07       $65.07
                    lesion.
54205............  Treatment of penis        Y................  .................  A2...............      $630.00      33.9306    $1,404.76      $823.69
                    lesion.
54220............  Treatment of penis        Y................  .................  A2...............      $131.50       2.0077       $83.12      $119.41
                    lesion.
54230............  Prepare penis study.....  N................  .................  N1...............  ...........  ...........  ...........  ...........
54231............  Dynamic cavernosometry..  Y................  .................  P3...............  ...........       1.3741       $56.89       $56.89
54235............  Penile injection........  Y................  .................  P3...............  ...........       0.9628       $39.86       $39.86
54240............  Penis study.............  Y................  .................  P3...............  ...........       0.6667       $27.60       $27.60
54250............  Penis study.............  Y................  .................  P3...............  ...........       0.2304        $9.54        $9.54
54300............  Revision of penis.......  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69

[[Page 9900]]

 
54304............  Revision of penis.......  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54308............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54312............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54316............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54318............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54322............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54324............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54326............  Reconstruction of         Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    urethra.
54328............  Revise penis/urethra....  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54340............  Secondary urethral        Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    surgery.
54344............  Secondary urethral        Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    surgery.
54348............  Secondary urethral        Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    surgery.
54352............  Reconstruct urethra/      Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    penis.
54360............  Penis plastic surgery...  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54380............  Repair penis............  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54385............  Repair penis............  Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
54400............  Insert semi-rigid         N................  CH...............  H8...............      $510.00     106.8568    $4,423.98    $3,548.50
                    prosthesis.
54401............  Insert self-contd         N................  .................  H8...............      $510.00     193.4277    $8,008.10    $6,758.50
                    prosthesis.
54405............  Insert multi-comp penis   N................  .................  H8...............      $510.00     193.4277    $8,008.10    $6,758.50
                    pros.
54406............  Remove muti-comp penis    Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    pros.
54408............  Repair multi-comp penis   Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    pros.
54410............  Remove/replace penis      N................  .................  H8...............      $510.00     193.4277    $8,008.10    $6,758.50
                    prosth.
54415............  Remove self-contd penis   Y................  .................  A2...............      $510.00      33.9306    $1,404.76      $733.69
                    pros.
54416............  Remv/repl penis contain   N................  .................  H8...............      $510.00     193.4277    $8,008.10    $6,758.50
                    pros.
54420............  Revision of penis.......  Y................  .................  A2...............      $630.00      33.9306    $1,404.76      $823.69
54435............  Revision of penis.......  Y................  .................  A2...............      $630.00      33.9306    $1,404.76      $823.69
54440............  Repair of penis.........  Y................  .................  A2...............      $630.00      33.9306    $1,404.76      $823.69
54450............  Preputial stretching....  Y................  .................  A2...............      $209.48       3.0469      $126.14      $188.65
54500............  Biopsy of testis........  Y................  .................  A2...............      $333.00      13.5764      $562.08      $390.27
54505............  Biopsy of testis........  Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
54512............  Excise lesion testis....  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54520............  Removal of testis.......  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54522............  Orchiectomy, partial....  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54530............  Removal of testis.......  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
54550............  Exploration for testis..  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
54560............  Exploration for testis..  Y................  .................  G2...............  ...........      22.3251      $924.28      $924.28
54600............  Reduce testis torsion...  Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
54620............  Suspension of testis....  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54640............  Suspension of testis....  Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
54660............  Revision of testis......  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54670............  Repair testis injury....  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54680............  Relocation of testis(es)  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54690............  Laparoscopy, orchiectomy  Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
54692............  Laparoscopy, orchiopexy.  Y................  .................  G2...............  ...........      69.6652    $2,884.21    $2,884.21
54700............  Drainage of scrotum.....  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
54800............  Biopsy of epididymis....  Y................  .................  A2...............      $127.16        4.327      $179.14      $140.16
54830............  Remove epididymis lesion  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54840............  Remove epididymis lesion  Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
54860............  Removal of epididymis...  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
54861............  Removal of epididymis...  Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
54865............  Explore epididymis......  Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
54900............  Fusion of spermatic       Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
                    ducts.
54901............  Fusion of spermatic       Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
                    ducts.
55000............  Drainage of hydrocele...  Y................  .................  P3...............  ...........       1.6128       $66.77       $66.77
55040............  Removal of hydrocele....  Y................  .................  A2...............      $510.00      30.6788    $1,270.13      $700.03
55041............  Removal of hydroceles...  Y................  .................  A2...............      $717.00      30.6788    $1,270.13      $855.28
55060............  Repair of hydrocele.....  Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
55100............  Drainage of scrotum       Y................  .................  A2...............      $333.00      11.5594      $478.57      $369.39
                    abscess.
55110............  Explore scrotum.........  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
55120............  Removal of scrotum        Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
                    lesion.
55150............  Removal of scrotum......  Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
55175............  Revision of scrotum.....  Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
55180............  Revision of scrotum.....  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
55200............  Incision of sperm duct..  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
55250............  Removal of sperm duct(s)  Y................  .................  A2...............      $446.00      22.3251      $924.28      $565.57
55300............  Prepare, sperm duct x-    N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
55400............  Repair of sperm duct....  Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
55450............  Ligation of sperm duct..  Y................  .................  P3...............  ...........       5.1264      $212.24      $212.24
55500............  Removal of hydrocele....  Y................  .................  A2...............      $510.00      22.3251      $924.28      $613.57
55520............  Removal of sperm cord     Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
                    lesion.
55530............  Revise spermatic cord     Y................  .................  A2...............      $630.00      22.3251      $924.28      $703.57
                    veins.
55535............  Revise spermatic cord     Y................  .................  A2...............      $630.00      30.6788    $1,270.13      $790.03
                    veins.
55540............  Revise hernia & sperm     Y................  .................  A2...............      $717.00      30.6788    $1,270.13      $855.28
                    veins.
55550............  Laparo ligate spermatic   Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    vein.
55600............  Incise sperm duct pouch.  Y................  .................  R2...............  ...........      22.3251      $924.28      $924.28
55680............  Remove sperm pouch        Y................  .................  A2...............      $333.00      22.3251      $924.28      $480.82
                    lesion.
55700............  Biopsy of prostate......  Y................  .................  A2...............      $345.83      11.0338      $456.81      $373.58

[[Page 9901]]

 
55705............  Biopsy of prostate......  Y................  .................  A2...............      $345.83      11.0338      $456.81      $373.58
55720............  Drainage of prostate      Y................  .................  A2...............      $333.00      24.7749    $1,025.71      $506.18
                    abscess.
55725............  Drainage of prostate      Y................  .................  A2...............      $446.00      24.7749    $1,025.71      $590.93
                    abscess.
55860............  Surgical exposure,        Y................  .................  G2...............  ...........      19.3414      $800.75      $800.75
                    prostate.
55870............  Electroejaculation......  Y................  .................  P3...............  ...........       1.6541       $68.48       $68.48
55873............  Cryoablate prostate.....  Y................  .................  H8...............    $1,339.00     162.5379    $6,729.23    $6,219.63
55875............  Transperi needle place,   N................  .................  A2...............    $1,339.00      36.0774    $1,493.64    $1,377.66
                    pros.
55876 *..........  Place rt device/marker,   Y................  .................  P3...............  ...........       1.7033       $70.52       $70.52
                    pros.
55920............  Place needles pelvic for  Y................  NI...............  G2...............  ...........      25.6947    $1,063.79    $1,063.79
                    rt.
56405............  I & d of vulva/perineum.  Y................  .................  P3...............  ...........       1.0287       $42.59       $42.59
56420............  Drainage of gland         Y................  .................  P2...............  ...........        1.352       $55.97       $55.97
                    abscess.
56440............  Surgery for vulva lesion  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
56441............  Lysis of labial           Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
                    lesion(s).
56442............  Hymenotomy..............  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
56501............  Destroy, vulva lesions,   Y................  .................  P3...............  ...........       1.4072       $58.26       $58.26
                    sim.
56515............  Destroy vulva lesion/s    Y................  .................  A2...............      $510.00      19.9041      $824.05      $588.51
                    compl.
56605............  Biopsy of vulva/perineum  Y................  .................  P3...............  ...........       0.8229       $34.07       $34.07
56606............  Biopsy of vulva/perineum  Y................  .................  P3...............  ...........       0.3539       $14.65       $14.65
56620............  Partial removal of vulva  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
56625............  Complete removal of       Y................  .................  A2...............      $995.00      19.0203      $787.46      $943.12
                    vulva.
56700............  Partial removal of hymen  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
56740............  Remove vagina gland       Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
                    lesion.
56800............  Repair of vagina........  Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
56805............  Repair clitoris.........  Y................  .................  G2...............  ...........      19.0203      $787.46      $787.46
56810............  Repair of perineum......  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
56820............  Exam of vulva w/scope...  Y................  .................  P3...............  ...........       1.0287       $42.59       $42.59
56821............  Exam/biopsy of vulva w/   Y................  .................  P2...............  ...........        1.352       $55.97       $55.97
                    scope.
57000............  Exploration of vagina...  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
57010............  Drainage of pelvic        Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
                    abscess.
57020............  Drainage of pelvic fluid  Y................  .................  A2...............      $409.33       6.0783      $251.65      $369.91
57022............  I & d vaginal hematoma,   Y................  .................  G2...............  ...........      11.5594      $478.57      $478.57
                    pp.
57023............  I & d vag hematoma, non-  Y................  .................  A2...............      $333.00      18.3197      $758.45      $439.36
                    ob.
57061............  Destroy vag lesions,      Y................  .................  P3...............  ...........       1.3084       $54.17       $54.17
                    simple.
57065............  Destroy vag lesions,      Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
                    complex.
57100............  Biopsy of vagina........  Y................  .................  P3...............  ...........       0.8394       $34.75       $34.75
57105............  Biopsy of vagina........  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57130............  Remove vagina lesion....  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57135............  Remove vagina lesion....  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57150............  Treat vagina infection..  Y................  CH...............  P3...............  ...........       0.6913       $28.62       $28.62
57155............  Insert uteri tandems/     Y................  .................  A2...............      $409.33       6.0783      $251.65      $369.91
                    ovoids.
57160............  Insert pessary/other      Y................  .................  P3...............  ...........       0.8476       $35.09       $35.09
                    device.
57170............  Fitting of diaphragm/cap  Y................  .................  P2...............  ...........       0.1309        $5.42        $5.42
57180............  Treat vaginal bleeding..  Y................  .................  A2...............      $178.05        1.352       $55.97      $147.53
57200............  Repair of vagina........  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
57210............  Repair vagina/perineum..  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57220............  Revision of urethra.....  Y................  .................  A2...............      $510.00      42.7099    $1,768.23      $824.56
57230............  Repair of urethral        Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
                    lesion.
57240............  Repair bladder & vagina.  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
57250............  Repair rectum & vagina..  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
57260............  Repair of vagina........  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
57265............  Extensive repair of       Y................  .................  A2...............      $995.00      42.7099    $1,768.23    $1,188.31
                    vagina.
57267............  Insert mesh/pelvic flr    Y................  .................  A2...............      $995.00      32.4237    $1,342.37    $1,081.84
                    addon.
57268............  Repair of bowel bulge...  Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
57287............  Revise/remove sling       Y................  .................  G2...............  ...........      32.4237    $1,342.37    $1,342.37
                    repair.
57288............  Repair bladder defect...  Y................  .................  A2...............      $717.00      42.7099    $1,768.23      $979.81
57289............  Repair bladder & vagina.  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
57291............  Construction of vagina..  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
57300............  Repair rectum-vagina      Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
                    fistula.
57320............  Repair bladder-vagina     Y................  .................  G2...............  ...........      32.4237    $1,342.37    $1,342.37
                    lesion.
57400............  Dilation of vagina......  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57410............  Pelvic examination......  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57415............  Remove vaginal foreign    Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
                    body.
57420............  Exam of vagina w/scope..  Y................  .................  P3...............  ...........       1.0616       $43.95       $43.95
57421............  Exam/biopsy of vag w/     Y................  .................  P3...............  ...........       1.4154       $58.60       $58.60
                    scope.
57452............  Exam of cervix w/scope..  Y................  .................  P3...............  ...........       1.0121       $41.90       $41.90
57454............  Bx/curett of cervix w/    Y................  .................  P3...............  ...........       1.2507       $51.78       $51.78
                    scope.
57455............  Biopsy of cervix w/scope  Y................  .................  P3...............  ...........       1.3248       $54.85       $54.85
57456............  Endocerv curettage w/     Y................  .................  P3...............  ...........       1.2756       $52.81       $52.81
                    scope.
57460............  Bx of cervix w/scope,     Y................  .................  P3...............  ...........       4.1639      $172.39      $172.39
                    leep.
57461............  Conz of cervix w/scope,   Y................  .................  P3...............  ...........       4.3941      $181.92      $181.92
                    leep.
57500............  Biopsy of cervix........  Y................  .................  P3...............  ...........       1.8763       $77.68       $77.68
57505............  Endocervical curettage..  Y................  .................  P3...............  ...........       1.1437       $47.35       $47.35
57510............  Cauterization of cervix.  Y................  .................  P3...............  ...........       1.1768       $48.72       $48.72
57511............  Cryocautery of cervix...  Y................  .................  P2...............  ...........        1.352       $55.97       $55.97
57513............  Laser surgery of cervix.  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57520............  Conization of cervix....  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
57522............  Conization of cervix....  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37

[[Page 9902]]

 
57530............  Removal of cervix.......  Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
57550............  Removal of residual       Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
                    cervix.
57556............  Remove cervix, repair     Y................  .................  A2...............      $717.00      42.7099    $1,768.23      $979.81
                    bowel.
57558............  D&c of cervical stump...  Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
57700............  Revision of cervix......  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
57720............  Revision of cervix......  Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
57800............  Dilation of cervical      Y................  .................  P3...............  ...........       0.6089       $25.21       $25.21
                    canal.
58100............  Biopsy of uterus lining.  Y................  .................  P3...............  ...........       1.0121       $41.90       $41.90
58110............  Bx done w/colposcopy add- N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    on.
58120............  Dilation and curettage..  Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
58145............  Myomectomy vag method...  Y................  .................  A2...............      $717.00      32.4237    $1,342.37      $873.34
58301............  Remove intrauterine       Y................  .................  P3...............  ...........        0.971       $40.20       $40.20
                    device.
58321............  Artificial insemination.  Y................  .................  P3...............  ...........       0.8558       $35.43       $35.43
58322............  Artificial insemination.  Y................  .................  P3...............  ...........       0.9217       $38.16       $38.16
58323............  Sperm washing...........  Y................  .................  P3...............  ...........       0.2797       $11.58       $11.58
58340............  Catheter for              N................  .................  N1...............  ...........  ...........  ...........  ...........
                    hysterography.
58345............  Reopen fallopian tube...  Y................  .................  R2...............  ...........      19.0203      $787.46      $787.46
58346............  Insert heyman uteri       Y................  .................  A2...............      $446.00      19.0203      $787.46      $531.37
                    capsule.
58350............  Reopen fallopian tube...  Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
58353............  Endometr ablate, thermal  Y................  .................  A2...............      $995.00      32.4237    $1,342.37    $1,081.84
58356............  Endometrial cryoablation  Y................  .................  P2...............  ...........      42.7099    $1,768.23    $1,768.23
58545............  Laparoscopic myomectomy.  Y................  .................  A2...............    $1,339.00      34.3958    $1,424.02    $1,360.26
58546............  Laparo-myomectomy,        Y................  .................  A2...............    $1,339.00      45.5317    $1,885.06    $1,475.52
                    complex.
58550............  Laparo-asst vag           Y................  .................  A2...............    $1,339.00      69.6652    $2,884.21    $1,725.30
                    hysterectomy.
58552............  Laparo-vag hyst incl t/o  Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
58555............  Hysteroscopy, dx, sep     Y................  .................  A2...............      $333.00      21.6576      $896.65      $473.91
                    proc.
58558............  Hysteroscopy, biopsy....  Y................  .................  A2...............      $510.00      21.6576      $896.65      $606.66
58559............  Hysteroscopy, lysis.....  Y................  .................  A2...............      $446.00      21.6576      $896.65      $558.66
58560............  Hysteroscopy, resect      Y................  .................  A2...............      $510.00      34.2048    $1,416.11      $736.53
                    septum.
58561............  Hysteroscopy, remove      Y................  .................  A2...............      $510.00      34.2048    $1,416.11      $736.53
                    myoma.
58562............  Hysteroscopy, remove fb.  Y................  .................  A2...............      $510.00      21.6576      $896.65      $606.66
58563............  Hysteroscopy, ablation..  Y................  .................  A2...............    $1,339.00      34.2048    $1,416.11    $1,358.28
58565............  Hysteroscopy,             Y................  .................  A2...............    $1,339.00      42.7099    $1,768.23    $1,446.31
                    sterilization.
58600............  Division of fallopian     Y................  .................  G2...............  ...........      32.4237    $1,342.37    $1,342.37
                    tube.
58615............  Occlude fallopian         Y................  .................  G2...............  ...........      19.0203      $787.46      $787.46
                    tube(s).
58660............  Laparoscopy, lysis......  Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
58661............  Laparoscopy, remove       Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
                    adnexa.
58662............  Laparoscopy, excise       Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
                    lesions.
58670............  Laparoscopy, tubal        Y................  .................  A2...............      $510.00      45.5317    $1,885.06      $853.77
                    cautery.
58671............  Laparoscopy, tubal block  Y................  .................  A2...............      $510.00      45.5317    $1,885.06      $853.77
58672............  Laparoscopy,              Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
                    fimbrioplasty.
58673............  Laparoscopy,              Y................  .................  A2...............      $717.00      45.5317    $1,885.06    $1,009.02
                    salpingostomy.
58800............  Drainage of ovarian       Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
                    cyst(s).
58805............  Drainage of ovarian       Y................  CH...............  G2...............  ...........      32.4237    $1,342.37    $1,342.37
                    cyst(s).
58820............  Drain ovary abscess,      Y................  .................  A2...............      $510.00      32.4237    $1,342.37      $718.09
                    open.
58900............  Biopsy of ovary(s)......  Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
58970............  Retrieval of oocyte.....  Y................  .................  A2...............      $245.92       2.7584      $114.20      $212.99
58974............  Transfer of embryo......  Y................  .................  A2...............      $245.92       2.7584      $114.20      $212.99
58976............  Transfer of embryo......  Y................  .................  A2...............      $245.92       2.7584      $114.20      $212.99
59000............  Amniocentesis,            Y................  CH...............  P3...............  ...........       1.5717       $65.07       $65.07
                    diagnostic.
59001............  Amniocentesis,            Y................  .................  R2...............  ...........       6.0783      $251.65      $251.65
                    therapeutic.
59012............  Fetal cord puncture,      Y................  .................  G2...............  ...........       2.7584      $114.20      $114.20
                    prenatal.
59015............  Chorion biopsy..........  Y................  .................  P3...............  ...........       1.2178       $50.42       $50.42
59020............  Fetal contract stress     Y................  .................  P3...............  ...........       0.5761       $23.85       $23.85
                    test.
59025............  Fetal non-stress test...  Y................  .................  P3...............  ...........       0.2961       $12.26       $12.26
59070............  Transabdom amnioinfus w/  Y................  .................  G2...............  ...........       2.7584      $114.20      $114.20
                    us.
59072............  Umbilical cord occlud w/  Y................  .................  G2...............  ...........       2.7584      $114.20      $114.20
                    us.
59076............  Fetal shunt placement, w/ Y................  .................  G2...............  ...........       2.7584      $114.20      $114.20
                    us.
59100............  Remove uterus lesion....  Y................  .................  R2...............  ...........      32.4237    $1,342.37    $1,342.37
59150............  Treat ectopic pregnancy.  Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
59151............  Treat ectopic pregnancy.  Y................  .................  G2...............  ...........      45.5317    $1,885.06    $1,885.06
59160............  D & c after delivery....  Y................  .................  A2...............      $510.00      19.0203      $787.46      $579.37
59200............  Insert cervical dilator.  Y................  .................  P3...............  ...........       0.8722       $36.11       $36.11
59300............  Episiotomy or vaginal     Y................  .................  P3...............  ...........       1.7939       $74.27       $74.27
                    repair.
59320............  Revision of cervix......  Y................  .................  A2...............      $333.00      19.0203      $787.46      $446.62
59412............  Antepartum manipulation.  Y................  .................  G2...............  ...........      19.0203      $787.46      $787.46
59414............  Deliver placenta........  Y................  .................  G2...............  ...........      19.0203      $787.46      $787.46
59812............  Treatment of miscarriage  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59820............  Care of miscarriage.....  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59821............  Treatment of miscarriage  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59840............  Abortion................  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59841............  Abortion................  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59866............  Abortion (mpr)..........  Y................  .................  G2...............  ...........       2.7584      $114.20      $114.20
59870............  Evacuate mole of uterus.  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
59871............  Remove cerclage suture..  Y................  .................  A2...............      $717.00      19.0203      $787.46      $734.62
60000............  Drain thyroid/tongue      Y................  .................  A2...............      $333.00       7.4474      $308.33      $326.83
                    cyst.
60001............  Aspirate/inject thyriod   N................  CH...............  D5...............  ...........  ...........  ...........  ...........
                    cyst.

[[Page 9903]]

 
60100............  Biopsy of thyroid.......  Y................  .................  P3...............  ...........       1.1191       $46.33       $46.33
60200............  Remove thyroid lesion...  Y................  .................  A2...............      $446.00       44.324    $1,835.06      $793.27
60280............  Remove thyroid duct       Y................  .................  A2...............      $630.00       44.324    $1,835.06      $931.27
                    lesion.
60281............  Remove thyroid duct       Y................  .................  A2...............      $630.00       44.324    $1,835.06      $931.27
                    lesion.
60300............  Aspir/inj thyroid cyst..  Y................  NI...............  P3...............  ...........       1.3741       $56.89       $56.89
61000............  Remove cranial cavity     Y................  .................  R2...............  ...........       8.5263      $353.00      $353.00
                    fluid.
61001............  Remove cranial cavity     Y................  .................  R2...............  ...........       8.5263      $353.00      $353.00
                    fluid.
61020............  Remove brain cavity       Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
                    fluid.
61026............  Injection into brain      Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
                    canal.
61050............  Remove brain canal fluid  Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
61055............  Injection into brain      Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
                    canal.
61070............  Brain canal shunt         Y................  .................  A2...............      $183.83       3.2383      $134.07      $171.39
                    procedure.
61215............  Insert brain-fluid        Y................  .................  A2...............      $510.00      36.2768    $1,501.90      $757.98
                    device.
61330............  Decompress eye socket...  Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
61334............  Explore orbit/remove      Y................  .................  G2...............  ...........      39.8776    $1,650.97    $1,650.97
                    object.
61790............  Treat trigeminal nerve..  Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
61791............  Treat trigeminal tract..  Y................  .................  A2...............      $351.92      14.4879      $599.81      $413.89
61795............  Brain surgery using       N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    computer.
61880............  Revise/remove             Y................  .................  G2...............  ...........      22.4734      $930.42      $930.42
                    neuroelectrode.
61885............  Insrt/redo neurostim 1    N................  .................  H8...............      $446.00      269.543   $11,159.35   $10,493.89
                    array.
61886............  Implant neurostim arrays  N................  .................  H8...............      $510.00     395.2777   $16,364.89   $15,586.16
61888............  Revise/remove             Y................  .................  A2...............      $333.00      34.4166    $1,424.88      $605.97
                    neuroreceiver.
62194............  Replace/irrigate          Y................  .................  A2...............      $333.00       8.5263      $353.00      $338.00
                    catheter.
62225............  Replace/irrigate          Y................  .................  A2...............      $333.00      15.3545      $635.69      $408.67
                    catheter.
62230............  Replace/revise brain      Y................  .................  A2...............      $446.00      36.2768    $1,501.90      $709.98
                    shunt.
62252............  Csf shunt reprogram.....  N................  .................  P3...............  ...........       1.0698       $44.29       $44.29
62263............  Epidural lysis mult       Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    sessions.
62264............  Epidural lysis on single  Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    day.
62268............  Drain spinal cord cyst..  Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
62269............  Needle biopsy, spinal     Y................  .................  A2...............      $333.00       9.3354      $386.49      $346.37
                    cord.
62270............  Spinal fluid tap,         Y................  .................  A2...............      $139.00       4.0964      $169.60      $146.65
                    diagnostic.
62272............  Drain cerebro spinal      Y................  .................  A2...............      $139.00       4.0964      $169.60      $146.65
                    fluid.
62273............  Inject epidural patch...  Y................  .................  A2...............      $333.00       4.0964      $169.60      $292.15
62280............  Treat spinal cord lesion  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
62281............  Treat spinal cord lesion  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
62282............  Treat spinal canal        Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    lesion.
62284............  Injection for myelogram.  N................  .................  N1...............  ...........  ...........  ...........  ...........
62287............  Percutaneous diskectomy.  Y................  .................  A2...............    $1,339.00      33.2707    $1,377.44    $1,348.61
62290............  Inject for spine disk x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
62291............  Inject for spine disk x-  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
62292............  Injection into disk       Y................  CH...............  R2...............  ...........       8.5263      $353.00      $353.00
                    lesion.
62294............  Injection into spinal     Y................  .................  A2...............      $183.83       8.5263      $353.00      $226.12
                    artery.
62310............  Inject spine c/t........  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
62311............  Inject spine l/s (cd)...  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
62318............  Inject spine w/cath, c/t  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
62319............  Inject spine w/cath l/s   Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    (cd).
62350............  Implant spinal canal      Y................  .................  A2...............      $446.00      36.2768    $1,501.90      $709.98
                    cath.
62355............  Remove spinal canal       Y................  .................  A2...............      $446.00      14.4879      $599.81      $484.45
                    catheter.
62360............  Insert spine infusion     Y................  .................  A2...............      $446.00      36.2768    $1,501.90      $709.98
                    device.
62361............  Implant spine infusion    Y................  .................  H8...............      $446.00     263.8315   $10,922.89   $10,157.07
                    pump.
62362............  Implant spine infusion    Y................  .................  H8...............      $446.00     263.8315   $10,922.89   $10,157.07
                    pump.
62365............  Remove spine infusion     Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    device.
62367............  Analyze spine infusion    N................  .................  P3...............  ...........        0.428       $17.72       $17.72
                    pump.
62368............  Analyze spine infusion    N................  .................  P3...............  ...........       0.5183       $21.46       $21.46
                    pump.
63600............  Remove spinal cord        Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    lesion.
63610............  Stimulation of spinal     Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
                    cord.
63615............  Remove lesion of spinal   Y................  .................  R2...............  ...........      18.0518      $747.36      $747.36
                    cord.
63650............  Implant neuroelectrodes.  N................  .................  H8...............      $446.00      83.1135    $3,440.98    $2,909.36
63655............  Implant neuroelectrodes.  N................  .................  J8...............  ...........     109.8976    $4,549.87    $4,549.87
63660............  Revise/remove             Y................  .................  A2...............      $333.00      22.4734      $930.42      $482.36
                    neuroelectrode.
63685............  Insrt/redo spine n        N................  .................  H8...............      $446.00     350.8302   $14,524.72   $13,727.20
                    generator.
63688............  Revise/remove             Y................  .................  A2...............      $333.00      34.4166    $1,424.88      $605.97
                    neuroreceiver.
63744............  Revision of spinal shunt  Y................  .................  A2...............      $510.00      36.2768    $1,501.90      $757.98
63746............  Removal of spinal shunt.  Y................  .................  A2...............      $446.00       5.6614      $234.39      $393.10
64400............  N block inj, trigeminal.  Y................  .................  P3...............  ...........       1.3659       $56.55       $56.55
64402............  N block inj, facial.....  Y................  .................  P3...............  ...........       1.2425       $51.44       $51.44
64405............  N block inj, occipital..  Y................  .................  P3...............  ...........        1.078       $44.63       $44.63
64408............  N block inj, vagus......  Y................  .................  P3...............  ...........       1.2425       $51.44       $51.44
64410............  N block inj, phrenic....  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64412............  N block inj, spinal       Y................  .................  P3...............  ...........       1.9666       $81.42       $81.42
                    accessor.
64413............  N block inj, cervical     Y................  .................  P3...............  ...........       1.3002       $53.83       $53.83
                    plexus.
64415............  N block inj, brachial     Y................  .................  A2...............      $139.00       4.0964      $169.60      $146.65
                    plexus.
64416............  N block cont infuse, b    Y................  .................  G2...............  ...........       7.0546      $292.07      $292.07
                    plex.
64417............  N block inj, axillary...  Y................  .................  A2...............      $139.00       4.0964      $169.60      $146.65
64418............  N block inj,              Y................  .................  P3...............  ...........       1.8596       $76.99       $76.99
                    suprascapular.
64420............  N block inj, intercost,   Y................  .................  A2...............      $139.00       4.0964      $169.60      $146.65
                    sng.
64421............  N block inj, intercost,   Y................  .................  A2...............      $333.00       4.0964      $169.60      $292.15
                    mlt.

[[Page 9904]]

 
64425............  N block inj, ilio-ing/    Y................  .................  P3...............  ...........       1.2096       $50.08       $50.08
                    hypogi.
64430............  N block inj, pudendal...  Y................  .................  A2...............      $139.00       7.0546      $292.07      $177.27
64435............  N block inj,              Y................  .................  P3...............  ...........       1.8596       $76.99       $76.99
                    paracervical.
64445............  N block inj, sciatic,     Y................  .................  P3...............  ...........       1.7693       $73.25       $73.25
                    sng.
64446............  N blk inj, sciatic, cont  Y................  .................  G2...............  ...........      14.4879      $599.81      $599.81
                    inf.
64447............  N block inj fem, single.  Y................  CH...............  R2...............  ...........       4.0964      $169.60      $169.60
64450............  N block, other            Y................  .................  P3...............  ...........       1.0369       $42.93       $42.93
                    peripheral.
64470............  Inj paravertebral c/t...  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64472............  Inj paravertebral c/t     Y................  .................  A2...............      $333.00       4.0964      $169.60      $292.15
                    add-on.
64475............  Inj paravertebral l/s...  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64476............  Inj paravertebral l/s     Y................  .................  A2...............      $333.00       2.3213       $96.10      $273.78
                    add-on.
64479............  Inj foramen epidural c/t  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64480............  Inj foramen epidural add- Y................  .................  A2...............      $333.00       4.0964      $169.60      $292.15
                    on.
64483............  Inj foramen epidural l/s  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64484............  Inj foramen epidural add- Y................  .................  A2...............      $333.00       4.0964      $169.60      $292.15
                    on.
64505............  N block, spenopalatine    Y................  .................  P3...............  ...........        0.971       $40.20       $40.20
                    gangl.
64508............  N block, carotid sinus s/ Y................  .................  P3...............  ...........       2.2053       $91.30       $91.30
                    p.
64510............  N block, stellate         Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    ganglion.
64517............  N block inj, hypogas      Y................  .................  A2...............      $139.00       7.0546      $292.07      $177.27
                    plxs.
64520............  N block, lumbar/thoracic  Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
64530............  N block inj, celiac       Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    pelus.
64553............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     316.5407   $13,105.10   $12,022.95
64555............  Implant neuroelectrodes.  N................  .................  J8...............  ...........      83.1135    $3,440.98    $3,440.98
64560............  Implant neuroelectrodes.  N................  .................  J8...............  ...........      83.1135    $3,440.98    $3,440.98
64561............  Implant neuroelectrodes.  N................  .................  H8...............      $510.00      83.1135    $3,440.98    $2,957.36
64565............  Implant neuroelectrodes.  N................  .................  J8...............  ...........      83.1135    $3,440.98    $3,440.98
64573............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     316.5407   $13,105.10   $12,022.95
64575............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     109.8976    $4,549.87    $3,785.92
64577............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     109.8976    $4,549.87    $3,785.92
64580............  Implant neuroelectrodes.  N................  .................  H8...............      $333.00     109.8976    $4,549.87    $3,785.92
64581............  Implant neuroelectrodes.  N................  .................  H8...............      $510.00     109.8976    $4,549.87    $3,918.67
64585............  Revise/remove             Y................  .................  A2...............      $333.00      22.4734      $930.42      $482.36
                    neuroelectrode.
64590............  Insrt/redo pn/gastr       N................  .................  H8...............      $446.00      269.543   $11,159.35   $10,493.89
                    stimul.
64595............  Revise/rmv pn/gastr       Y................  .................  A2...............      $333.00      34.4166    $1,424.88      $605.97
                    stimul.
64600............  Injection treatment of    Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    nerve.
64605............  Injection treatment of    Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    nerve.
64610............  Injection treatment of    Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    nerve.
64612............  Destroy nerve, face       Y................  .................  P3...............  ...........       1.6705       $69.16       $69.16
                    muscle.
64613............  Destroy nerve, neck       Y................  .................  P3...............  ...........       1.7693       $73.25       $73.25
                    muscle.
64614............  Destroy nerve, extrem     Y................  .................  P3...............  ...........       1.9915       $82.45       $82.45
                    musc.
64620............  Injection treatment of    Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    nerve.
64622............  Destr paravertebrl nerve  Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    l/s.
64623............  Destr paravertebral n     Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    add-on.
64626............  Destr paravertebrl nerve  Y................  .................  A2...............      $333.00      14.4879      $599.81      $399.70
                    c/t.
64627............  Destr paravertebral n     Y................  .................  A2...............      $333.00       2.3213       $96.10      $273.78
                    add-on.
64630............  Injection treatment of    Y................  .................  A2...............      $351.92       7.0546      $292.07      $336.96
                    nerve.
64640............  Injection treatment of    Y................  .................  P3...............  ...........       2.7156      $112.43      $112.43
                    nerve.
64650............  Chemodenerv eccrine       Y................  CH...............  P3...............  ...........         0.65       $26.91       $26.91
                    glands.
64653............  Chemodenerv eccrine       Y................  CH...............  P3...............  ...........       0.6831       $28.28       $28.28
                    glands.
64680............  Injection treatment of    Y................  .................  A2...............      $390.95      14.4879      $599.81      $443.17
                    nerve.
64681............  Injection treatment of    Y................  .................  A2...............      $446.00      14.4879      $599.81      $484.45
                    nerve.
64702............  Revise finger/toe nerve.  Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
64704............  Revise hand/foot nerve..  Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
64708............  Revise arm/leg nerve....  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64712............  Revision of sciatic       Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    nerve.
64713............  Revision of arm nerve(s)  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64714............  Revise low back nerve(s)  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64716............  Revision of cranial       Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
                    nerve.
64718............  Revise ulnar nerve at     Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    elbow.
64719............  Revise ulnar nerve at     Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    wrist.
64721............  Carpal tunnel surgery...  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64722............  Relieve pressure on       Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
                    nerve(s).
64726............  Release foot/toe nerve..  Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
64727............  Internal nerve revision.  Y................  .................  A2...............      $333.00      18.0518      $747.36      $436.59
64732............  Incision of brow nerve..  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64734............  Incision of cheek nerve.  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64736............  Incision of chin nerve..  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64738............  Incision of jaw nerve...  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64740............  Incision of tongue nerve  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64742............  Incision of facial nerve  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64744............  Incise nerve, back of     Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    head.
64746............  Incise diaphragm nerve..  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64761............  Incision of pelvis nerve  Y................  .................  G2...............  ...........      18.0518      $747.36      $747.36
64763............  Incise hip/thigh nerve..  Y................  .................  G2...............  ...........      18.0518      $747.36      $747.36
64766............  Incise hip/thigh nerve..  Y................  .................  G2...............  ...........      33.2707    $1,377.44    $1,377.44
64771............  Sever cranial nerve.....  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64772............  Incision of spinal nerve  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34

[[Page 9905]]

 
64774............  Remove skin nerve lesion  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64776............  Remove digit nerve        Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
                    lesion.
64778............  Digit nerve surgery add-  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    on.
64782............  Remove limb nerve lesion  Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
64783............  Limb nerve surgery add-   Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    on.
64784............  Remove nerve lesion.....  Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
64786............  Remove sciatic nerve      Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    lesion.
64787............  Implant nerve end.......  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64788............  Remove skin nerve lesion  Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
64790............  Removal of nerve lesion.  Y................  .................  A2...............      $510.00      18.0518      $747.36      $569.34
64792............  Removal of nerve lesion.  Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
64795............  Biopsy of nerve.........  Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
64802............  Remove sympathetic        Y................  .................  A2...............      $446.00      18.0518      $747.36      $521.34
                    nerves.
64820............  Remove sympathetic        Y................  .................  G2...............  ...........      18.0518      $747.36      $747.36
                    nerves.
64821............  Remove sympathetic        Y................  .................  A2...............      $630.00      26.3105    $1,089.28      $744.82
                    nerves.
64822............  Remove sympathetic        Y................  .................  G2...............  ...........      26.3105    $1,089.28    $1,089.28
                    nerves.
64823............  Remove sympathetic        Y................  .................  G2...............  ...........      26.3105    $1,089.28    $1,089.28
                    nerves.
64831............  Repair of digit nerve...  Y................  .................  A2...............      $630.00      33.2707    $1,377.44      $816.86
64832............  Repair nerve add-on.....  Y................  .................  A2...............      $333.00      33.2707    $1,377.44      $594.11
64834............  Repair of hand or foot    Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    nerve.
64835............  Repair of hand or foot    Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    nerve.
64836............  Repair of hand or foot    Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    nerve.
64837............  Repair nerve add-on.....  Y................  .................  A2...............      $333.00      33.2707    $1,377.44      $594.11
64840............  Repair of leg nerve.....  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64856............  Repair/transpose nerve..  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64857............  Repair arm/leg nerve....  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64858............  Repair sciatic nerve....  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64859............  Nerve surgery...........  Y................  .................  A2...............      $333.00      33.2707    $1,377.44      $594.11
64861............  Repair of arm nerves....  Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
64862............  Repair of low back        Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    nerves.
64864............  Repair of facial nerve..  Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
64865............  Repair of facial nerve..  Y................  .................  A2...............      $630.00      33.2707    $1,377.44      $816.86
64870............  Fusion of facial/other    Y................  .................  A2...............      $630.00      33.2707    $1,377.44      $816.86
                    nerve.
64872............  Subsequent repair of      Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    nerve.
64874............  Repair & revise nerve     Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    add-on.
64876............  Repair nerve/shorten      Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    bone.
64885............  Nerve graft, head or      Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    neck.
64886............  Nerve graft, head or      Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    neck.
64890............  Nerve graft, hand or      Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    foot.
64891............  Nerve graft, hand or      Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
                    foot.
64892............  Nerve graft, arm or leg.  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64893............  Nerve graft, arm or leg.  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64895............  Nerve graft, hand or      Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    foot.
64896............  Nerve graft, hand or      Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
                    foot.
64897............  Nerve graft, arm or leg.  Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
64898............  Nerve graft, arm or leg.  Y................  .................  A2...............      $510.00      33.2707    $1,377.44      $726.86
64901............  Nerve graft add-on......  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64902............  Nerve graft add-on......  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64905............  Nerve pedicle transfer..  Y................  .................  A2...............      $446.00      33.2707    $1,377.44      $678.86
64907............  Nerve pedicle transfer..  Y................  .................  A2...............      $333.00      33.2707    $1,377.44      $594.11
64910............  Nerve repair w/allograft  Y................  CH...............  G2...............  ...........      18.0518      $747.36      $747.36
65091............  Revise eye..............  Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
65093............  Revise eye with implant.  Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
65101............  Removal of eye..........  Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
65103............  Remove eye/insert         Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
                    implant.
65105............  Remove eye/attach         Y................  .................  A2...............      $630.00      37.7243    $1,561.82      $862.96
                    implant.
65110............  Removal of eye..........  Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
65112............  Remove eye/revise socket  Y................  .................  A2...............      $995.00      37.7243    $1,561.82    $1,136.71
65114............  Remove eye/revise socket  Y................  .................  A2...............      $995.00      37.7243    $1,561.82    $1,136.71
65125............  Revise ocular implant...  Y................  .................  G2...............  ...........      18.7307      $775.47      $775.47
65130............  Insert ocular implant...  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
65135............  Insert ocular implant...  Y................  .................  A2...............      $446.00      24.3077    $1,006.36      $586.09
65140............  Attach ocular implant...  Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
65150............  Revise ocular implant...  Y................  .................  A2...............      $446.00      24.3077    $1,006.36      $586.09
65155............  Reinsert ocular implant.  Y................  .................  A2...............      $510.00      37.7243    $1,561.82      $772.96
65175............  Removal of ocular         Y................  .................  A2...............      $333.00      18.7307      $775.47      $443.62
                    implant.
65205............  Remove foreign body from  N................  .................  P3...............  ...........       0.4937       $20.44       $20.44
                    eye.
65210............  Remove foreign body from  N................  .................  P3...............  ...........       0.6253       $25.89       $25.89
                    eye.
65220............  Remove foreign body from  N................  .................  G2...............  ...........       0.8696       $36.00       $36.00
                    eye.
65222............  Remove foreign body from  N................  .................  P3...............  ...........       0.6831       $28.28       $28.28
                    eye.
65235............  Remove foreign body from  Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    eye.
65260............  Remove foreign body from  Y................  .................  A2...............      $510.00       18.235      $754.95      $571.24
                    eye.
65265............  Remove foreign body from  Y................  .................  A2...............      $630.00       27.845    $1,152.81      $760.70
                    eye.
65270............  Repair of eye wound.....  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
65272............  Repair of eye wound.....  Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
65275............  Repair of eye wound.....  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
65280............  Repair of eye wound.....  Y................  .................  A2...............      $630.00       18.235      $754.95      $661.24

[[Page 9906]]

 
65285............  Repair of eye wound.....  Y................  .................  A2...............      $630.00      37.2078    $1,540.44      $857.61
65286............  Repair of eye wound.....  Y................  .................  P2...............  ...........       5.1169      $211.84      $211.84
65290............  Repair of eye socket      Y................  .................  A2...............      $510.00      24.1291      $998.97      $632.24
                    wound.
65400............  Removal of eye lesion...  Y................  .................  A2...............      $333.00       16.171      $669.50      $417.13
65410............  Biopsy of cornea........  Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
65420............  Removal of eye lesion...  Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
65426............  Removal of eye lesion...  Y................  .................  A2...............      $717.00      23.1758      $959.50      $777.63
65430............  Corneal smear...........  N................  CH...............  P2...............  ...........       0.8696       $36.00       $36.00
65435............  Curette/treat cornea....  Y................  .................  P3...............  ...........       0.7652       $31.68       $31.68
65436............  Curette/treat cornea....  Y................  .................  G2...............  ...........       16.171      $669.50      $669.50
65450............  Treatment of corneal      N................  .................  G2...............  ...........        2.179       $90.21       $90.21
                    lesion.
65600............  Revision of cornea......  Y................  .................  P3...............  ...........        3.884      $160.80      $160.80
65710............  Corneal transplant......  Y................  .................  A2...............      $995.00      37.4896    $1,552.11    $1,134.28
65730............  Corneal transplant......  Y................  .................  A2...............      $995.00      37.4896    $1,552.11    $1,134.28
65750............  Corneal transplant......  Y................  .................  A2...............      $995.00      37.4896    $1,552.11    $1,134.28
65755............  Corneal transplant......  Y................  .................  A2...............      $995.00      37.4896    $1,552.11    $1,134.28
65770............  Revise cornea with        Y................  .................  A2...............      $995.00      84.8039    $3,510.97    $1,623.99
                    implant.
65772............  Correction of             Y................  .................  A2...............      $630.00       16.171      $669.50      $639.88
                    astigmatism.
65775............  Correction of             Y................  .................  A2...............      $630.00       16.171      $669.50      $639.88
                    astigmatism.
65780............  Ocular reconst,           Y................  .................  A2...............      $717.00      37.4896    $1,552.11      $925.78
                    transplant.
65781............  Ocular reconst,           Y................  .................  A2...............      $717.00      37.4896    $1,552.11      $925.78
                    transplant.
65782............  Ocular reconst,           Y................  .................  A2...............      $717.00      37.4896    $1,552.11      $925.78
                    transplant.
65800............  Drainage of eye.........  Y................  .................  A2...............      $333.00       16.171      $669.50      $417.13
65805............  Drainage of eye.........  Y................  .................  A2...............      $333.00       16.171      $669.50      $417.13
65810............  Drainage of eye.........  Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
65815............  Drainage of eye.........  Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
65820............  Relieve inner eye         Y................  .................  A2...............      $333.00       5.1169      $211.84      $302.71
                    pressure.
65850............  Incision of eye.........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
65855............  Laser surgery of eye....  Y................  .................  P3...............  ...........       3.2093      $132.87      $132.87
65860............  Incise inner eye          Y................  .................  P3...............  ...........       3.0036      $124.35      $124.35
                    adhesions.
65865............  Incise inner eye          Y................  .................  A2...............      $333.00       16.171      $669.50      $417.13
                    adhesions.
65870............  Incise inner eye          Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
                    adhesions.
65875............  Incise inner eye          Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
                    adhesions.
65880............  Incise inner eye          Y................  .................  A2...............      $630.00       16.171      $669.50      $639.88
                    adhesions.
65900............  Remove eye lesion.......  Y................  .................  A2...............      $717.00       16.171      $669.50      $705.13
65920............  Remove implant of eye...  Y................  .................  A2...............      $995.00      23.1758      $959.50      $986.13
65930............  Remove blood clot from    Y................  .................  A2...............      $717.00      23.1758      $959.50      $777.63
                    eye.
66020............  Injection treatment of    Y................  .................  A2...............      $333.00       16.171      $669.50      $417.13
                    eye.
66030............  Injection treatment of    Y................  .................  A2...............      $333.00       5.1169      $211.84      $302.71
                    eye.
66130............  Remove eye lesion.......  Y................  .................  A2...............      $995.00      23.1758      $959.50      $986.13
66150............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
66155............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
66160............  Glaucoma surgery........  Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
66165............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
66170............  Glaucoma surgery........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
66172............  Incision of eye.........  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
66180............  Implant eye shunt.......  Y................  .................  A2...............      $717.00      39.7101    $1,644.04      $948.76
66185............  Revise eye shunt........  Y................  .................  A2...............      $446.00      39.7101    $1,644.04      $745.51
66220............  Repair eye lesion.......  Y................  .................  A2...............      $510.00      37.2078    $1,540.44      $767.61
66225............  Repair/graft eye lesion.  Y................  .................  A2...............      $630.00      39.7101    $1,644.04      $883.51
66250............  Follow-up surgery of eye  Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
66500............  Incision of iris........  Y................  .................  A2...............      $333.00       5.1169      $211.84      $302.71
66505............  Incision of iris........  Y................  .................  A2...............      $333.00       5.1169      $211.84      $302.71
66600............  Remove iris and lesion..  Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
66605............  Removal of iris.........  Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
66625............  Removal of iris.........  Y................  .................  A2...............      $372.94       5.1169      $211.84      $332.67
66630............  Removal of iris.........  Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
66635............  Removal of iris.........  Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
66680............  Repair iris & ciliary     Y................  .................  A2...............      $510.00      23.1758      $959.50      $622.38
                    body.
66682............  Repair iris & ciliary     Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
                    body.
66700............  Destruction, ciliary      Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    body.
66710............  Ciliary transsleral       Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    therapy.
66711............  Ciliary endoscopic        Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    ablation.
66720............  Destruction, ciliary      Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    body.
66740............  Destruction, ciliary      Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
                    body.
66761............  Revision of iris........  Y................  .................  P3...............  ...........       4.3695      $180.90      $180.90
66762............  Revision of iris........  Y................  .................  P3...............  ...........       4.4272      $183.29      $183.29
66770............  Removal of inner eye      Y................  .................  P3...............  ...........        4.781      $197.94      $197.94
                    lesion.
66820............  Incision, secondary       Y................  .................  G2...............  ...........       5.1169      $211.84      $211.84
                    cataract.
66821............  After cataract laser      Y................  .................  A2...............      $312.50       5.2001      $215.29      $288.20
                    surgery.
66825............  Reposition intraocular    Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
                    lens.
66830............  Removal of lens lesion..  Y................  .................  A2...............      $372.94       5.1169      $211.84      $332.67
66840............  Removal of lens material  Y................  .................  A2...............      $630.00      14.9171      $617.58      $626.90
66850............  Removal of lens material  Y................  .................  A2...............      $995.00      28.7035    $1,188.35    $1,043.34
66852............  Removal of lens material  Y................  .................  A2...............      $630.00      28.7035    $1,188.35      $769.59
66920............  Extraction of lens......  Y................  .................  A2...............      $630.00      28.7035    $1,188.35      $769.59
66930............  Extraction of lens......  Y................  .................  A2...............      $717.00      28.7035    $1,188.35      $834.84

[[Page 9907]]

 
66940............  Extraction of lens......  Y................  .................  A2...............      $717.00      14.9171      $617.58      $692.15
66982............  Cataract surgery,         Y................  .................  A2...............      $973.00      23.8649      $988.03      $976.76
                    complex.
66983............  Cataract surg w/iol, 1    Y................  .................  A2...............      $973.00      23.8649      $988.03      $976.76
                    stage.
66984............  Cataract surg w/iol, 1    Y................  .................  A2...............      $973.00      23.8649      $988.03      $976.76
                    stage.
66985............  Insert lens prosthesis..  Y................  .................  A2...............      $826.00      23.8649      $988.03      $866.51
66986............  Exchange lens prosthesis  Y................  .................  A2...............      $826.00      23.8649      $988.03      $866.51
66990............  Ophthalmic endoscope add- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    on.
67005............  Partial removal of eye    Y................  .................  A2...............      $630.00       27.845    $1,152.81      $760.70
                    fluid.
67010............  Partial removal of eye    Y................  .................  A2...............      $630.00       27.845    $1,152.81      $760.70
                    fluid.
67015............  Release of eye fluid....  Y................  .................  A2...............      $333.00       27.845    $1,152.81      $537.95
67025............  Replace eye fluid.......  Y................  .................  A2...............      $333.00       27.845    $1,152.81      $537.95
67027............  Implant eye drug system.  Y................  .................  A2...............      $630.00      37.2078    $1,540.44      $857.61
67028............  Injection eye drug......  N................  .................  P3...............  ...........       1.9997       $82.79       $82.79
67030............  Incise inner eye strands  Y................  .................  A2...............      $333.00       18.235      $754.95      $438.49
67031............  Laser surgery, eye        Y................  .................  A2...............      $312.50       5.2001      $215.29      $288.20
                    strands.
67036............  Removal of inner eye      Y................  .................  A2...............      $630.00      37.2078    $1,540.44      $857.61
                    fluid.
67038............  Strip retinal membrane..  N................  CH...............  D5...............  ...........  ...........  ...........  ...........
67039............  Laser treatment of        Y................  .................  A2...............      $995.00      37.2078    $1,540.44    $1,131.36
                    retina.
67040............  Laser treatment of        Y................  .................  A2...............      $995.00      37.2078    $1,540.44    $1,131.36
                    retina.
67041............  Vit for macular pucker..  Y................  NI...............  G2...............  ...........      37.2078    $1,540.44    $1,540.44
67042............  Vit for macular hole....  Y................  NI...............  G2...............  ...........      37.2078    $1,540.44    $1,540.44
67043............  Vit for membrane dissect  Y................  NI...............  G2...............  ...........      37.2078    $1,540.44    $1,540.44
67101............  Repair detached retina..  Y................  .................  P3...............  ...........       7.2496      $300.14      $300.14
67105............  Repair detached retina..  Y................  .................  P2...............  ...........       5.2001      $215.29      $215.29
67107............  Repair detached retina..  Y................  .................  A2...............      $717.00      37.2078    $1,540.44      $922.86
67108............  Repair detached retina..  Y................  .................  A2...............      $995.00      37.2078    $1,540.44    $1,131.36
67110............  Repair detached retina..  Y................  .................  P3...............  ...........       7.8831      $326.37      $326.37
67112............  Rerepair detached retina  Y................  .................  A2...............      $995.00      37.2078    $1,540.44    $1,131.36
67113............  Repair retinal detach,    Y................  NI...............  G2...............  ...........      37.2078    $1,540.44    $1,540.44
                    cplx.
67115............  Release encircling        Y................  .................  A2...............      $446.00       18.235      $754.95      $523.24
                    material.
67120............  Remove eye implant        Y................  .................  A2...............      $446.00       18.235      $754.95      $523.24
                    material.
67121............  Remove eye implant        Y................  .................  A2...............      $446.00       27.845    $1,152.81      $622.70
                    material.
67141............  Treatment of retina.....  Y................  .................  A2...............      $241.77       4.1331      $171.11      $224.11
67145............  Treatment of retina.....  Y................  .................  P3...............  ...........       4.5506      $188.40      $188.40
67208............  Treatment of retinal      Y................  .................  P3...............  ...........       4.8467      $200.66      $200.66
                    lesion.
67210............  Treatment of retinal      Y................  CH...............  P3...............  ...........       5.1349      $212.59      $212.59
                    lesion.
67218............  Treatment of retinal      Y................  .................  A2...............      $717.00       18.235      $754.95      $726.49
                    lesion.
67220............  Treatment of choroid      Y................  .................  P2...............  ...........       4.1331      $171.11      $171.11
                    lesion.
67221............  Ocular photodynamic ther  Y................  .................  P3...............  ...........       2.9789      $123.33      $123.33
67225............  Eye photodynamic ther     Y................  .................  P3...............  ...........       0.1976        $8.18        $8.18
                    add-on.
67227............  Treatment of retinal      Y................  .................  A2...............      $333.00       27.845    $1,152.81      $537.95
                    lesion.
67228............  Treatment of retinal      Y................  .................  P2...............  ...........       5.2001      $215.29      $215.29
                    lesion.
67229 *..........  Tr retinal les preterm    Y................  NI...............  R2...............  ...........       5.2001      $215.29      $215.29
                    inf.
67250............  Reinforce eye wall......  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67255............  Reinforce/graft eye wall  Y................  .................  A2...............      $510.00       27.845    $1,152.81      $670.70
67311............  Revise eye muscle.......  Y................  .................  A2...............      $510.00      24.1291      $998.97      $632.24
67312............  Revise two eye muscles..  Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
67314............  Revise eye muscle.......  Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
67316............  Revise two eye muscles..  Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
67318............  Revise eye muscle(s)....  Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
67320............  Revise eye muscle(s) add- Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
                    on.
67331............  Eye surgery follow-up     Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
                    add-on.
67332............  Rerevise eye muscles add- Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
                    on.
67334............  Revise eye muscle w/      Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
                    suture.
67335............  Eye suture during         Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
                    surgery.
67340............  Revise eye muscle add-on  Y................  .................  A2...............      $630.00      24.1291      $998.97      $722.24
67343............  Release eye tissue......  Y................  .................  A2...............      $995.00      24.1291      $998.97      $995.99
67345............  Destroy nerve of eye      Y................  .................  P3...............  ...........       1.9584       $81.08       $81.08
                    muscle.
67346............  Biopsy, eye muscle......  Y................  .................  A2...............      $333.00      13.7453      $569.07      $392.02
67400............  Explore/biopsy eye        Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
                    socket.
67405............  Explore/drain eye socket  Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
67412............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      24.3077    $1,006.36      $789.34
67413............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      24.3077    $1,006.36      $789.34
67414............  Explr/decompress eye      Y................  .................  G2...............  ...........      37.7243    $1,561.82    $1,561.82
                    socket.
67415............  Aspiration, orbital       Y................  .................  A2...............      $333.00      18.7307      $775.47      $443.62
                    contents.
67420............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
67430............  Explore/treat eye socket  Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
67440............  Explore/drain eye socket  Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
67445............  Explr/decompress eye      Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
                    socket.
67450............  Explore/biopsy eye        Y................  .................  A2...............      $717.00      37.7243    $1,561.82      $928.21
                    socket.
67500............  Inject/treat eye socket.  N................  .................  G2...............  ...........        2.179       $90.21       $90.21
67505............  Inject/treat eye socket.  Y................  .................  G2...............  ...........       2.9022      $120.15      $120.15
67515............  Inject/treat eye socket.  Y................  .................  P3...............  ...........       0.5596       $23.17       $23.17
67550............  Insert eye socket         Y................  .................  A2...............      $630.00      37.7243    $1,561.82      $862.96
                    implant.
67560............  Revise eye socket         Y................  .................  A2...............      $446.00      24.3077    $1,006.36      $586.09
                    implant.
67570............  Decompress optic nerve..  Y................  .................  A2...............      $630.00      37.7243    $1,561.82      $862.96
67700............  Drainage of eyelid        Y................  .................  P2...............  ...........       2.9022      $120.15      $120.15
                    abscess.

[[Page 9908]]

 
67710............  Incision of eyelid......  Y................  .................  P3...............  ...........       3.7359      $154.67      $154.67
67715............  Incision of eyelid fold.  Y................  .................  A2...............      $333.00      18.7307      $775.47      $443.62
67800............  Remove eyelid lesion....  Y................  .................  P3...............  ...........       1.2343       $51.10       $51.10
67801............  Remove eyelid lesions...  Y................  .................  P3...............  ...........       1.4975       $62.00       $62.00
67805............  Remove eyelid lesions...  Y................  .................  P3...............  ...........       1.9338       $80.06       $80.06
67808............  Remove eyelid lesion(s).  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
67810............  Biopsy of eyelid........  Y................  .................  P2...............  ...........       2.9022      $120.15      $120.15
67820............  Revise eyelashes........  N................  .................  P3...............  ...........        0.428       $17.72       $17.72
67825............  Revise eyelashes........  Y................  .................  P3...............  ...........        1.292       $53.49       $53.49
67830............  Revise eyelashes........  Y................  .................  A2...............      $446.00       7.2847      $301.59      $409.90
67835............  Revise eyelashes........  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
67840............  Remove eyelid lesion....  Y................  .................  P3...............  ...........       3.8593      $159.78      $159.78
67850............  Treat eyelid lesion.....  Y................  .................  P3...............  ...........       2.7403      $113.45      $113.45
67875............  Closure of eyelid by      Y................  .................  G2...............  ...........       7.2847      $301.59      $301.59
                    suture.
67880............  Revision of eyelid......  Y................  .................  A2...............      $510.00       16.171      $669.50      $549.88
67882............  Revision of eyelid......  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67900............  Repair brow defect......  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67901............  Repair eyelid defect....  Y................  .................  A2...............      $717.00      18.7307      $775.47      $731.62
67902............  Repair eyelid defect....  Y................  .................  A2...............      $717.00      18.7307      $775.47      $731.62
67903............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67904............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67906............  Repair eyelid defect....  Y................  .................  A2...............      $717.00      18.7307      $775.47      $731.62
67908............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67909............  Revise eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67911............  Revise eyelid defect....  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67912............  Correction eyelid w/      Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
                    implant.
67914............  Repair eyelid defect....  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67915............  Repair eyelid defect....  Y................  .................  P3...............  ...........       4.2378      $175.45      $175.45
67916............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67917............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67921............  Repair eyelid defect....  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67922............  Repair eyelid defect....  Y................  .................  P3...............  ...........       4.1472      $171.70      $171.70
67923............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67924............  Repair eyelid defect....  Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
67930............  Repair eyelid wound.....  Y................  .................  P3...............  ...........       4.1472      $171.70      $171.70
67935............  Repair eyelid wound.....  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
67938............  Remove eyelid foreign     N................  .................  P2...............  ...........        2.179       $90.21       $90.21
                    body.
67950............  Revision of eyelid......  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
67961............  Revision of eyelid......  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67966............  Revision of eyelid......  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
67971............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
67973............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
67974............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
67975............  Reconstruction of eyelid  Y................  .................  A2...............      $510.00      18.7307      $775.47      $576.37
68020............  Incise/drain eyelid       Y................  .................  P3...............  ...........       1.0862       $44.97       $44.97
                    lining.
68040............  Treatment of eyelid       N................  .................  P3...............  ...........       0.5432       $22.49       $22.49
                    lesions.
68100............  Biopsy of eyelid lining.  Y................  .................  P3...............  ...........       2.3123       $95.73       $95.73
68110............  Remove eyelid lining      Y................  .................  P3...............  ...........        2.954      $122.30      $122.30
                    lesion.
68115............  Remove eyelid lining      Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
                    lesion.
68130............  Remove eyelid lining      Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    lesion.
68135............  Remove eyelid lining      Y................  .................  P3...............  ...........        1.399       $57.92       $57.92
                    lesion.
68200............  Treat eyelid by           N................  .................  P3...............  ...........       0.4031       $16.69       $16.69
                    injection.
68320............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
                    lining.
68325............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
                    lining.
68326............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
                    lining.
68328............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
                    lining.
68330............  Revise eyelid lining....  Y................  .................  A2...............      $630.00      23.1758      $959.50      $712.38
68335............  Revise/graft eyelid       Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
                    lining.
68340............  Separate eyelid           Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
                    adhesions.
68360............  Revise eyelid lining....  Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
68362............  Revise eyelid lining....  Y................  .................  A2...............      $446.00      23.1758      $959.50      $574.38
68371............  Harvest eye tissue,       Y................  .................  A2...............      $446.00       16.171      $669.50      $501.88
                    alograft.
68400............  Incise/drain tear gland.  Y................  .................  P2...............  ...........       2.9022      $120.15      $120.15
68420............  Incise/drain tear sac...  Y................  .................  P3...............  ...........       4.4354      $183.63      $183.63
68440............  Incise tear duct opening  Y................  .................  P3...............  ...........       1.3741       $56.89       $56.89
68500............  Removal of tear gland...  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
68505............  Partial removal, tear     Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
                    gland.
68510............  Biopsy of tear gland....  Y................  .................  A2...............      $333.00      18.7307      $775.47      $443.62
68520............  Removal of tear sac.....  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
68525............  Biopsy of tear sac......  Y................  .................  A2...............      $333.00      18.7307      $775.47      $443.62
68530............  Clearance of tear duct..  Y................  .................  P3...............  ...........       5.6697      $234.73      $234.73
68540............  Remove tear gland lesion  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
68550............  Remove tear gland lesion  Y................  .................  A2...............      $510.00      24.3077    $1,006.36      $634.09
68700............  Repair tear ducts.......  Y................  .................  A2...............      $446.00      24.3077    $1,006.36      $586.09
68705............  Revise tear duct opening  Y................  .................  P2...............  ...........       2.9022      $120.15      $120.15
68720............  Create tear sac drain...  Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
68745............  Create tear duct drain..  Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09

[[Page 9909]]

 
68750............  Create tear duct drain..  Y................  .................  A2...............      $630.00      24.3077    $1,006.36      $724.09
68760............  Close tear duct opening.  N................  .................  P2...............  ...........        2.179       $90.21       $90.21
68761............  Close tear duct opening.  N................  .................  P3...............  ...........       1.6869       $69.84       $69.84
68770............  Close tear system         Y................  .................  A2...............      $630.00      18.7307      $775.47      $666.37
                    fistula.
68801............  Dilate tear duct opening  N................  .................  P2...............  ...........       0.8696       $36.00       $36.00
68810............  Probe nasolacrimal duct.  N................  .................  A2...............      $131.86        2.179       $90.21      $121.45
68811............  Probe nasolacrimal duct.  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
68815............  Probe nasolacrimal duct.  Y................  .................  A2...............      $446.00      18.7307      $775.47      $528.37
68816 *..........  Probe nl duct w/balloon.  Y................  NI...............  P3...............  ...........      10.4918      $434.37      $434.37
68840............  Explore/irrigate tear     N................  CH...............  P3...............  ...........       1.2756       $52.81       $52.81
                    ducts.
68850............  Injection for tear sac x- N................  .................  N1...............  ...........  ...........  ...........  ...........
                    ray.
69000............  Drain external ear        Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
                    lesion.
69005............  Drain external ear        Y................  .................  P3...............  ...........       2.4357      $100.84      $100.84
                    lesion.
69020............  Drain outer ear canal     Y................  .................  P2...............  ...........       1.4066       $58.23       $58.23
                    lesion.
69100............  Biopsy of external ear..  Y................  .................  P3...............  ...........       1.4647       $60.64       $60.64
69105............  Biopsy of external ear    Y................  .................  P3...............  ...........        2.049       $84.83       $84.83
                    canal.
69110............  Remove external ear,      Y................  .................  A2...............      $333.00      16.1001      $666.56      $416.39
                    partial.
69120............  Removal of external ear.  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
69140............  Remove ear canal          Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
                    lesion(s).
69145............  Remove ear canal          Y................  .................  A2...............      $446.00      16.1001      $666.56      $501.14
                    lesion(s).
69150............  Extensive ear canal       Y................  .................  A2...............      $464.15       7.4474      $308.33      $425.20
                    surgery.
69200............  Clear outer ear canal...  N................  .................  P2...............  ...........        0.631       $26.12       $26.12
69205............  Clear outer ear canal...  Y................  .................  A2...............      $333.00      21.1098      $873.97      $468.24
69210............  Remove impacted ear wax.  N................  .................  P3...............  ...........       0.4937       $20.44       $20.44
69220............  Clean out mastoid cavity  Y................  .................  P2...............  ...........        0.793       $32.83       $32.83
69222............  Clean out mastoid cavity  Y................  .................  P3...............  ...........       3.2176      $133.21      $133.21
69300............  Revise external ear.....  Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
69310............  Rebuild outer ear canal.  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
69320............  Rebuild outer ear canal.  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69400............  Inflate middle ear canal  Y................  .................  P3...............  ...........        2.049       $84.83       $84.83
69401............  Inflate middle ear canal  Y................  .................  P3...............  ...........       1.1355       $47.01       $47.01
69405............  Catheterize middle ear    Y................  .................  P3...............  ...........       2.9458      $121.96      $121.96
                    canal.
69420............  Incision of eardrum.....  Y................  .................  P2...............  ...........       2.5002      $103.51      $103.51
69421............  Incision of eardrum.....  Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
69424............  Remove ventilating tube.  Y................  .................  P3...............  ...........       1.8596       $76.99       $76.99
69433............  Create eardrum opening..  Y................  .................  P3...............  ...........       2.6415      $109.36      $109.36
69436............  Create eardrum opening..  Y................  .................  A2...............      $510.00      16.3288      $676.03      $551.51
69440............  Exploration of middle     Y................  .................  A2...............      $510.00      23.9765      $992.65      $630.66
                    ear.
69450............  Eardrum revision........  Y................  .................  A2...............      $333.00      39.8776    $1,650.97      $662.49
69501............  Mastoidectomy...........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69502............  Mastoidectomy...........  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
69505............  Remove mastoid            Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    structures.
69511............  Extensive mastoid         Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    surgery.
69530............  Extensive mastoid         Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    surgery.
69540............  Remove ear lesion.......  Y................  .................  P3...............  ...........       3.1434      $130.14      $130.14
69550............  Remove ear lesion.......  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69552............  Remove ear lesion.......  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69601............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69602............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69603............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69604............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69605............  Mastoid surgery revision  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69610............  Repair of eardrum.......  Y................  .................  P3...............  ...........        4.312      $178.52      $178.52
69620............  Repair of eardrum.......  Y................  .................  A2...............      $446.00      23.9765      $992.65      $582.66
69631............  Repair eardrum            Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    structures.
69632............  Rebuild eardrum           Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    structures.
69633............  Rebuild eardrum           Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    structures.
69635............  Repair eardrum            Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    structures.
69636............  Rebuild eardrum           Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    structures.
69637............  Rebuild eardrum           Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    structures.
69641............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69642............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69643............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69644............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69645............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69646............  Revise middle ear &       Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69650............  Release middle ear bone.  Y................  .................  A2...............      $995.00      23.9765      $992.65      $994.41
69660............  Revise middle ear bone..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69661............  Revise middle ear bone..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69662............  Revise middle ear bone..  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69666............  Repair middle ear         Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    structures.
69667............  Repair middle ear         Y................  .................  A2...............      $630.00      39.8776    $1,650.97      $885.24
                    structures.
69670............  Remove mastoid air cells  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
69676............  Remove middle ear nerve.  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
69700............  Close mastoid fistula...  Y................  .................  A2...............      $510.00      39.8776    $1,650.97      $795.24
69711............  Remove/repair hearing     Y................  .................  A2...............      $333.00      39.8776    $1,650.97      $662.49
                    aid.
69714............  Implant temple bone w/    Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
                    stimul.

[[Page 9910]]

 
69715............  Temple bne implnt w/      Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
                    stimulat.
69717............  Temple bone implant       Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
                    revision.
69718............  Revise temple bone        Y................  .................  A2...............    $1,339.00      39.8776    $1,650.97    $1,416.99
                    implant.
69720............  Release facial nerve....  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69740............  Repair facial nerve.....  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69745............  Repair facial nerve.....  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69801............  Incise inner ear........  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69802............  Incise inner ear........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69805............  Explore inner ear.......  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69806............  Explore inner ear.......  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69820............  Establish inner ear       Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
                    window.
69840............  Revise inner ear window.  Y................  .................  A2...............      $717.00      39.8776    $1,650.97      $950.49
69905............  Remove inner ear........  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69910............  Remove inner ear &        Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
                    mastoid.
69915............  Incise inner ear nerve..  Y................  .................  A2...............      $995.00      39.8776    $1,650.97    $1,158.99
69930............  Implant cochlear device.  Y................  .................  H8...............      $995.00     568.8394   $23,550.52   $22,213.76
69990............  Microsurgery add-on.....  N................  .................  N1...............  ...........  ...........  ...........  ...........
C9716............  Radiofrequency energy to  Y................  .................  G2...............  ...........      30.1606    $1,248.68    $1,248.68
                    anu.
C9724............  EPS gast cardia plic....  Y................  .................  G2...............  ...........      25.3233    $1,048.41    $1,048.41
C9725............  Place endorectal app....  N................  .................  G2...............  ...........       8.6351      $357.50      $357.50
C9726............  Rxt breast appl place/    N................  .................  G2...............  ...........      10.2051      $422.50      $422.50
                    remov.
C9727............  Insert palate implants..  N................  .................  G2...............  ...........      13.3451      $552.50      $552.50
C9728............  Place device/marker, non  Y................  CH...............  R2...............  ...........       3.0469      $126.14      $126.14
                    pro.
G0104............  CA screen;flexi           N................  .................  P3...............  ...........       1.9748       $81.76       $81.76
                    sigmoidscope.
G0105............  Colorectal scrn; hi risk  Y................  .................  A2...............      $446.00       7.8504      $325.01      $415.75
                    ind.
G0121............  Colon ca scrn not hi rsk  Y................  .................  A2...............      $446.00       7.8504      $325.01      $415.75
                    ind.
G0127............  Trim nail(s)............  Y................  .................  P3...............  ...........       0.2633       $10.90       $10.90
G0186............  Dstry eye lesn,fdr vssl   Y................  .................  R2...............  ...........       4.1331      $171.11      $171.11
                    tech.
G0247............  Routine footcare pt w     Y................  .................  P3...............  ...........       0.4937       $20.44       $20.44
                    lops.
G0259............  Inject for sacroiliac     N................  .................  N1...............  ...........  ...........  ...........  ...........
                    joint.
G0260............  Inj for sacroiliac jt     Y................  .................  A2...............      $333.00       7.0546      $292.07      $322.77
                    anesth.
G0268............  Removal of impacted wax   N................  CH...............  N1...............  ...........  ...........  ...........  ...........
                    md.
G0269............  Occlusive device in vein  N................  .................  N1...............  ...........  ...........  ...........  ...........
                    art.
G0289............  Arthro, loose body +      N................  .................  N1...............  ...........  ...........  ...........  ...........
                    chondro.
G0364............  Bone marrow aspirate &    Y................  .................  P3...............  ...........       0.1234        $5.11        $5.11
                    biopsy.
G0392............  AV fistula or graft       Y................  .................  A2...............    $1,339.00      45.3845    $1,878.96    $1,473.99
                    arterial.
G0393............  AV fistula or graft       Y................  .................  A2...............    $1,339.00      45.3845    $1,878.96    $1,473.99
                    venous.
--------------------------------------------------------------------------------------------------------------------------------------------------------
Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20 percent of the total payment amount,
  except for screening flexible sigmoidoscopies and screening colonoscopies for which the program payment is 75 percent and the beneficiary coinsurance
  is 25 percent.
* Refers to codes designated as ``office-based,'' whose designation as office-based is temporary because we have insufficient claims data. We will
  reconsider this designation when new claims data become available.


[[Page 9911]]


        Addendum BB.--ASC Covered Ancillary Services Integral to Covered Surgical Procedures for CY 2008
                          [Including Ancillary Services for Which Payment Is Packaged]
----------------------------------------------------------------------------------------------------------------
                                                                                          CY 2008
     HCPCS code           Short descriptor       Comment indicator   Payment indicator    payment      CY 2008
                                                                                           weight      payment
----------------------------------------------------------------------------------------------------------------
0028T..............  Dexa body composition      ..................  N1................  ...........  ...........
                      study.
0042T..............  Ct perfusion w/contrast,   ..................  N1................  ...........  ...........
                      cbf.
0054T..............  Bone surgery using         CH................  D5................  ...........  ...........
                      computer.
0055T..............  Bone surgery using         CH................  D5................  ...........  ...........
                      computer.
0056T..............  Bone surgery using         CH................  D5................  ...........  ...........
                      computer.
0067T..............  Ct colonography;dx.......  ..................  Z2................       3.0109      $124.65
0071T..............  U/s leiomyomata ablate     ..................  Z2................      61.6965    $2,554.30
                      <200.
0072T..............  U/s leiomyomata ablate     ..................  Z2................      61.6965    $2,554.30
                      >200.
0073T..............  Delivery, comp imrt......  ..................  Z2................       5.4582      $225.97
0126T..............  Chd risk imt study.......  ..................  N1................  ...........  ...........
0144T..............  Ct heart wo dye; qual      ..................  Z2................       1.5839       $65.58
                      calc.
0145T..............  Ct heart w/wo dye funct..  ..................  Z2................       4.7005      $194.61
0146T..............  Ccta w/wo dye............  ..................  Z2................       4.7005      $194.61
0147T..............  Ccta w/wo, quan calcium..  ..................  Z2................       4.7005      $194.61
0148T..............  Ccta w/wo, strxr.........  ..................  Z2................       4.7005      $194.61
0149T..............  Ccta w/wo, strxr quan      ..................  Z2................       4.7005      $194.61
                      calc.
0150T..............  Ccta w/wo, disease strxr.  ..................  Z2................       4.7005      $194.61
0151T..............  Ct heart funct add-on....  ..................  Z2................       1.5839       $65.58
0159T..............  Cad breast mri...........  ..................  N1................  ...........  ...........
0174T..............  Cad cxr with interp......  ..................  N1................  ...........  ...........
0175T..............  Cad cxr remote...........  ..................  N1................  ...........  ...........
0182T..............  Hdr elect brachytherapy..  CH................  Z2................      27.4752    $1,137.50
0185T..............  Comptr probability         NI................  N1................  ...........  ...........
                      analysis.
70010..............  Contrast x-ray of brain..  CH................  N1................  ...........  ...........
70015..............  Contrast x-ray of brain..  CH................  N1................  ...........  ...........
70030..............  X-ray eye for foreign      ..................  Z3................       0.3949       $16.35
                      body.
70100..............  X-ray exam of jaw........  ..................  Z3................       0.4526       $18.74
70110..............  X-ray exam of jaw........  ..................  Z3................       0.5514       $22.83
70120..............  X-ray exam of mastoids...  ..................  Z3................       0.5183       $21.46
70130..............  X-ray exam of mastoids...  ..................  Z2................       0.6954       $28.79
70134..............  X-ray exam of middle ear.  ..................  Z3................       0.6253       $25.89
70140..............  X-ray exam of facial       ..................  Z3................       0.4609       $19.08
                      bones.
70150..............  X-ray exam of facial       ..................  Z3................       0.6336       $26.23
                      bones.
70160..............  X-ray exam of nasal bones  ..................  Z3................       0.4773       $19.76
70170..............  X-ray exam of tear duct..  CH................  N1................  ...........  ...........
70190..............  X-ray exam of eye sockets  ..................  Z3................       0.5266       $21.80
70200..............  X-ray exam of eye sockets  ..................  Z3................       0.6418       $26.57
70210..............  X-ray exam of sinuses....  ..................  Z3................       0.4691       $19.42
70220..............  X-ray exam of sinuses....  ..................  Z3................       0.5925       $24.53
70240..............  X-ray exam, pituitary      ..................  Z3................       0.3949       $16.35
                      saddle.
70250..............  X-ray exam of skull......  ..................  Z3................       0.5101       $21.12
70260..............  X-ray exam of skull......  ..................  Z3................       0.6831       $28.28
70300..............  X-ray exam of teeth......  ..................  Z3................       0.1894        $7.84
70310..............  X-ray exam of teeth......  ..................  Z3................       0.4855       $20.10
70320..............  Full mouth x-ray of teeth  ..................  Z2................       0.5749       $23.80
70328..............  X-ray exam of jaw joint..  ..................  Z3................       0.4362       $18.06
70330..............  X-ray exam of jaw joints.  CH................  Z2................       0.6954       $28.79
70332..............  X-ray exam of jaw joint..  CH................  N1................  ...........  ...........
70336..............  Magnetic image, jaw joint  ..................  Z2................        4.883      $202.16
70350..............  X-ray head for             ..................  Z3................       0.2715       $11.24
                      orthodontia.
70355..............  Panoramic x-ray of jaws..  ..................  Z3................       0.3292       $13.63
70360..............  X-ray exam of neck.......  ..................  Z3................       0.3785       $15.67
70370..............  Throat x-ray &             ..................  Z3................       1.1768       $48.72
                      fluoroscopy.
70371..............  Speech evaluation,         ..................  Z2................       1.3271       $54.94
                      complex.
70373..............  Contrast x-ray of larynx.  CH................  N1................  ...........  ...........
70380..............  X-ray exam of salivary     ..................  Z3................       0.5925       $24.53
                      gland.
70390..............  X-ray exam of salivary     CH................  N1................  ...........  ...........
                      duct.
70450..............  Ct head/brain w/o dye....  ..................  Z2................       3.0109      $124.65
70460..............  Ct head/brain w/dye......  ..................  Z2................       4.3564      $180.36
70470..............  Ct head/brain w/o & w/dye  ..................  Z2................       5.1125      $211.66
70480..............  Ct orbit/ear/fossa w/o     ..................  Z2................       3.0109      $124.65
                      dye.
70481..............  Ct orbit/ear/fossa w/dye.  ..................  Z2................       4.3564      $180.36
70482..............  Ct orbit/ear/fossa w/o &   ..................  Z2................       5.1125      $211.66
                      w/dye.
70486..............  Ct maxillofacial w/o dye.  ..................  Z2................       3.0109      $124.65
70487..............  Ct maxillofacial w/dye...  ..................  Z2................       4.3564      $180.36
70488..............  Ct maxillofacial w/o & w/  ..................  Z2................       5.1125      $211.66
                      dye.
70490..............  Ct soft tissue neck w/o    ..................  Z2................       3.0109      $124.65
                      dye.
70491..............  Ct soft tissue neck w/dye  ..................  Z2................       4.3564      $180.36
70492..............  Ct sft tsue nck w/o & w/   ..................  Z2................       5.1125      $211.66
                      dye.

[[Page 9912]]

 
70496..............  Ct angiography, head.....  ..................  Z2................       5.1641      $213.80
70498..............  Ct angiography, neck.....  ..................  Z2................       5.1641      $213.80
70540..............  Mri orbit/face/neck w/o    ..................  Z2................       5.3933      $223.29
                      dye.
70542..............  Mri orbit/face/neck w/dye  ..................  Z2................        6.235      $258.14
70543..............  Mri orbt/fac/nck w/o & w/  ..................  Z2................       8.2463      $341.41
                      dye.
70544..............  Mr angiography head w/o    ..................  Z2................       5.3933      $223.29
                      dye.
70545..............  Mr angiography head w/dye  ..................  Z2................        6.235      $258.14
70546..............  Mr angiograph head w/o &   ..................  Z2................       8.2463      $341.41
                      w/dye.
70547..............  Mr angiography neck w/o    ..................  Z2................       5.3933      $223.29
                      dye.
70548..............  Mr angiography neck w/dye  ..................  Z2................        6.235      $258.14
70549..............  Mr angiograph neck w/o &   ..................  Z2................       8.2463      $341.41
                      w/dye.
70551..............  Mri brain w/o dye........  ..................  Z2................       5.3933      $223.29
70552..............  Mri brain w/dye..........  ..................  Z2................        6.235      $258.14
70553..............  Mri brain w/o & w/dye....  ..................  Z2................       8.2463      $341.41
70554..............  Fmri brain by tech.......  ..................  Z2................       5.3933      $223.29
70555..............  Fmri brain by phys/psych.  ..................  Z2................       5.3933      $223.29
70557..............  Mri brain w/o dye........  ..................  Z2................       5.3933      $223.29
70558..............  Mri brain w/dye..........  ..................  Z2................        6.235      $258.14
70559..............  Mri brain w/o & w/dye....  ..................  Z2................       8.2463      $341.41
71010..............  Chest x-ray..............  ..................  Z3................       0.3456       $14.31
71015..............  Chest x-ray..............  ..................  Z3................       0.4196       $17.37
71020..............  Chest x-ray..............  ..................  Z3................       0.4609       $19.08
71021..............  Chest x-ray..............  ..................  Z3................       0.5596       $23.17
71022..............  Chest x-ray..............  ..................  Z3................       0.6253       $25.89
71023..............  Chest x-ray and            ..................  Z3................       0.8968       $37.13
                      fluoroscopy.
71030..............  Chest x-ray..............  ..................  Z3................       0.6582       $27.25
71034..............  Chest x-ray and            ..................  Z2................       1.3271       $54.94
                      fluoroscopy.
71035..............  Chest x-ray..............  ..................  Z3................       0.5101       $21.12
71040..............  Contrast x-ray of bronchi  CH................  N1................  ...........  ...........
71060..............  Contrast x-ray of bronchi  CH................  N1................  ...........  ...........
71090..............  X-ray & pacemaker          CH................  N1................  ...........  ...........
                      insertion.
71100..............  X-ray exam of ribs.......  ..................  Z3................       0.4609       $19.08
71101..............  X-ray exam of ribs/chest.  ..................  Z3................       0.5514       $22.83
71110..............  X-ray exam of ribs.......  ..................  Z3................       0.6007       $24.87
71111..............  X-ray exam of ribs/chest.  ..................  Z3................       0.7652       $31.68
71120..............  X-ray exam of breastbone.  ..................  Z3................       0.5019       $20.78
71130..............  X-ray exam of breastbone.  ..................  Z3................       0.5679       $23.51
71250..............  Ct thorax w/o dye........  ..................  Z2................       3.0109      $124.65
71260..............  Ct thorax w/dye..........  ..................  Z2................       4.3564      $180.36
71270..............  Ct thorax w/o & w/dye....  ..................  Z2................       5.1125      $211.66
71275..............  Ct angiography, chest....  ..................  Z2................       5.1641      $213.80
71550..............  Mri chest w/o dye........  ..................  Z2................       5.3933      $223.29
71551..............  Mri chest w/dye..........  ..................  Z2................        6.235      $258.14
71552..............  Mri chest w/o & w/dye....  ..................  Z2................       8.2463      $341.41
72010..............  X-ray exam of spine......  ..................  Z2................       0.6954       $28.79
72020..............  X-ray exam of spine......  ..................  Z3................       0.3456       $14.31
72040..............  X-ray exam of neck spine.  ..................  Z3................       0.5348       $22.14
72050..............  X-ray exam of neck spine.  ..................  Z3................       0.7652       $31.68
72052..............  X-ray exam of neck spine.  ..................  Z3................       0.9874       $40.88
72069..............  X-ray exam of trunk spine  ..................  Z3................       0.4773       $19.76
72070..............  X-ray exam of thoracic     ..................  Z3................       0.5019       $20.78
                      spine.
72072..............  X-ray exam of thoracic     ..................  Z3................       0.5843       $24.19
                      spine.
72074..............  X-ray exam of thoracic     CH................  Z2................       0.6954       $28.79
                      spine.
72080..............  X-ray exam of trunk spine  ..................  Z3................       0.5266       $21.80
72090..............  X-ray exam of trunk spine  ..................  Z3................         0.65       $26.91
72100..............  X-ray exam of lower spine  ..................  Z3................       0.5761       $23.85
72110..............  X-ray exam of lower spine  ..................  Z3................       0.7983       $33.05
72114..............  X-ray exam of lower spine  ..................  Z3................        1.078       $44.63
72120..............  X-ray exam of lower spine  ..................  Z3................       0.7734       $32.02
72125..............  Ct neck spine w/o dye....  ..................  Z2................       3.0109      $124.65
72126..............  Ct neck spine w/dye......  ..................  Z2................       4.3564      $180.36
72127..............  Ct neck spine w/o & w/dye  ..................  Z2................       5.1125      $211.66
72128..............  Ct chest spine w/o dye...  ..................  Z2................       3.0109      $124.65
72129..............  Ct chest spine w/dye.....  ..................  Z2................       4.3564      $180.36
72130..............  Ct chest spine w/o & w/    ..................  Z2................       5.1125      $211.66
                      dye.
72131..............  Ct lumbar spine w/o dye..  ..................  Z2................       3.0109      $124.65
72132..............  Ct lumbar spine w/dye....  ..................  Z2................       4.3564      $180.36
72133..............  Ct lumbar spine w/o & w/   ..................  Z2................       5.1125      $211.66
                      dye.

[[Page 9913]]

 
72141..............  Mri neck spine w/o dye...  ..................  Z2................       5.3933      $223.29
72142..............  Mri neck spine w/dye.....  ..................  Z2................        6.235      $258.14
72146..............  Mri chest spine w/o dye..  ..................  Z2................       5.3933      $223.29
72147..............  Mri chest spine w/dye....  ..................  Z2................        6.235      $258.14
72148..............  Mri lumbar spine w/o dye.  ..................  Z2................       5.3933      $223.29
72149..............  Mri lumbar spine w/dye...  ..................  Z2................        6.235      $258.14
72156..............  Mri neck spine w/o & w/    ..................  Z2................       8.2463      $341.41
                      dye.
72157..............  Mri chest spine w/o & w/   ..................  Z2................       8.2463      $341.41
                      dye.
72158..............  Mri lumbar spine w/o & w/  ..................  Z2................       8.2463      $341.41
                      dye.
72170..............  X-ray exam of pelvis.....  ..................  Z3................       0.3949       $16.35
72190..............  X-ray exam of pelvis.....  ..................  Z3................       0.5925       $24.53
72191..............  Ct angiograph pelv w/o &   ..................  Z2................       5.1641      $213.80
                      w/dye.
72192..............  Ct pelvis w/o dye........  ..................  Z2................       3.0109      $124.65
72193..............  Ct pelvis w/dye..........  ..................  Z2................       4.3564      $180.36
72194..............  Ct pelvis w/o & w/dye....  ..................  Z2................       5.1125      $211.66
72195..............  Mri pelvis w/o dye.......  ..................  Z2................       5.3933      $223.29
72196..............  Mri pelvis w/dye.........  ..................  Z2................        6.235      $258.14
72197..............  Mri pelvis w/o & w/dye...  ..................  Z2................       8.2463      $341.41
72200..............  X-ray exam sacroiliac      ..................  Z3................       0.4362       $18.06
                      joints.
72202..............  X-ray exam sacroiliac      ..................  Z3................       0.5348       $22.14
                      joints.
72220..............  X-ray exam of tailbone...  ..................  Z3................       0.4526       $18.74
72240..............  Contrast x-ray of neck     CH................  N1................  ...........  ...........
                      spine.
72255..............  Contrast x-ray, thorax     CH................  N1................  ...........  ...........
                      spine.
72265..............  Contrast x-ray, lower      CH................  N1................  ...........  ...........
                      spine.
72270..............  Contrast x-ray, spine....  CH................  N1................  ...........  ...........
72275..............  Epidurography............  CH................  N1................  ...........  ...........
72285..............  X-ray c/t spine disk.....  CH................  N1................  ...........  ...........
72291..............  Perq vertebroplasty,       CH................  N1................  ...........  ...........
                      fluor.
72292..............  Perq vertebroplasty, ct..  CH................  N1................  ...........  ...........
72295..............  X-ray of lower spine disk  CH................  N1................  ...........  ...........
73000..............  X-ray exam of collar bone  ..................  Z3................       0.4196       $17.37
73010..............  X-ray exam of shoulder     ..................  Z3................        0.428       $17.72
                      blade.
73020..............  X-ray exam of shoulder...  ..................  Z3................       0.3539       $14.65
73030..............  X-ray exam of shoulder...  ..................  Z3................       0.4444       $18.40
73040..............  Contrast x-ray of          CH................  N1................  ...........  ...........
                      shoulder.
73050..............  X-ray exam of shoulders..  ..................  Z3................       0.5432       $22.49
73060..............  X-ray exam of humerus....  ..................  Z3................       0.4444       $18.40
73070..............  X-ray exam of elbow......  ..................  Z3................       0.4196       $17.37
73080..............  X-ray exam of elbow......  ..................  Z3................       0.5183       $21.46
73085..............  Contrast x-ray of elbow..  CH................  N1................  ...........  ...........
73090..............  X-ray exam of forearm....  ..................  Z3................       0.4196       $17.37
73092..............  X-ray exam of arm, infant  ..................  Z3................       0.4196       $17.37
73100..............  X-ray exam of wrist......  ..................  Z3................        0.428       $17.72
73110..............  X-ray exam of wrist......  ..................  Z3................       0.5101       $21.12
73115..............  Contrast x-ray of wrist..  CH................  N1................  ...........  ...........
73120..............  X-ray exam of hand.......  ..................  Z3................       0.4113       $17.03
73130..............  X-ray exam of hand.......  ..................  Z3................       0.4691       $19.42
73140..............  X-ray exam of finger(s)..  ..................  Z3................       0.4362       $18.06
73200..............  Ct upper extremity w/o     ..................  Z2................       3.0109      $124.65
                      dye.
73201..............  Ct upper extremity w/dye.  ..................  Z2................       4.3564      $180.36
73202..............  Ct uppr extremity w/o & w/ ..................  Z2................       5.1125      $211.66
                      dye.
73206..............  Ct angio upr extrm w/o &   ..................  Z2................       5.1641      $213.80
                      w/dye.
73218..............  Mri upper extremity w/o    ..................  Z2................       5.3933      $223.29
                      dye.
73219..............  Mri upper extremity w/dye  ..................  Z2................        6.235      $258.14
73220..............  Mri uppr extremity w/o &   ..................  Z2................       8.2463      $341.41
                      w/dye.
73221..............  Mri joint upr extrem w/o   ..................  Z2................       5.3933      $223.29
                      dye.
73222..............  Mri joint upr extrem w/    ..................  Z2................        6.235      $258.14
                      dye.
73223..............  Mri joint upr extr w/o &   ..................  Z2................       8.2463      $341.41
                      w/dye.
73500..............  X-ray exam of hip........  ..................  Z3................       0.3703       $15.33
73510..............  X-ray exam of hip........  ..................  Z3................       0.5266       $21.80
73520..............  X-ray exam of hips.......  ..................  Z3................       0.5596       $23.17
73525..............  Contrast x-ray of hip....  CH................  N1................  ...........  ...........
73530..............  X-ray exam of hip........  CH................  N1................  ...........  ...........
73540..............  X-ray exam of pelvis &     ..................  Z3................       0.5348       $22.14
                      hips.
73542..............  X-ray exam, sacroiliac     CH................  N1................  ...........  ...........
                      joint.
73550..............  X-ray exam of thigh......  ..................  Z3................       0.4362       $18.06
73560..............  X-ray exam of knee, 1 or   ..................  Z3................        0.428       $17.72
                      2.
73562..............  X-ray exam of knee, 3....  ..................  Z3................       0.5101       $21.12

[[Page 9914]]

 
73564..............  X-ray exam, knee, 4 or     ..................  Z3................       0.5761       $23.85
                      more.
73565..............  X-ray exam of knees......  ..................  Z3................       0.4444       $18.40
73580..............  Contrast x-ray of knee     CH................  N1................  ...........  ...........
                      joint.
73590..............  X-ray exam of lower leg..  ..................  Z3................       0.4113       $17.03
73592..............  X-ray exam of leg, infant  ..................  Z3................       0.4196       $17.37
73600..............  X-ray exam of ankle......  ..................  Z3................       0.4113       $17.03
73610..............  X-ray exam of ankle......  ..................  Z3................       0.4691       $19.42
73615..............  Contrast x-ray of ankle..  CH................  N1................  ...........  ...........
73620..............  X-ray exam of foot.......  ..................  Z3................       0.4031       $16.69
73630..............  X-ray exam of foot.......  ..................  Z3................       0.4691       $19.42
73650..............  X-ray exam of heel.......  ..................  Z3................       0.3949       $16.35
73660..............  X-ray exam of toe(s).....  ..................  Z3................       0.4196       $17.37
73700..............  Ct lower extremity w/o     ..................  Z2................       3.0109      $124.65
                      dye.
73701..............  Ct lower extremity w/dye.  ..................  Z2................       4.3564      $180.36
73702..............  Ct lwr extremity w/o & w/  ..................  Z2................       5.1125      $211.66
                      dye.
73706..............  Ct angio lwr extr w/o & w/ ..................  Z2................       5.1641      $213.80
                      dye.
73718..............  Mri lower extremity w/o    ..................  Z2................       5.3933      $223.29
                      dye.
73719..............  Mri lower extremity w/dye  ..................  Z2................        6.235      $258.14
73720..............  Mri lwr extremity w/o & w/ ..................  Z2................       8.2463      $341.41
                      dye.
73721..............  Mri jnt of lwr extre w/o   ..................  Z2................       5.3933      $223.29
                      dye.
73722..............  Mri joint of lwr extr w/   ..................  Z2................        6.235      $258.14
                      dye.
73723..............  Mri joint lwr extr w/o &   ..................  Z2................       8.2463      $341.41
                      w/dye.
74000..............  X-ray exam of abdomen....  ..................  Z3................       0.3785       $15.67
74010..............  X-ray exam of abdomen....  ..................  Z3................       0.5266       $21.80
74020..............  X-ray exam of abdomen....  ..................  Z3................       0.5514       $22.83
74022..............  X-ray exam series,         ..................  Z3................       0.6582       $27.25
                      abdomen.
74150..............  Ct abdomen w/o dye.......  ..................  Z2................       3.0109      $124.65
74160..............  Ct abdomen w/dye.........  ..................  Z2................       4.3564      $180.36
74170..............  Ct abdomen w/o & w/dye...  ..................  Z2................       5.1125      $211.66
74175..............  Ct angio abdom w/o & w/    ..................  Z2................       5.1641      $213.80
                      dye.
74181..............  Mri abdomen w/o dye......  ..................  Z2................       5.3933      $223.29
74182..............  Mri abdomen w/dye........  ..................  Z2................        6.235      $258.14
74183..............  Mri abdomen w/o & w/dye..  ..................  Z2................       8.2463      $341.41
74190..............  X-ray exam of peritoneum.  CH................  N1................  ...........  ...........
74210..............  Contrst x-ray exam of      ..................  Z3................       1.1686       $48.38
                      throat.
74220..............  Contrast x-ray, esophagus  ..................  Z3................       1.2507       $51.78
74230..............  Cine/vid x-ray, throat/    ..................  Z3................       1.2674       $52.47
                      esoph.
74235..............  Remove esophagus           CH................  N1................  ...........  ...........
                      obstruction.
74240..............  X-ray exam, upper gi       CH................  Z2................       1.3834       $57.27
                      tract.
74241..............  X-ray exam, upper gi       ..................  Z2................       1.3834       $57.27
                      tract.
74245..............  X-ray exam, upper gi       ..................  Z2................       2.2222       $92.00
                      tract.
74246..............  Contrst x-ray uppr gi      ..................  Z2................       1.3834       $57.27
                      tract.
74247..............  Contrst x-ray uppr gi      ..................  Z2................       1.3834       $57.27
                      tract.
74249..............  Contrst x-ray uppr gi      ..................  Z2................       2.2222       $92.00
                      tract.
74250..............  X-ray exam of small bowel  CH................  Z2................       1.3834       $57.27
74251..............  X-ray exam of small bowel  ..................  Z2................       2.2222       $92.00
74260..............  X-ray exam of small bowel  ..................  Z2................       1.3834       $57.27
74270..............  Contrast x-ray exam of     ..................  Z2................       1.3834       $57.27
                      colon.
74280..............  Contrast x-ray exam of     ..................  Z2................       2.2222       $92.00
                      colon.
74283..............  Contrast x-ray exam of     ..................  Z2................       1.3834       $57.27
                      colon.
74290..............  Contrast x-ray,            ..................  Z3................       0.9053       $37.48
                      gallbladder.
74291..............  Contrast x-rays,           ..................  Z3................       0.7816       $32.36
                      gallbladder.
74300..............  X-ray bile ducts/pancreas  CH................  N1................  ...........  ...........
74301..............  X-rays at surgery add-on.  CH................  N1................  ...........  ...........
74305..............  X-ray bile ducts/pancreas  CH................  N1................  ...........  ...........
74320..............  Contrast x-ray of bile     CH................  N1................  ...........  ...........
                      ducts.
74327..............  X-ray bile stone removal.  CH................  N1................  ...........  ...........
74328..............  X-ray bile duct endoscopy  ..................  N1................  ...........  ...........
74329..............  X-ray for pancreas         ..................  N1................  ...........  ...........
                      endoscopy.
74330..............  X-ray bile/panc endoscopy  ..................  N1................  ...........  ...........
74340..............  X-ray guide for gi tube..  CH................  N1................  ...........  ...........
74350..............  X-ray guide, stomach tube  CH................  D5................  ...........  ...........
74355..............  X-ray guide, intestinal    CH................  N1................  ...........  ...........
                      tube.
74360..............  X-ray guide, gi dilation.  CH................  N1................  ...........  ...........
74363..............  X-ray, bile duct dilation  CH................  N1................  ...........  ...........
74400..............  Contrst x-ray, urinary     ..................  Z3................       1.6869       $69.84
                      tract.
74410..............  Contrst x-ray, urinary     ..................  Z3................        1.835       $75.97
                      tract.
74415..............  Contrst x-ray, urinary     ..................  Z3................       2.1478       $88.92
                      tract.

[[Page 9915]]

 
74420..............  Contrst x-ray, urinary     ..................  Z2................       2.6121      $108.14
                      tract.
74425..............  Contrst x-ray, urinary     CH................  N1................  ...........  ...........
                      tract.
74430..............  Contrast x-ray, bladder..  CH................  N1................  ...........  ...........
74440..............  X-ray, male genital tract  CH................  N1................  ...........  ...........
74445..............  X-ray exam of penis......  CH................  N1................  ...........  ...........
74450..............  X-ray, urethra/bladder...  CH................  N1................  ...........  ...........
74455..............  X-ray, urethra/bladder...  CH................  N1................  ...........  ...........
74470..............  X-ray exam of kidney       CH................  N1................  ...........  ...........
                      lesion.
74475..............  X-ray control, cath        CH................  N1................  ...........  ...........
                      insert.
74480..............  X-ray control, cath        CH................  N1................  ...........  ...........
                      insert.
74485..............  X-ray guide, gu dilation.  CH................  N1................  ...........  ...........
74710..............  X-ray measurement of       ..................  Z3................         0.65       $26.91
                      pelvis.
74740..............  X-ray, female genital      CH................  N1................  ...........  ...........
                      tract.
74742..............  X-ray, fallopian tube....  CH................  N1................  ...........  ...........
74775..............  X-ray exam of perineum...  ..................  Z2................       2.6121      $108.14
75552..............  Heart mri for morph w/o    CH................  D5................  ...........  ...........
                      dye.
75553..............  Heart mri for morph w/dye  CH................  D5................  ...........  ...........
75554..............  Cardiac MRI/function.....  CH................  D5................  ...........  ...........
75555..............  Cardiac MRI/limited study  CH................  D5................  ...........  ...........
75557..............  Cardiac mri for morph....  NI................  Z2................       5.3933      $223.29
75559..............  Cardiac mri w/stress img.  NI................  Z2................       5.3933      $223.29
75561..............  Cardiac mri for morph w/   NI................  Z2................       8.2463      $341.41
                      dye.
75563..............  Card mri w/stress img &    NI................  Z2................       8.2463      $341.41
                      dye.
75600..............  Contrast x-ray exam of     CH................  N1................  ...........  ...........
                      aorta.
75605..............  Contrast x-ray exam of     CH................  N1................  ...........  ...........
                      aorta.
75625..............  Contrast x-ray exam of     CH................  N1................  ...........  ...........
                      aorta.
75630..............  X-ray aorta, leg arteries  CH................  N1................  ...........  ...........
75635..............  Ct angio abdominal         CH................  N1................  ...........  ...........
                      arteries.
75650..............  Artery x-rays, head &      CH................  N1................  ...........  ...........
                      neck.
75658..............  Artery x-rays, arm.......  CH................  N1................  ...........  ...........
75660..............  Artery x-rays, head &      CH................  N1................  ...........  ...........
                      neck.
75662..............  Artery x-rays, head &      CH................  N1................  ...........  ...........
                      neck.
75665..............  Artery x-rays, head &      CH................  N1................  ...........  ...........
                      neck.
75671..............  Artery x-rays, head &      CH................  N1................  ...........  ...........
                      neck.
75676..............  Artery x-rays, neck......  CH................  N1................  ...........  ...........
75680..............  Artery x-rays, neck......  CH................  N1................  ...........  ...........
75685..............  Artery x-rays, spine.....  CH................  N1................  ...........  ...........
75705..............  Artery x-rays, spine.....  CH................  N1................  ...........  ...........
75710..............  Artery x-rays, arm/leg...  CH................  N1................  ...........  ...........
75716..............  Artery x-rays, arms/legs.  CH................  N1................  ...........  ...........
75722..............  Artery x-rays, kidney....  CH................  N1................  ...........  ...........
75724..............  Artery x-rays, kidneys...  CH................  N1................  ...........  ...........
75726..............  Artery x-rays, abdomen...  CH................  N1................  ...........  ...........
75731..............  Artery x-rays, adrenal     CH................  N1................  ...........  ...........
                      gland.
75733..............  Artery x-rays, adrenals..  CH................  N1................  ...........  ...........
75736..............  Artery x-rays, pelvis....  CH................  N1................  ...........  ...........
75741..............  Artery x-rays, lung......  CH................  N1................  ...........  ...........
75743..............  Artery x-rays, lungs.....  CH................  N1................  ...........  ...........
75746..............  Artery x-rays, lung......  CH................  N1................  ...........  ...........
75756..............  Artery x-rays, chest.....  CH................  N1................  ...........  ...........
75774..............  Artery x-ray, each vessel  CH................  N1................  ...........  ...........
75790..............  Visualize a-v shunt......  CH................  N1................  ...........  ...........
75801..............  Lymph vessel x-ray, arm/   CH................  N1................  ...........  ...........
                      leg.
75803..............  Lymph vessel x-ray,arms/   CH................  N1................  ...........  ...........
                      legs.
75805..............  Lymph vessel x-ray, trunk  CH................  N1................  ...........  ...........
75807..............  Lymph vessel x-ray, trunk  CH................  N1................  ...........  ...........
75809..............  Nonvascular shunt, x-ray.  CH................  N1................  ...........  ...........
75810..............  Vein x-ray, spleen/liver.  CH................  N1................  ...........  ...........
75820..............  Vein x-ray, arm/leg......  CH................  N1................  ...........  ...........
75822..............  Vein x-ray, arms/legs....  CH................  N1................  ...........  ...........
75825..............  Vein x-ray, trunk........  CH................  N1................  ...........  ...........
75827..............  Vein x-ray, chest........  CH................  N1................  ...........  ...........
75831..............  Vein x-ray, kidney.......  CH................  N1................  ...........  ...........
75833..............  Vein x-ray, kidneys......  CH................  N1................  ...........  ...........
75840..............  Vein x-ray, adrenal gland  CH................  N1................  ...........  ...........
75842..............  Vein x-ray, adrenal        CH................  N1................  ...........  ...........
                      glands.
75860..............  Vein x-ray, neck.........  CH................  N1................  ...........  ...........
75870..............  Vein x-ray, skull........  CH................  N1................  ...........  ...........

[[Page 9916]]

 
75872..............  Vein x-ray, skull........  CH................  N1................  ...........  ...........
75880..............  Vein x-ray, eye socket...  CH................  N1................  ...........  ...........
75885..............  Vein x-ray, liver........  CH................  N1................  ...........  ...........
75887..............  Vein x-ray, liver........  CH................  N1................  ...........  ...........
75889..............  Vein x-ray, liver........  CH................  N1................  ...........  ...........
75891..............  Vein x-ray, liver........  CH................  N1................  ...........  ...........
75893..............  Venous sampling by         ..................  N1................  ...........  ...........
                      catheter.
75894..............  X-rays, transcath therapy  CH................  N1................  ...........  ...........
75896..............  X-rays, transcath therapy  CH................  N1................  ...........  ...........
75898..............  Follow-up angiography....  CH................  N1................  ...........  ...........
75901..............  Remove cva device          CH................  N1................  ...........  ...........
                      obstruct.
75902..............  Remove cva lumen obstruct  CH................  N1................  ...........  ...........
75940..............  X-ray placement, vein      CH................  N1................  ...........  ...........
                      filter.
75945..............  Intravascular us.........  CH................  N1................  ...........  ...........
75946..............  Intravascular us add-on..  CH................  N1................  ...........  ...........
75960..............  Transcath iv stent rs & i  CH................  N1................  ...........  ...........
75961..............  Retrieval, broken          CH................  N1................  ...........  ...........
                      catheter.
75962..............  Repair arterial blockage.  CH................  N1................  ...........  ...........
75964..............  Repair artery blockage,    CH................  N1................  ...........  ...........
                      each.
75966..............  Repair arterial blockage.  CH................  N1................  ...........  ...........
75968..............  Repair artery blockage,    CH................  N1................  ...........  ...........
                      each.
75970..............  Vascular biopsy..........  CH................  N1................  ...........  ...........
75978..............  Repair venous blockage...  CH................  N1................  ...........  ...........
75980..............  Contrast xray exam bile    CH................  N1................  ...........  ...........
                      duct.
75982..............  Contrast xray exam bile    CH................  N1................  ...........  ...........
                      duct.
75984..............  Xray control catheter      CH................  N1................  ...........  ...........
                      change.
75989..............  Abscess drainage under x-  ..................  N1................  ...........  ...........
                      ray.
75992..............  Atherectomy, x-ray exam..  CH................  N1................  ...........  ...........
75993..............  Atherectomy, x-ray exam..  CH................  N1................  ...........  ...........
75994..............  Atherectomy, x-ray exam..  CH................  N1................  ...........  ...........
75995..............  Atherectomy, x-ray exam..  CH................  N1................  ...........  ...........
75996..............  Atherectomy, x-ray exam..  CH................  N1................  ...........  ...........
76000..............  Fluoroscope examination..  CH................  N1................  ...........  ...........
76001..............  Fluoroscope exam,          ..................  N1................  ...........  ...........
                      extensive.
76010..............  X-ray, nose to rectum....  ..................  Z3................       0.4113       $17.03
76080..............  X-ray exam of fistula....  CH................  N1................  ...........  ...........
76098..............  X-ray exam, breast         ..................  Z3................       0.2797       $11.58
                      specimen.
76100..............  X-ray exam of body         ..................  Z2................        1.157       $47.90
                      section.
76101..............  Complex body section x-    ..................  Z2................       2.6838      $111.11
                      ray.
76102..............  Complex body section x-    ..................  Z2................       2.6838      $111.11
                      rays.
76120..............  Cine/video x-rays........  ..................  Z3................       1.1521       $47.70
76125..............  Cine/video x-rays add-on.  CH................  N1................  ...........  ...........
76150..............  X-ray exam, dry process..  ..................  Z3................       0.4526       $18.74
76350..............  Special x-ray contrast     ..................  N1................  ...........  ...........
                      study.
76376..............  3d render w/o postprocess  CH................  N1................  ...........  ...........
76377..............  3d rendering w/            CH................  N1................  ...........  ...........
                      postprocess.
76380..............  Cat scan follow-up study.  ..................  Z2................       1.5839       $65.58
76496..............  Fluoroscopic procedure...  ..................  Z2................       1.3271       $54.94
76497..............  Ct procedure.............  ..................  Z2................       1.5839       $65.58
76498..............  Mri procedure............  ..................  Z2................        4.883      $202.16
76499..............  Radiographic procedure...  ..................  Z2................       0.6954       $28.79
76506..............  Echo exam of head........  ..................  Z2................        0.957       $39.62
76510..............  Ophth us, b & quant a....  CH................  Z3................       1.5963       $66.09
76511..............  Ophth us, quant a only...  ..................  Z3................       1.2589       $52.12
76512..............  Ophth us, b w/non-quant a  ..................  Z3................       1.0862       $44.97
76513..............  Echo exam of eye, water    ..................  Z3................       1.1604       $48.04
                      bath.
76514..............  Echo exam of eye,          ..................  Z3................       0.0659        $2.73
                      thickness.
76516..............  Echo exam of eye.........  ..................  Z3................       0.9053       $37.48
76519..............  Echo exam of eye.........  ..................  Z3................       0.9874       $40.88
76529..............  Echo exam of eye.........  ..................  Z3................       0.8558       $35.43
76536..............  Us exam of head and neck.  CH................  Z2................       1.5094       $62.49
76604..............  Us exam, chest...........  ..................  Z2................        0.957       $39.62
76645..............  Us exam, breast(s).......  ..................  Z2................        0.957       $39.62
76700..............  Us exam, abdom, complete.  ..................  Z2................       1.5094       $62.49
76705..............  Echo exam of abdomen.....  ..................  Z3................       1.4647       $60.64
76770..............  Us exam abdo back wall,    ..................  Z2................       1.5094       $62.49
                      comp.
76775..............  Us exam abdo back wall,    ..................  Z3................       1.4893       $61.66
                      lim.
76776..............  Us exam k transpl w/       ..................  Z2................       1.5094       $62.49
                      doppler.

[[Page 9917]]

 
76800..............  Us exam, spinal canal....  ..................  Z3................       1.4154       $58.60
76801..............  Ob us < 14 wks, single     ..................  Z2................       1.5094       $62.49
                      fetus.
76802..............  Ob us < 14 wks, add?l      ..................  Z3................       0.7241       $29.98
                      fetus.
76805..............  Ob us >/= 14 wks, sngl     ..................  Z2................       1.5094       $62.49
                      fetus.
76810..............  Ob us >/= 14 wks, addl     ..................  Z3................       0.9874       $40.88
                      fetus.
76811..............  Ob us, detailed, sngl      CH................  Z2................       2.3792       $98.50
                      fetus.
76812..............  Ob us, detailed, addl      ..................  Z2................        0.957       $39.62
                      fetus.
76813..............  Ob us nuchal meas, 1 gest  ..................  Z3................       1.4893       $61.66
76814..............  Ob us nuchal meas, add-on  ..................  Z3................       0.7077       $29.30
76815..............  Ob us, limited, fetus(s).  ..................  Z2................        0.957       $39.62
76816..............  Ob us, follow-up, per      ..................  Z2................        0.957       $39.62
                      fetus.
76817..............  Transvaginal us,           ..................  Z2................        0.957       $39.62
                      obstetric.
76818..............  Fetal biophys profile w/   ..................  Z3................       1.4483       $59.96
                      nst.
76819..............  Fetal biophys profil w/o   ..................  Z3................       1.2343       $51.10
                      nst.
76820..............  Umbilical artery echo....  ..................  Z3................       0.8311       $34.41
76821..............  Middle cerebral artery     ..................  Z3................       1.3495       $55.87
                      echo.
76825..............  Echo exam of fetal heart.  ..................  Z2................       1.5094       $62.49
76826..............  Echo exam of fetal heart.  CH................  Z2................        0.957       $39.62
76827..............  Echo exam of fetal heart.  CH................  Z2................        0.957       $39.62
76828..............  Echo exam of fetal heart.  ..................  Z3................         0.65       $26.91
76830..............  Transvaginal us, non-ob..  ..................  Z2................       1.5094       $62.49
76831..............  Echo exam, uterus........  ..................  Z3................       1.6623       $68.82
76856..............  Us exam, pelvic, complete  ..................  Z2................       1.5094       $62.49
76857..............  Us exam, pelvic, limited.  ..................  Z2................        0.957       $39.62
76870..............  Us exam, scrotum.........  ..................  Z2................       1.5094       $62.49
76872..............  Us, transrectal..........  ..................  Z2................       1.5094       $62.49
76873..............  Echograp trans r, pros     ..................  Z2................       1.5094       $62.49
                      study.
76880..............  Us exam, extremity.......  ..................  Z2................       1.5094       $62.49
76885..............  Us exam infant hips,       ..................  Z2................        0.957       $39.62
                      dynamic.
76886..............  Us exam infant hips,       ..................  Z2................        0.957       $39.62
                      static.
76930..............  Echo guide,                CH................  N1................  ...........  ...........
                      cardiocentesis.
76932..............  Echo guide for heart       CH................  N1................  ...........  ...........
                      biopsy.
76936..............  Echo guide for artery      CH................  N1................  ...........  ...........
                      repair.
76937..............  Us guide, vascular access  ..................  N1................  ...........  ...........
76940..............  Us guide, tissue ablation  CH................  N1................  ...........  ...........
76941..............  Echo guide for             CH................  N1................  ...........  ...........
                      transfusion.
76942..............  Echo guide for biopsy....  CH................  N1................  ...........  ...........
76945..............  Echo guide, villus         CH................  N1................  ...........  ...........
                      sampling.
76946..............  Echo guide for             CH................  N1................  ...........  ...........
                      amniocentesis.
76948..............  Echo guide, ova            CH................  N1................  ...........  ...........
                      aspiration.
76950..............  Echo guidance              CH................  N1................  ...........  ...........
                      radiotherapy.
76965..............  Echo guidance              CH................  N1................  ...........  ...........
                      radiotherapy.
76970..............  Ultrasound exam follow-up  ..................  Z2................        0.957       $39.62
76975..............  Gi endoscopic ultrasound.  CH................  N1................  ...........  ...........
76977..............  Us bone density measure..  ..................  Z3................       0.3785       $15.67
76998..............  Us guide, intraop........  CH................  N1................  ...........  ...........
76999..............  Echo examination           ..................  Z2................        0.957       $39.62
                      procedure.
77001..............  Fluoroguide for vein       ..................  N1................  ...........  ...........
                      device.
77002..............  Needle localization by     ..................  N1................  ...........  ...........
                      xray.
77003..............  Fluoroguide for spine      ..................  N1................  ...........  ...........
                      inject.
77011..............  Ct scan for localization.  CH................  N1................  ...........  ...........
77012..............  Ct scan for needle biopsy  CH................  N1................  ...........  ...........
77013..............  Ct guide for tissue        CH................  N1................  ...........  ...........
                      ablation.
77014..............  Ct scan for therapy guide  CH................  N1................  ...........  ...........
77021..............  Mr guidance for needle     CH................  N1................  ...........  ...........
                      place.
77022..............  Mri for tissue ablation..  CH................  N1................  ...........  ...........
77031..............  Stereotact guide for brst  CH................  N1................  ...........  ...........
                      bx.
77032..............  Guidance for needle,       CH................  N1................  ...........  ...........
                      breast.
77053..............  X-ray of mammary duct....  CH................  N1................  ...........  ...........
77054..............  X-ray of mammary ducts...  CH................  N1................  ...........  ...........
77071..............  X-ray stress view........  ..................  Z3................       0.3949       $16.35
77072..............  X-rays for bone age......  ..................  Z3................       0.2961       $12.26
77073..............  X-rays, bone length        ..................  Z3................       0.5596       $23.17
                      studies.
77074..............  X-rays, bone survey,       ..................  Z3................       0.9381       $38.84
                      limited.
77075..............  X-rays, bone survey        ..................  Z2................        1.157       $47.90
                      complete.
77076..............  X-rays, bone survey,       ..................  Z2................       0.6954       $28.79
                      infant.
77077..............  Joint survey, single view  ..................  Z3................       0.6831       $28.28
77078..............  Ct bone density, axial...  ..................  Z2................       1.1384       $47.13

[[Page 9918]]

 
77079..............  Ct bone density,           ..................  Z3................       1.5224       $63.03
                      peripheral.
77080..............  Dxa bone density, axial..  ..................  Z2................       1.1384       $47.13
77081..............  Dxa bone density/          CH................  Z3................       0.4773       $19.76
                      peripheral.
77082..............  Dxa bone density, vert fx  ..................  Z3................       0.5019       $20.78
77083..............  Radiographic               ..................  Z3................       0.4362       $18.06
                      absorptiometry.
77084..............  Magnetic image, bone       ..................  Z2................        4.883      $202.16
                      marrow.
77280..............  Set radiation therapy      ..................  Z2................       1.5576       $64.49
                      field.
77285..............  Set radiation therapy      ..................  Z2................       3.9276      $162.61
                      field.
77290..............  Set radiation therapy      ..................  Z2................       3.9276      $162.61
                      field.
77295..............  Set radiation therapy      CH................  Z2................      13.5621      $561.48
                      field.
77299..............  Radiation therapy          ..................  Z2................       1.5576       $64.49
                      planning.
77300..............  Radiation therapy dose     ..................  Z3................       0.9546       $39.52
                      plan.
77301..............  Radiotherapy dose plan,    ..................  Z2................      13.5621      $561.48
                      imrt.
77305..............  Teletx isodose plan        ..................  Z3................       1.0451       $43.27
                      simple.
77310..............  Teletx isodose plan        ..................  Z3................       1.3331       $55.19
                      intermed.
77315..............  Teletx isodose plan        ..................  Z3................       1.7444       $72.22
                      complex.
77321..............  Special teletx port plan.  ..................  Z3................        2.156       $89.26
77326..............  Brachytx isodose calc      ..................  Z2................       1.5576       $64.49
                      simp.
77327..............  Brachytx isodose calc      ..................  Z3................       2.9294      $121.28
                      interm.
77328..............  Brachytx isodose plan      ..................  Z3................       3.9168      $162.16
                      compl.
77331..............  Special radiation          ..................  Z3................       0.4196       $17.37
                      dosimetry.
77332..............  Radiation treatment        ..................  Z3................       1.1191       $46.33
                      aid(s).
77333..............  Radiation treatment        ..................  Z3................       0.8804       $36.45
                      aid(s).
77334..............  Radiation treatment        ..................  Z3................       2.2876       $94.71
                      aid(s).
77336..............  Radiation physics consult  ..................  Z2................       1.5576       $64.49
77370..............  Radiation physics consult  ..................  Z2................       1.5576       $64.49
77371..............  Srs, multisource.........  ..................  Z3................      24.7769    $1,025.79
77399..............  External radiation         ..................  Z2................       1.5576       $64.49
                      dosimetry.
77401..............  Radiation treatment        ..................  Z3................       0.9217       $38.16
                      delivery.
77402..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77403..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77404..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77406..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77407..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77408..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77409..............  Radiation treatment        ..................  Z2................       1.4229       $58.91
                      delivery.
77411..............  Radiation treatment        ..................  Z2................       2.2167       $91.77
                      delivery.
77412..............  Radiation treatment        ..................  Z2................       2.2167       $91.77
                      delivery.
77413..............  Radiation treatment        ..................  Z2................       2.2167       $91.77
                      delivery.
77414..............  Radiation treatment        ..................  Z2................       2.2167       $91.77
                      delivery.
77416..............  Radiation treatment        ..................  Z2................       2.2167       $91.77
                      delivery.
77417..............  Radiology port film(s)...  CH................  N1................  ...........  ...........
77418..............  Radiation tx delivery,     ..................  Z2................       5.4582      $225.97
                      imrt.
77421..............  Stereoscopic x-ray         CH................  N1................  ...........  ...........
                      guidance.
77422..............  Neutron beam tx, simple..  ..................  Z2................       2.2167       $91.77
77423..............  Neutron beam tx, complex.  ..................  Z2................       2.2167       $91.77
77435..............  Sbrt management..........  ..................  N1................  ...........  ...........
77470..............  Special radiation          ..................  Z3................       5.1018      $211.22
                      treatment.
77520..............  Proton trmt, simple w/o    ..................  Z2................      12.8205      $530.78
                      comp.
77522..............  Proton trmt, simple w/     ..................  Z2................      12.8205      $530.78
                      comp.
77523..............  Proton trmt, intermediate  ..................  Z2................      15.3404      $635.11
77525..............  Proton treatment, complex  ..................  Z2................      15.3404      $635.11
77600..............  Hyperthermia treatment...  CH................  Z3................       5.2665      $218.04
77605..............  Hyperthermia treatment...  ..................  Z2................       5.7996      $240.11
77610..............  Hyperthermia treatment...  ..................  Z2................       5.7996      $240.11
77615..............  Hyperthermia treatment...  ..................  Z2................       5.7996      $240.11
77620..............  Hyperthermia treatment...  CH................  Z3................       5.4146      $224.17
77750..............  Infuse radioactive         ..................  Z3................       1.7529       $72.57
                      materials.
77761..............  Apply intrcav radiat       ..................  Z3................        3.127      $129.46
                      simple.
77762..............  Apply intrcav radiat       ..................  Z3................       3.8511      $159.44
                      interm.
77763..............  Apply intrcav radiat       ..................  Z3................       4.9455      $204.75
                      compl.
77776..............  Apply interstit radiat     ..................  Z3................       3.2833      $135.93
                      simpl.
77777..............  Apply interstit radiat     ..................  Z3................        3.991      $165.23
                      inter.
77778..............  Apply interstit radiat     ..................  Z3................       5.2501      $217.36
                      compl.
77781..............  High intensity             ..................  Z3................      10.0063      $414.27
                      brachytherapy.
77782..............  High intensity             ..................  Z2................      11.6779      $483.48
                      brachytherapy.
77783..............  High intensity             ..................  Z2................      11.6779      $483.48
                      brachytherapy.
77784..............  High intensity             ..................  Z2................      11.6779      $483.48
                      brachytherapy.

[[Page 9919]]

 
77789..............  Apply surface radiation..  ..................  Z3................       0.8558       $35.43
77790..............  Radiation handling.......  ..................  N1................  ...........  ...........
77799..............  Radium/radioisotope        ..................  Z2................        8.514      $352.49
                      therapy.
78000..............  Thyroid, single uptake...  ..................  Z3................       1.1355       $47.01
78001..............  Thyroid, multiple uptakes  ..................  Z3................       1.4483       $59.96
78003..............  Thyroid suppress/stimul..  ..................  Z3................       1.1437       $47.35
78006..............  Thyroid imaging with       ..................  Z2................       3.4513      $142.89
                      uptake.
78007..............  Thyroid image, mult        ..................  Z3................       2.2466       $93.01
                      uptakes.
78010..............  Thyroid imaging..........  CH................  Z2................       2.0471       $84.75
78011..............  Thyroid imaging with flow  ..................  Z2................       2.0471       $84.75
78015..............  Thyroid met imaging......  ..................  Z3................        3.168      $131.16
78016..............  Thyroid met imaging/       CH................  Z3................       4.8303      $199.98
                      studies.
78018..............  Thyroid met imaging, body  ..................  Z2................       5.0681      $209.82
78020..............  Thyroid met uptake.......  CH................  N1................  ...........  ...........
78070..............  Parathyroid nuclear        CH................  Z3................       3.0777      $127.42
                      imaging.
78075..............  Adrenal nuclear imaging..  CH................  Z3................       6.9122      $286.17
78099..............  Endocrine nuclear          ..................  Z2................       2.0471       $84.75
                      procedure.
78102..............  Bone marrow imaging, ltd.  ..................  Z3................       2.4852      $102.89
78103..............  Bone marrow imaging, mult  ..................  Z3................       3.4398      $142.41
78104..............  Bone marrow imaging, body  ..................  Z2................       3.9293      $162.68
78110..............  Plasma volume, single....  ..................  Z3................       1.2425       $51.44
78111..............  Plasma volume, multiple..  ..................  Z3................       1.9091       $79.04
78120..............  Red cell mass, single....  ..................  Z3................       1.5471       $64.05
78121..............  Red cell mass, multiple..  ..................  Z3................       2.0654       $85.51
78122..............  Blood volume.............  ..................  Z3................       2.7567      $114.13
78130..............  Red cell survival study..  ..................  Z3................       2.5263      $104.59
78135..............  Red cell survival          CH................  Z3................       5.4885      $227.23
                      kinetics.
78140..............  Red cell sequestration...  ..................  Z3................       2.7403      $113.45
78185..............  Spleen imaging...........  ..................  Z3................       3.0528      $126.39
78190..............  Platelet survival,         ..................  Z2................       2.9022      $120.15
                      kinetics.
78191..............  Platelet survival........  ..................  Z2................       2.9022      $120.15
78195..............  Lymph system imaging.....  ..................  Z2................       3.9293      $162.68
78199..............  Blood/lymph nuclear exam.  ..................  Z2................       3.9293      $162.68
78201..............  Liver imaging............  ..................  Z3................       2.8142      $116.51
78202..............  Liver imaging with flow..  ..................  Z3................       3.3161      $137.29
78205..............  Liver imaging (3d).......  CH................  Z2................       4.4603      $184.66
78206..............  Liver image (3d) with      ..................  Z2................       4.4603      $184.66
                      flow.
78215..............  Liver and spleen imaging.  ..................  Z3................        3.127      $129.46
78216..............  Liver & spleen image/flow  ..................  Z3................       2.5263      $104.59
78220..............  Liver function study.....  ..................  Z3................       2.7321      $113.11
78223..............  Hepatobiliary imaging....  ..................  Z2................       4.4603      $184.66
78230..............  Salivary gland imaging...  ..................  Z3................       2.5509      $105.61
78231..............  Serial salivary imaging..  ..................  Z3................       2.3864       $98.80
78232..............  Salivary gland function    ..................  Z3................       2.5345      $104.93
                      exam.
78258..............  Esophageal motility study  ..................  Z3................       3.3492      $138.66
78261..............  Gastric mucosa imaging...  ..................  Z2................       3.7911      $156.96
78262..............  Gastroesophageal reflux    ..................  Z2................       3.7911      $156.96
                      exam.
78264..............  Gastric emptying study...  ..................  Z2................       3.7911      $156.96
78270..............  Vit b-12 absorption exam.  ..................  Z3................       1.4072       $58.26
78271..............  Vit b-12 absrp exam, int   ..................  Z3................       1.4318       $59.28
                      fac.
78272..............  Vit b-12 absorp, combined  ..................  Z3................       1.7775       $73.59
78278..............  Acute gi blood loss        ..................  Z2................       3.7911      $156.96
                      imaging.
78282..............  Gi protein loss exam.....  ..................  Z2................       3.7911      $156.96
78290..............  Meckel?s divert exam.....  ..................  Z2................       3.7911      $156.96
78291..............  Leveen/shunt patency exam  ..................  Z3................         3.67      $151.94
78299..............  Gi nuclear procedure.....  ..................  Z2................       3.7911      $156.96
78300..............  Bone imaging, limited      ..................  Z3................       2.6743      $110.72
                      area.
78305..............  Bone imaging, multiple     ..................  Z3................       3.6453      $150.92
                      areas.
78306..............  Bone imaging, whole body.  CH................  Z2................       3.8039      $157.49
78315..............  Bone imaging, 3 phase....  ..................  Z2................       3.8039      $157.49
78320..............  Bone imaging (3d)........  ..................  Z2................       3.8039      $157.49
78399..............  Musculoskeletal nuclear    ..................  Z2................       3.8039      $157.49
                      exam.
78414..............  Non-imaging heart          ..................  Z2................        4.862      $201.29
                      function.
78428..............  Cardiac shunt imaging....  ..................  Z3................       2.9458      $121.96
78445..............  Vascular flow imaging....  CH................  Z3................       2.5427      $105.27
78456..............  Acute venous thrombus      ..................  Z2................       3.1433      $130.14
                      image.
78457..............  Venous thrombosis imaging  CH................  Z3................        2.913      $120.60
78458..............  Ven thrombosis images,     ..................  Z2................       3.1433      $130.14
                      bilat.

[[Page 9920]]

 
78459..............  Heart muscle imaging       ..................  Z2................      21.9955      $910.64
                      (pet).
78460..............  Heart muscle blood,        ..................  Z3................       2.7567      $114.13
                      single.
78461..............  Heart muscle blood,        ..................  Z3................       3.4313      $142.06
                      multiple.
78464..............  Heart image (3d), single.  CH................  Z3................       5.1182      $211.90
78465..............  Heart image (3d),          CH................  Z3................       9.2739      $383.95
                      multiple.
78466..............  Heart infarct image......  ..................  Z3................       2.8473      $117.88
78468..............  Heart infarct image (ef).  ..................  Z3................       3.7605      $155.69
78469..............  Heart infarct image (3d).  CH................  Z3................       4.5588      $188.74
78472..............  Gated heart, planar,       CH................  Z3................       4.5835      $189.76
                      single.
78473..............  Gated heart, multiple....  ..................  Z2................        4.862      $201.29
78478..............  Heart wall motion add-on.  CH................  N1................  ...........  ...........
78480..............  Heart function add-on....  CH................  N1................  ...........  ...........
78481..............  Heart first pass, single.  ..................  Z3................        4.032      $166.93
78483..............  Heart first pass,          ..................  Z2................        4.862      $201.29
                      multiple.
78491..............  Heart image (pet), single  ..................  Z2................      21.9955      $910.64
78492..............  Heart image (pet),         ..................  Z2................      21.9955      $910.64
                      multiple.
78494..............  Heart image, spect.......  ..................  Z2................        4.862      $201.29
78496..............  Heart first pass add-on..  CH................  N1................  ...........  ...........
78499..............  Cardiovascular nuclear     ..................  Z2................        4.862      $201.29
                      exam.
78580..............  Lung perfusion imaging...  ..................  Z2................       3.3954      $140.57
78584..............  Lung v/q image single      ..................  Z3................       2.4193      $100.16
                      breath.
78585..............  Lung v/q imaging.........  ..................  Z2................       4.9509      $204.97
78586..............  Aerosol lung image,        ..................  Z3................       2.7238      $112.77
                      single.
78587..............  Aerosol lung image,        ..................  Z3................       3.3246      $137.64
                      multiple.
78588..............  Perfusion lung image.....  ..................  Z3................       4.7233      $195.55
78591..............  Vent image, 1 breath, 1    ..................  Z3................       2.8306      $117.19
                      proj.
78593..............  Vent image, 1 proj, gas..  ..................  Z3................       3.3328      $137.98
78594..............  Vent image, mult proj,     ..................  Z2................       3.3954      $140.57
                      gas.
78596..............  Lung differential          ..................  Z2................       4.9509      $204.97
                      function.
78599..............  Respiratory nuclear exam.  ..................  Z2................       3.3954      $140.57
78600..............  Brain image < 4 views....  ..................  Z3................       2.9294      $121.28
78601..............  Brain image w/flow < 4     CH................  Z2................       3.2295      $133.70
                      views.
78605..............  Brain image 4+ views.....  CH................  Z2................       3.2295      $133.70
78606..............  Brain image w/flow 4 +     CH................  Z3................       5.0197      $207.82
                      views.
78607..............  Brain imaging (3d).......  CH................  Z3................        6.081      $251.76
78608..............  Brain imaging (pet)......  ..................  Z2................      16.6001      $687.26
78610..............  Brain flow imaging only..  ..................  Z3................        3.382      $140.02
78615..............  Cerebral vascular flow     CH................  D5................  ...........  ...........
                      image.
78630..............  Cerebrospinal fluid scan.  CH................  Z3................        5.538      $229.28
78635..............  Csf ventriculography.....  CH................  Z3................       4.5835      $189.76
78645..............  Csf shunt evaluation.....  ..................  Z2................       3.2295      $133.70
78647..............  Cerebrospinal fluid scan.  CH................  Z3................       5.8259      $241.20
78650..............  Csf leakage imaging......  CH................  Z3................       5.3487      $221.44
78660..............  Nuclear exam of tear flow  ..................  Z3................       2.5509      $105.61
78699..............  Nervous system nuclear     ..................  Z2................       3.2295      $133.70
                      exam.
78700..............  Kidney imaging, morphol..  ..................  Z3................       2.9953      $124.01
78701..............  Kidney imaging with flow.  ..................  Z3................       3.6125      $149.56
78707..............  K flow/funct image w/o     CH................  Z3................       3.9581      $163.87
                      drug.
78708..............  K flow/funct image w/drug  ..................  Z3................       3.0941      $128.10
78709..............  K flow/funct image,        ..................  Z2................       5.0824      $210.42
                      multiple.
78710..............  Kidney imaging (3d)......  CH................  Z3................       4.5175      $187.03
78725..............  Kidney function study....  CH................  Z3................       1.6541       $68.48
78730..............  Urinary bladder retention  CH................  Z3................       1.3908       $57.58
78740..............  Ureteral reflux study....  ..................  Z3................       3.1188      $129.12
78761..............  Testicular imaging w/flow  ..................  Z3................       3.2915      $136.27
78799..............  Genitourinary nuclear      ..................  Z2................       5.0824      $210.42
                      exam.
78800..............  Tumor imaging, limited     ..................  Z3................       3.1023      $128.44
                      area.
78801..............  Tumor imaging, mult areas  ..................  Z3................       4.1144      $170.34
78802..............  Tumor imaging, whole body  CH................  Z3................       5.5052      $227.92
78803..............  Tumor imaging (3d).......  CH................  Z3................       6.0564      $250.74
78804..............  Tumor imaging, whole body  CH................  Z3................      10.5082      $435.05
78805..............  Abscess imaging, ltd area  ..................  Z3................       3.0364      $125.71
78806..............  Abscess imaging, whole     CH................  Z3................       5.9658      $246.99
                      body.
78807..............  Nuclear localization/      CH................  Z3................       6.0482      $250.40
                      abscess.
78811..............  Pet image, ltd area......  ..................  Z2................      16.6001      $687.26
78812..............  Pet image, skull-thigh...  ..................  Z2................      16.6001      $687.26
78813..............  Pet image, full body.....  ..................  Z2................      16.6001      $687.26
78814..............  Pet image w/ct, lmtd.....  ..................  Z2................      16.6001      $687.26

[[Page 9921]]

 
78815..............  Pet image w/ct, skull-     ..................  Z2................      16.6001      $687.26
                      thigh.
78816..............  Pet image w/ct, full body  ..................  Z2................      16.6001      $687.26
78890..............  Nuclear medicine data      ..................  N1................  ...........  ...........
                      proc.
78891..............  Nuclear med data proc....  ..................  N1................  ...........  ...........
78999..............  Nuclear diagnostic exam..  ..................  Z2................        1.819       $75.31
79005..............  Nuclear rx, oral admin...  ..................  Z3................       1.6046       $66.43
79101..............  Nuclear rx, iv admin.....  ..................  Z3................       1.6705       $69.16
79200..............  Nuclear rx, intracav       ..................  Z3................        1.728       $71.54
                      admin.
79300..............  Nuclr rx, interstit        ..................  Z2................        3.302      $136.71
                      colloid.
79403..............  Hematopoietic nuclear tx.  ..................  Z3................       2.6497      $109.70
79440..............  Nuclear rx, intra-         ..................  Z3................       1.5553       $64.39
                      articular.
79445..............  Nuclear rx, intra-         ..................  Z2................        3.302      $136.71
                      arterial.
79999..............  Nuclear medicine therapy.  ..................  Z2................        3.302      $136.71
90296..............  Diphtheria antitoxin.....  CH................  N1................  ...........  ...........
90371..............  Hep b ig, im.............  ..................  K2................  ...........      $122.02
90375..............  Rabies ig, im/sc.........  ..................  K2................  ...........       $68.22
90376..............  Rabies ig, heat treated..  ..................  K2................  ...........       $71.69
90385..............  Rh ig, minidose, im......  CH................  N1................  ...........  ...........
90393..............  Vaccina ig, im...........  CH................  N1................  ...........  ...........
90396..............  Varicella-zoster ig, im..  ..................  K2................  ...........      $122.74
90476..............  Adenovirus vaccine, type   CH................  N1................  ...........  ...........
                      4.
90477..............  Adenovirus vaccine, type   CH................  N1................  ...........  ...........
                      7.
90581..............  Anthrax vaccine, sc......  CH................  N1................  ...........  ...........
90585..............  Bcg vaccine, percut......  ..................  K2................  ...........      $118.98
90632..............  Hep a vaccine, adult im..  CH................  N1................  ...........  ...........
90633..............  Hep a vacc, ped/adol, 2    CH................  N1................  ...........  ...........
                      dose.
90634..............  Hep a vacc, ped/adol, 3    CH................  N1................  ...........  ...........
                      dose.
90636..............  Hep a/hep b vacc, adult    CH................  N1................  ...........  ...........
                      im.
90645..............  Hib vaccine, hboc, im....  CH................  N1................  ...........  ...........
90646..............  Hib vaccine, prp-d, im...  CH................  N1................  ...........  ...........
90647..............  Hib vaccine, prp-omp, im.  CH................  N1................  ...........  ...........
90648..............  Hib vaccine, prp-t, im...  CH................  N1................  ...........  ...........
90665..............  Lyme disease vaccine, im.  CH................  N1................  ...........  ...........
90675..............  Rabies vaccine, im.......  ..................  K2................  ...........      $150.80
90676..............  Rabies vaccine, id.......  ..................  K2................  ...........      $119.86
90680..............  Rotovirus vacc 3 dose,     CH................  N1................  ...........  ...........
                      oral.
90690..............  Typhoid vaccine, oral....  CH................  N1................  ...........  ...........
90691..............  Typhoid vaccine, im......  CH................  N1................  ...........  ...........
90692..............  Typhoid vaccine, h-p, sc/  CH................  N1................  ...........  ...........
                      id.
90698..............  Dtap-hib-ip vaccine, im..  CH................  N1................  ...........  ...........
90700..............  Dtap vaccine, < 7 yrs, im  CH................  N1................  ...........  ...........
90701..............  Dtp vaccine, im..........  CH................  N1................  ...........  ...........
90702..............  Dt vaccine < 7, im.......  CH................  N1................  ...........  ...........
90703..............  Tetanus vaccine, im......  CH................  N1................  ...........  ...........
90704..............  Mumps vaccine, sc........  CH................  N1................  ...........  ...........
90705..............  Measles vaccine, sc......  CH................  N1................  ...........  ...........
90706..............  Rubella vaccine, sc......  CH................  N1................  ...........  ...........
90707..............  Mmr vaccine, sc..........  CH................  N1................  ...........  ...........
90708..............  Measles-rubella vaccine,   ..................  K2................  ...........       $45.53
                      sc.
90710..............  Mmrv vaccine, sc.........  CH................  N1................  ...........  ...........
90712..............  Oral poliovirus vaccine..  CH................  N1................  ...........  ...........
90713..............  Poliovirus, ipv, sc/im...  CH................  N1................  ...........  ...........
90714..............  Td vaccine no prsrv >/= 7  CH................  N1................  ...........  ...........
                      im.
90715..............  Tdap vaccine >7 im.......  CH................  N1................  ...........  ...........
90717..............  Yellow fever vaccine, sc.  CH................  N1................  ...........  ...........
90718..............  Td vaccine > 7, im.......  CH................  N1................  ...........  ...........
90719..............  Diphtheria vaccine, im...  CH................  N1................  ...........  ...........
90720..............  Dtp/hib vaccine, im......  CH................  N1................  ...........  ...........
90721..............  Dtap/hib vaccine, im.....  CH................  N1................  ...........  ...........
90725..............  Cholera vaccine,           CH................  N1................  ...........  ...........
                      injectable.
90727..............  Plague vaccine, im.......  CH................  N1................  ...........  ...........
90733..............  Meningococcal vaccine, sc  ..................  K2................  ...........       $85.29
90734..............  Meningococcal vaccine, im  ..................  K2................  ...........       $82.00
90735..............  Encephalitis vaccine, sc.  ..................  K2................  ...........       $98.17
90749..............  Vaccine toxoid...........  CH................  N1................  ...........  ...........
A4218..............  Sterile saline or water..  ..................  N1................  ...........  ...........
A4220..............  Infusion pump refill kit.  ..................  N1................  ...........  ...........
A4248..............  Chlorhexidine antisept...  ..................  N1................  ...........  ...........

[[Page 9922]]

 
A4262..............  Temporary tear duct plug.  ..................  N1................  ...........  ...........
A4263..............  Permanent tear duct plug.  ..................  N1................  ...........  ...........
A4270..............  Disposable endoscope       ..................  N1................  ...........  ...........
                      sheath.
A4300..............  Cath impl vasc access      ..................  N1................  ...........  ...........
                      portal.
A4301..............  Implantable access syst    ..................  N1................  ...........  ...........
                      perc.
A4305..............  Drug delivery system >=50  ..................  N1................  ...........  ...........
                      ML.
A4306..............  Drug delivery system <=50  ..................  N1................  ...........  ...........
                      ml.
A4648..............  Implantable tissue marker  NI................  N1................  ...........  ...........
A4650..............  Implant radiation          NI................  N1................  ...........  ...........
                      dosimeter.
A9527..............  Iodine I-125 sodium        CH................  H2................       0.4325       $27.55
                      iodide.
A9535..............  Injection, methylene blue  CH................  N1................  ...........  ...........
A9576..............  Inj prohance multipack...  NI................  N1................  ...........  ...........
A9577..............  Inj multihance...........  NI................  N1................  ...........  ...........
A9578..............  Inj multihance multipack.  NI................  N1................  ...........  ...........
A9579..............  Gad-base MR contrast       NI................  N1................  ...........  ...........
                      NOS,1ml.
A9698..............  Non-rad contrast           ..................  N1................  ...........  ...........
                      materialNOC.
C1713..............  Anchor/screw bn/bn,tis/bn  ..................  N1................  ...........  ...........
C1714..............  Cath, trans atherectomy,   ..................  N1................  ...........  ...........
                      dir.
C1715..............  Brachytherapy needle.....  ..................  N1................  ...........  ...........
C1716..............  Brachytx, non-str, Gold-   CH................  H2................       0.5228       $33.30
                      198.
C1717..............  Brachytx, non-str,HDR Ir-  CH................  H2................       2.7505      $175.19
                      192.
C1719..............  Brachytx, NS, Non-HDRIr-   CH................  H2................       1.0226       $65.13
                      192.
C1721..............  AICD, dual chamber.......  ..................  N1................  ...........  ...........
C1722..............  AICD, single chamber.....  ..................  N1................  ...........  ...........
C1724..............  Cath, trans                ..................  N1................  ...........  ...........
                      atherec,rotation.
C1725..............  Cath, translumin non-      ..................  N1................  ...........  ...........
                      laser.
C1726..............  Cath, bal dil, non-        ..................  N1................  ...........  ...........
                      vascular.
C1727..............  Cath, bal tis dis, non-    ..................  N1................  ...........  ...........
                      vas.
C1728..............  Cath, brachytx seed adm..  ..................  N1................  ...........  ...........
C1729..............  Cath, drainage...........  ..................  N1................  ...........  ...........
C1730..............  Cath, EP, 19 or few elect  ..................  N1................  ...........  ...........
C1731..............  Cath, EP, 20 or more elec  ..................  N1................  ...........  ...........
C1732..............  Cath, EP, diag/abl, 3D/    ..................  N1................  ...........  ...........
                      vect.
C1733..............  Cath, EP, othr than cool-  ..................  N1................  ...........  ...........
                      tip.
C1750..............  Cath, hemodialysis,long-   ..................  N1................  ...........  ...........
                      term.
C1751..............  Cath, inf, per/cent/       ..................  N1................  ...........  ...........
                      midline.
C1752..............  Cath,hemodialysis,short-   ..................  N1................  ...........  ...........
                      term.
C1753..............  Cath, intravas ultrasound  ..................  N1................  ...........  ...........
C1754..............  Catheter, intradiscal....  ..................  N1................  ...........  ...........
C1755..............  Catheter, intraspinal....  ..................  N1................  ...........  ...........
C1756..............  Cath, pacing, transesoph.  ..................  N1................  ...........  ...........
C1757..............  Cath, thrombectomy/        ..................  N1................  ...........  ...........
                      embolect.
C1758..............  Catheter, ureteral.......  ..................  N1................  ...........  ...........
C1759..............  Cath, intra                ..................  N1................  ...........  ...........
                      echocardiography.
C1760..............  Closure dev, vasc........  ..................  N1................  ...........  ...........
C1762..............  Conn tiss, human(inc       ..................  N1................  ...........  ...........
                      fascia).
C1763..............  Conn tiss, non-human.....  ..................  N1................  ...........  ...........
C1764..............  Event recorder, cardiac..  ..................  N1................  ...........  ...........
C1765..............  Adhesion barrier.........  ..................  N1................  ...........  ...........
C1766..............  Intro/sheath,strble,non-   ..................  N1................  ...........  ...........
                      peel.
C1767..............  Generator, neuro non-      ..................  N1................  ...........  ...........
                      recharg.
C1768..............  Graft, vascular..........  ..................  N1................  ...........  ...........
C1769..............  Guide wire...............  ..................  N1................  ...........  ...........
C1770..............  Imaging coil, MR,          ..................  N1................  ...........  ...........
                      insertable.
C1771..............  Rep dev, urinary, w/sling  ..................  N1................  ...........  ...........
C1772..............  Infusion pump,             ..................  N1................  ...........  ...........
                      programmable.
C1773..............  Ret dev, insertable......  ..................  N1................  ...........  ...........
C1776..............  Joint device               ..................  N1................  ...........  ...........
                      (implantable).
C1777..............  Lead, AICD, endo single    ..................  N1................  ...........  ...........
                      coil.
C1778..............  Lead, neurostimulator....  ..................  N1................  ...........  ...........
C1779..............  Lead, pmkr, transvenous    ..................  N1................  ...........  ...........
                      VDD.
C1780..............  Lens, intraocular (new     ..................  N1................  ...........  ...........
                      tech).
C1781..............  Mesh (implantable).......  ..................  N1................  ...........  ...........
C1782..............  Morcellator..............  ..................  N1................  ...........  ...........
C1783..............  Ocular imp, aqueous drain  ..................  N1................  ...........  ...........
                      de.
C1784..............  Ocular dev, intraop, det   ..................  N1................  ...........  ...........
                      ret.
C1785..............  Pmkr, dual, rate-resp....  ..................  N1................  ...........  ...........
C1786..............  Pmkr, single, rate-resp..  ..................  N1................  ...........  ...........

[[Page 9923]]

 
C1787..............  Patient progr, neurostim.  ..................  N1................  ...........  ...........
C1788..............  Port, indwelling, imp....  ..................  N1................  ...........  ...........
C1789..............  Prosthesis, breast, imp..  ..................  N1................  ...........  ...........
C1813..............  Prosthesis, penile,        ..................  N1................  ...........  ...........
                      inflatab.
C1814..............  Retinal tamp, silicone     ..................  N1................  ...........  ...........
                      oil.
C1815..............  Pros, urinary sph, imp...  ..................  N1................  ...........  ...........
C1816..............  Receiver/transmitter,      ..................  N1................  ...........  ...........
                      neuro.
C1817..............  Septal defect imp sys....  ..................  N1................  ...........  ...........
C1818..............  Integrated                 ..................  N1................  ...........  ...........
                      keratoprosthesis.
C1819..............  Tissue localization-       ..................  N1................  ...........  ...........
                      excision.
C1820..............  Generator neuro rechg bat  CH................  N1................  ...........  ...........
                      sy.
C1821..............  Interspinous implant.....  ..................  J7................  ...........  ...........
C1874..............  Stent, coated/cov w/del    ..................  N1................  ...........  ...........
                      sys.
C1875..............  Stent, coated/cov w/o del  ..................  N1................  ...........  ...........
                      sy.
C1876..............  Stent, non-coa/non-cov w/  ..................  N1................  ...........  ...........
                      del.
C1877..............  Stent, non-coat/cov w/o    ..................  N1................  ...........  ...........
                      del.
C1878..............  Matrl for vocal cord.....  ..................  N1................  ...........  ...........
C1879..............  Tissue marker,             ..................  N1................  ...........  ...........
                      implantable.
C1880..............  Vena cava filter.........  ..................  N1................  ...........  ...........
C1881..............  Dialysis access system...  ..................  N1................  ...........  ...........
C1882..............  AICD, other than sing/     ..................  N1................  ...........  ...........
                      dual.
C1883..............  Adapt/ext, pacing/neuro    ..................  N1................  ...........  ...........
                      lead.
C1884..............  Embolization Protect syst  ..................  N1................  ...........  ...........
C1885..............  Cath, translumin angio     ..................  N1................  ...........  ...........
                      laser.
C1887..............  Catheter, guiding........  ..................  N1................  ...........  ...........
C1888..............  Endovas non-cardiac abl    ..................  N1................  ...........  ...........
                      cath.
C1891..............  Infusion pump,non-prog,    ..................  N1................  ...........  ...........
                      perm.
C1892..............  Intro/sheath,fixed,peel-   ..................  N1................  ...........  ...........
                      away.
C1893..............  Intro/sheath, fixed,non-   ..................  N1................  ...........  ...........
                      peel.
C1894..............  Intro/sheath, non-laser..  ..................  N1................  ...........  ...........
C1895..............  Lead, AICD, endo dual      ..................  N1................  ...........  ...........
                      coil.
C1896..............  Lead, AICD, non sing/dual  ..................  N1................  ...........  ...........
C1897..............  Lead, neurostim test kit.  ..................  N1................  ...........  ...........
C1898..............  Lead, pmkr, other than     ..................  N1................  ...........  ...........
                      trans.
C1899..............  Lead, pmkr/AICD            ..................  N1................  ...........  ...........
                      combination.
C1900..............  Lead, coronary venous....  ..................  N1................  ...........  ...........
C2614..............  Probe, perc lumb disc....  ..................  N1................  ...........  ...........
C2615..............  Sealant, pulmonary,        ..................  N1................  ...........  ...........
                      liquid.
C2616..............  Brachytx, non-str,Yttrium- CH................  H2................     184.7105   $11,764.95
                      90.
C2617..............  Stent, non-cor, tem w/o    ..................  N1................  ...........  ...........
                      del.
C2618..............  Probe, cryoablation......  ..................  N1................  ...........  ...........
C2619..............  Pmkr, dual, non rate-resp  ..................  N1................  ...........  ...........
C2620..............  Pmkr, single, non rate-    ..................  N1................  ...........  ...........
                      resp.
C2621..............  Pmkr, other than sing/     ..................  N1................  ...........  ...........
                      dual.
C2622..............  Prosthesis, penile, non-   ..................  N1................  ...........  ...........
                      inf.
C2625..............  Stent, non-cor, tem w/del  ..................  N1................  ...........  ...........
                      sy.
C2626..............  Infusion pump, non-        ..................  N1................  ...........  ...........
                      prog,temp.
C2627..............  Cath, suprapubic/          ..................  N1................  ...........  ...........
                      cystoscopic.
C2628..............  Catheter, occlusion......  ..................  N1................  ...........  ...........
C2629..............  Intro/sheath, laser......  ..................  N1................  ...........  ...........
C2630..............  Cath, EP, cool-tip.......  ..................  N1................  ...........  ...........
C2631..............  Rep dev, urinary, w/o      ..................  N1................  ...........  ...........
                      sling.
C2634..............  Brachytx, non-str, HA, I-  CH................  H2................       0.4858       $30.94
                      125.
C2635..............  Brachytx, non-str, HA, P-  CH................  H2................       0.7366       $46.92
                      103.
C2636..............  Brachy linear, non-str,P-  CH................  H2................         0.66       $42.04
                      103.
C2638..............  Brachytx, stranded, I-125  CH................  H2................       0.7113       $45.31
C2639..............  Brachytx, non-stranded,I-  CH................  H2................       0.5039       $32.10
                      125.
C2640..............  Brachytx, stranded, P-103  CH................  H2................       1.0308       $65.66
C2641..............  Brachytx, non-stranded,P-  CH................  H2................       0.8077       $51.45
                      103.
C2642..............  Brachytx, stranded, C-131  CH................  H2................       1.5342       $97.72
C2643..............  Brachytx, non-stranded,C-  CH................  H2................        1.006       $64.08
                      131.
C2698..............  Brachytx, stranded, NOS..  CH................  H2................       0.7113       $45.31
C2699..............  Brachytx, non-stranded,    CH................  H2................       0.4858       $30.94
                      NOS.
C8900..............  MRA w/cont, abd..........  ..................  Z2................        6.235      $258.14
C8901..............  MRA w/o cont, abd........  ..................  Z2................       5.3933      $223.29
C8902..............  MRA w/o fol w/cont, abd..  ..................  Z2................       8.2463      $341.41
C8903..............  MRI w/cont, breast, uni..  ..................  Z2................        6.235      $258.14
C8904..............  MRI w/o cont, breast, uni  ..................  Z2................       5.3933      $223.29

[[Page 9924]]

 
C8905..............  MRI w/o fol w/cont, brst,  ..................  Z2................       8.2463      $341.41
                      un.
C8906..............  MRI w/cont, breast, bi...  ..................  Z2................        6.235      $258.14
C8907..............  MRI w/o cont, breast, bi.  ..................  Z2................       5.3933      $223.29
C8908..............  MRI w/o fol w/cont,        ..................  Z2................       8.2463      $341.41
                      breast,.
C8909..............  MRA w/cont, chest........  ..................  Z2................        6.235      $258.14
C8910..............  MRA w/o cont, chest......  ..................  Z2................       5.3933      $223.29
C8911..............  MRA w/o fol w/cont, chest  ..................  Z2................       8.2463      $341.41
C8912..............  MRA w/cont, lwr ext......  ..................  Z2................        6.235      $258.14
C8913..............  MRA w/o cont, lwr ext....  ..................  Z2................       5.3933      $223.29
C8914..............  MRA w/o fol w/cont, lwr    ..................  Z2................       8.2463      $341.41
                      ext.
C8918..............  MRA w/cont, pelvis.......  ..................  Z2................        6.235      $258.14
C8919..............  MRA w/o cont, pelvis.....  ..................  Z2................       5.3933      $223.29
C8920..............  MRA w/o fol w/cont,        ..................  Z2................       8.2463      $341.41
                      pelvis.
C9003..............  Palivizumab, per 50 mg...  ..................  K2................  ...........      $810.67
C9113..............  Inj pantoprazole sodium,   ..................  N1................  ...........  ...........
                      via.
C9121..............  Injection, argatroban....  ..................  K2................  ...........       $18.96
C9232..............  Injection, idursulfase...  CH................  D5................  ...........  ...........
C9233..............  Injection, ranibizumab...  CH................  D5................  ...........  ...........
C9234..............  Inj, alglucosidase alfa..  CH................  D5................  ...........  ...........
C9235..............  Injection, panitumumab...  CH................  D5................  ...........  ...........
C9238..............  Inj, levetiracetam.......  NI................  K2................  ...........        $6.30
C9239..............  Inj, temsirolimus........  NI................  K2................  ...........       $48.41
C9350..............  Porous collagen tube per   CH................  D5................  ...........  ...........
                      cm.
C9351..............  Acellular derm tissue      CH................  D5................  ...........  ...........
                      percm2.
C9352..............  Neuragen nerve guide, per  NI................  K2................  ...........      $482.56
                      cm.
C9353..............  Neurawrap nerve            NI................  K2................  ...........      $482.56
                      protector,cm.
C9399..............  Unclassified drugs or      ..................  K7................  ...........  ...........
                      biolog.
E0616..............  Cardiac event recorder...  ..................  N1................  ...........  ...........
E0749..............  Elec osteogen stim         ..................  N1................  ...........  ...........
                      implanted.
E0782..............  Non-programble infusion    ..................  N1................  ...........  ...........
                      pump.
E0783..............  Programmable infusion      ..................  N1................  ...........  ...........
                      pump.
E0785..............  Replacement impl pump      ..................  N1................  ...........  ...........
                      cathet.
E0786..............  Implantable pump           ..................  N1................  ...........  ...........
                      replacement.
G0130..............  Single energy x-ray study  ..................  Z3................       0.5348       $22.14
G0173..............  Linear acc stereo radsur   ..................  Z2................      61.6965    $2,554.30
                      com.
G0251..............  Linear acc based stero     ..................  Z2................      16.5911      $686.89
                      radio.
G0288..............  Recon, CTA for surg plan.  CH................  N1................  ...........  ...........
G0339..............  Robot lin-radsurg com,     ..................  Z2................      61.6965    $2,554.30
                      first.
G0340..............  Robt lin-radsurg fractx 2- ..................  Z2................      45.0693    $1,865.91
                      5.
J0120..............  Tetracyclin injection....  ..................  N1................  ...........  ...........
J0128..............  Abarelix injection.......  ..................  K2................  ...........       $67.97
J0129..............  Abatacept injection......  ..................  K2................  ...........       $18.69
J0130..............  Abciximab injection......  ..................  K2................  ...........      $420.17
J0132..............  Acetylcysteine injection.  CH................  N1................  ...........  ...........
J0133..............  Acyclovir injection......  ..................  N1................  ...........  ...........
J0135..............  Adalimumab injection.....  ..................  K2................  ...........      $329.58
J0150..............  Injection adenosine 6 MG.  ..................  K2................  ...........       $25.10
J0152..............  Adenosine injection......  ..................  K2................  ...........       $67.89
J0170..............  Adrenalin epinephrin       ..................  N1................  ...........  ...........
                      inject.
J0180..............  Agalsidase beta injection  ..................  K2................  ...........      $126.00
J0190..............  Inj biperiden lactate/5    ..................  K2................  ...........       $88.15
                      mg.
J0200..............  Alatrofloxacin mesylate..  ..................  N1................  ...........  ...........
J0205..............  Alglucerase injection....  ..................  K2................  ...........       $38.85
J0207..............  Amifostine...............  ..................  K2................  ...........      $490.93
J0210..............  Methyldopate hcl           ..................  K2................  ...........       $13.04
                      injection.
J0215..............  Alefacept................  ..................  K2................  ...........       $26.47
J0220..............  Aglucosidase alfa          NI................  K2................  ...........      $126.00
                      injection.
J0256..............  Alpha 1 proteinase         ..................  K2................  ...........        $3.28
                      inhibitor.
J0278..............  Amikacin sulfate           ..................  N1................  ...........  ...........
                      injection.
J0280..............  Aminophyllin 250 MG inj..  ..................  N1................  ...........  ...........
J0282..............  Amiodarone HCl...........  ..................  N1................  ...........  ...........
J0285..............  Amphotericin B...........  ..................  N1................  ...........  ...........
J0287..............  Amphotericin b lipid       ..................  K2................  ...........       $10.40
                      complex.
J0288..............  Ampho b cholesteryl        ..................  K2................  ...........       $11.89
                      sulfate.
J0289..............  Amphotericin b liposome    ..................  K2................  ...........       $16.21
                      inj.
J0290..............  Ampicillin 500 MG inj....  ..................  N1................  ...........  ...........
J0295..............  Ampicillin sodium per 1.5  ..................  N1................  ...........  ...........
                      gm.
J0300..............  Amobarbital 125 MG inj...  ..................  N1................  ...........  ...........

[[Page 9925]]

 
J0330..............  Succinycholine chloride    ..................  N1................  ...........  ...........
                      inj.
J0348..............  Anadulafungin injection..  ..................  K2................  ...........        $1.91
J0350..............  Injection anistreplase 30  ..................  K2................  ...........    $2,693.80
                      u.
J0360..............  Hydralazine hcl injection  ..................  N1................  ...........  ...........
J0364..............  Apomorphine hydrochloride  CH................  N1................  ...........  ...........
J0365..............  Aprotonin, 10,000 kiu....  ..................  K2................  ...........        $2.66
J0380..............  Inj metaraminol            CH................  N1................  ...........  ...........
                      bitartrate.
J0390..............  Chloroquine injection....  ..................  N1................  ...........  ...........
J0395..............  Arbutamine HCl injection.  CH................  N1................  ...........  ...........
J0400..............  Aripiprazole injection...  NI................  K2................  ...........        $0.28
J0456..............  Azithromycin.............  ..................  N1................  ...........  ...........
J0460..............  Atropine sulfate           ..................  N1................  ...........  ...........
                      injection.
J0470..............  Dimecaprol injection.....  ..................  N1................  ...........  ...........
J0475..............  Baclofen 10 MG injection.  ..................  K2................  ...........      $193.29
J0476..............  Baclofen intrathecal       ..................  K2................  ...........       $69.73
                      trial.
J0480..............  Basiliximab..............  ..................  K2................  ...........    $1,541.03
J0500..............  Dicyclomine injection....  ..................  N1................  ...........  ...........
J0515..............  Inj benztropine mesylate.  ..................  N1................  ...........  ...........
J0520..............  Bethanechol chloride       ..................  N1................  ...........  ...........
                      inject.
J0530..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0540..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0550..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0560..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0570..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0580..............  Penicillin g benzathine    ..................  N1................  ...........  ...........
                      inj.
J0583..............  Bivalirudin..............  ..................  K2................  ...........        $1.84
J0585..............  Botulinum toxin a per      ..................  K2................  ...........        $5.21
                      unit.
J0587..............  Botulinum toxin type B...  ..................  K2................  ...........        $8.63
J0592..............  Buprenorphine              ..................  N1................  ...........  ...........
                      hydrochloride.
J0594..............  Busulfan injection.......  ..................  K2................  ...........        $9.17
J0595..............  Butorphanol tartrate 1 mg  ..................  N1................  ...........  ...........
J0600..............  Edetate calcium disodium   ..................  K2................  ...........       $49.64
                      inj.
J0610..............  Calcium gluconate          ..................  N1................  ...........  ...........
                      injection.
J0620..............  Calcium glycer & lact/10   ..................  N1................  ...........  ...........
                      ML.
J0630..............  Calcitonin salmon          ..................  N1................  ...........  ...........
                      injection.
J0636..............  Inj calcitriol per 0.1     ..................  N1................  ...........  ...........
                      mcg.
J0637..............  Caspofungin acetate......  ..................  K2................  ...........       $24.05
J0640..............  Leucovorin calcium         ..................  N1................  ...........  ...........
                      injection.
J0670..............  Inj mepivacaine HCL/10 ml  ..................  N1................  ...........  ...........
J0690..............  Cefazolin sodium           ..................  N1................  ...........  ...........
                      injection.
J0692..............  Cefepime HCl for           ..................  N1................  ...........  ...........
                      injection.
J0694..............  Cefoxitin sodium           ..................  N1................  ...........  ...........
                      injection.
J0696..............  Ceftriaxone sodium         ..................  N1................  ...........  ...........
                      injection.
J0697..............  Sterile cefuroxime         ..................  N1................  ...........  ...........
                      injection.
J0698..............  Cefotaxime sodium          ..................  N1................  ...........  ...........
                      injection.
J0702..............  Betamethasone acet & sod   ..................  N1................  ...........  ...........
                      phosp.
J0704..............  Betamethasone sod phosp/4  ..................  N1................  ...........  ...........
                      MG.
J0706..............  Caffeine citrate           CH................  N1................  ...........  ...........
                      injection.
J0710..............  Cephapirin sodium          ..................  N1................  ...........  ...........
                      injection.
J0713..............  Inj ceftazidime per 500    ..................  N1................  ...........  ...........
                      mg.
J0715..............  Ceftizoxime sodium/500 MG  ..................  N1................  ...........  ...........
J0720..............  Chloramphenicol sodium     ..................  N1................  ...........  ...........
                      injec.
J0725..............  Chorionic gonadotropin/    ..................  N1................  ...........  ...........
                      1000u.
J0735..............  Clonidine hydrochloride..  ..................  K2................  ...........       $62.78
J0740..............  Cidofovir injection......  ..................  K2................  ...........      $754.39
J0743..............  Cilastatin sodium          ..................  N1................  ...........  ...........
                      injection.
J0744..............  Ciprofloxacin iv.........  ..................  N1................  ...........  ...........
J0745..............  Inj codeine phosphate /30  ..................  N1................  ...........  ...........
                      MG.
J0760..............  Colchicine injection.....  ..................  N1................  ...........  ...........
J0770..............  Colistimethate sodium inj  ..................  N1................  ...........  ...........
J0780..............  Prochlorperazine           ..................  N1................  ...........  ...........
                      injection.
J0795..............  Corticorelin ovine         ..................  K2................  ...........        $4.43
                      triflutal.
J0800..............  Corticotropin injection..  ..................  K2................  ...........      $169.77
J0835..............  Inj cosyntropin per 0.25   ..................  K2................  ...........       $64.01
                      MG.
J0850..............  Cytomegalovirus imm IV /   ..................  K2................  ...........      $870.53
                      vial.
J0878..............  Daptomycin injection.....  ..................  K2................  ...........        $0.35
J0881..............  Darbepoetin alfa, non-     ..................  K2................  ...........        $2.88
                      esrd.
J0885..............  Epoetin alfa, non-esrd...  ..................  K2................  ...........        $8.97

[[Page 9926]]

 
J0894..............  Decitabine injection.....  ..................  K2................  ...........       $26.48
J0895..............  Deferoxamine mesylate inj  CH................  N1................  ...........  ...........
J0900..............  Testosterone enanthate     ..................  N1................  ...........  ...........
                      inj.
J0945..............  Brompheniramine maleate    ..................  N1................  ...........  ...........
                      inj.
J0970..............  Estradiol valerate         ..................  N1................  ...........  ...........
                      injection.
J1000..............  Depo-estradiol cypionate   ..................  N1................  ...........  ...........
                      inj.
J1020..............  Methylprednisolone 20 MG   ..................  N1................  ...........  ...........
                      inj.
J1030..............  Methylprednisolone 40 MG   ..................  N1................  ...........  ...........
                      inj.
J1040..............  Methylprednisolone 80 MG   ..................  N1................  ...........  ...........
                      inj.
J1051..............  Medroxyprogesterone inj..  ..................  N1................  ...........  ...........
J1060..............  Testosterone cypionate 1   ..................  N1................  ...........  ...........
                      ML.
J1070..............  Testosterone cypionat 100  ..................  N1................  ...........  ...........
                      MG.
J1080..............  Testosterone cypionat 200  ..................  N1................  ...........  ...........
                      MG.
J1094..............  Inj dexamethasone acetate  ..................  N1................  ...........  ...........
J1100..............  Dexamethasone sodium phos  ..................  N1................  ...........  ...........
J1110..............  Inj dihydroergotamine      ..................  N1................  ...........  ...........
                      mesylt.
J1120..............  Acetazolamid sodium        ..................  N1................  ...........  ...........
                      injectio.
J1160..............  Digoxin injection........  ..................  N1................  ...........  ...........
J1162..............  Digoxin immune fab         ..................  K2................  ...........      $478.88
                      (ovine).
J1165..............  Phenytoin sodium           ..................  N1................  ...........  ...........
                      injection.
J1170..............  Hydromorphone injection..  ..................  N1................  ...........  ...........
J1180..............  Dyphylline injection.....  ..................  N1................  ...........  ...........
J1190..............  Dexrazoxane HCl injection  ..................  K2................  ...........      $162.11
J1200..............  Diphenhydramine hcl        ..................  N1................  ...........  ...........
                      injectio.
J1205..............  Chlorothiazide sodium inj  ..................  K2................  ...........      $141.07
J1212..............  Dimethyl sulfoxide 50% 50  ..................  N1................  ...........  ...........
                      ML.
J1230..............  Methadone injection......  ..................  N1................  ...........  ...........
J1240..............  Dimenhydrinate injection.  ..................  N1................  ...........  ...........
J1245..............  Dipyridamole injection...  ..................  N1................  ...........  ...........
J1250..............  Inj dobutamine HCL/250 mg  ..................  N1................  ...........  ...........
J1260..............  Dolasetron mesylate......  ..................  K2................  ...........        $4.66
J1265..............  Dopamine injection.......  ..................  N1................  ...........  ...........
J1270..............  Injection,                 ..................  N1................  ...........  ...........
                      doxercalciferol.
J1300..............  Eculizumab injection.....  NI................  K2................  ...........      $176.38
J1320..............  Amitriptyline injection..  ..................  N1................  ...........  ...........
J1324..............  Enfuvirtide injection....  ..................  K2................  ...........        $0.40
J1325..............  Epoprostenol injection...  ..................  N1................  ...........  ...........
J1327..............  Eptifibatide injection...  ..................  K2................  ...........       $17.67
J1330..............  Ergonovine maleate         CH................  N1................  ...........  ...........
                      injection.
J1335..............  Ertapenem injection......  ..................  N1................  ...........  ...........
J1364..............  Erythro lactobionate /500  ..................  N1................  ...........  ...........
                      MG.
J1380..............  Estradiol valerate 10 MG   ..................  N1................  ...........  ...........
                      inj.
J1390..............  Estradiol valerate 20 MG   ..................  N1................  ...........  ...........
                      inj.
J1410..............  Inj estrogen conjugate 25  ..................  K2................  ...........       $66.64
                      MG.
J1430..............  Ethanolamine oleate 100    ..................  K2................  ...........       $79.23
                      mg.
J1435..............  Injection estrone per 1    ..................  N1................  ...........  ...........
                      MG.
J1436..............  Etidronate disodium inj..  ..................  K2................  ...........       $70.73
J1438..............  Etanercept injection.....  ..................  K2................  ...........      $167.12
J1440..............  Filgrastim 300 mcg         ..................  K2................  ...........      $193.79
                      injection.
J1441..............  Filgrastim 480 mcg         ..................  K2................  ...........      $298.39
                      injection.
J1450..............  Fluconazole..............  ..................  N1................  ...........  ...........
J1451..............  Fomepizole, 15 mg........  ..................  K2................  ...........       $12.80
J1452..............  Intraocular Fomivirsen na  CH................  N1................  ...........  ...........
J1455..............  Foscarnet sodium           CH................  N1................  ...........  ...........
                      injection.
J1457..............  Gallium nitrate injection  CH................  K2................  ...........        $1.61
J1458..............  Galsulfase injection.....  ..................  K2................  ...........      $306.88
J1460..............  Gamma globulin 1 CC inj..  ..................  K2................  ...........       $11.91
J1470..............  Gamma globulin 2 CC inj..  CH................  K2................  ...........       $23.82
J1480..............  Gamma globulin 3 CC inj..  CH................  K2................  ...........       $35.72
J1490..............  Gamma globulin 4 CC inj..  CH................  K2................  ...........       $47.64
J1500..............  Gamma globulin 5 CC inj..  CH................  K2................  ...........       $59.54
J1510..............  Gamma globulin 6 CC inj..  CH................  K2................  ...........       $71.50
J1520..............  Gamma globulin 7 CC inj..  CH................  K2................  ...........       $83.30
J1530..............  Gamma globulin 8 CC inj..  CH................  K2................  ...........       $95.27
J1540..............  Gamma globulin 9 CC inj..  CH................  K2................  ...........      $107.25
J1550..............  Gamma globulin 10 CC inj.  CH................  K2................  ...........      $119.09
J1560..............  Gamma globulin > 10 CC     CH................  K2................  ...........      $119.09
                      inj.
J1561..............  Gamunex injection........  NI................  K2................  ...........       $32.06

[[Page 9927]]

 
J1562..............  Vivaglobin, inj..........  ..................  K2................  ...........        $7.01
J1565..............  RSV-ivig.................  ..................  K2................  ...........       $16.02
J1566..............  Immune globulin, powder..  ..................  K2................  ...........       $26.89
J1567..............  Immune globulin, liquid..  CH................  D5................  ...........  ...........
J1568..............  Octagam injection........  NI................  K2................  ...........       $33.19
J1569..............  Gammagard liquid           NI................  K2................  ...........       $31.06
                      injection.
J1570..............  Ganciclovir sodium         ..................  N1................  ...........  ...........
                      injection.
J1571..............  Hepagam B IM injection...  NI................  K2................  ...........       $63.51
J1572..............  Flebogamma injection.....  NI................  K2................  ...........       $32.27
J1573..............  Hepagam B intravenous,     NI................  K2................  ...........       $63.51
                      inj.
J1580..............  Garamycin gentamicin inj.  ..................  N1................  ...........  ...........
J1590..............  Gatifloxacin injection...  ..................  N1................  ...........  ...........
J1595..............  Injection glatiramer       CH................  K2................  ...........       $52.04
                      acetate.
J1600..............  Gold sodium thiomaleate    ..................  N1................  ...........  ...........
                      inj.
J1610..............  Glucagon hydrochloride/1   ..................  K2................  ...........       $68.84
                      MG.
J1620..............  Gonadorelin hydroch/ 100   ..................  K2................  ...........      $178.59
                      mcg.
J1626..............  Granisetron HCl injection  ..................  K2................  ...........        $5.74
J1630..............  Haloperidol injection....  ..................  N1................  ...........  ...........
J1631..............  Haloperidol decanoate inj  ..................  N1................  ...........  ...........
J1640..............  Hemin, 1 mg..............  ..................  K2................  ...........        $7.08
J1642..............  Inj heparin sodium per 10  ..................  N1................  ...........  ...........
                      u.
J1644..............  Inj heparin sodium per     ..................  N1................  ...........  ...........
                      1000u.
J1645..............  Dalteparin sodium........  ..................  N1................  ...........  ...........
J1650..............  Inj enoxaparin sodium....  ..................  N1................  ...........  ...........
J1652..............  Fondaparinux sodium......  CH................  K2................  ...........        $5.92
J1655..............  Tinzaparin sodium          CH................  N1................  ...........  ...........
                      injection.
J1670..............  Tetanus immune globulin    ..................  K2................  ...........      $103.46
                      inj.
J1700..............  Hydrocortisone acetate     ..................  N1................  ...........  ...........
                      inj.
J1710..............  Hydrocortisone sodium ph   ..................  N1................  ...........  ...........
                      inj.
J1720..............  Hydrocortisone sodium      ..................  N1................  ...........  ...........
                      succ i.
J1730..............  Diazoxide injection......  ..................  K2................  ...........      $113.24
J1740..............  Ibandronate sodium         ..................  K2................  ...........      $138.96
                      injection.
J1742..............  Ibutilide fumarate         ..................  K2................  ...........      $287.15
                      injection.
J1743..............  Idursulfase injection....  NI................  K2................  ...........      $455.03
J1745..............  Infliximab injection.....  ..................  K2................  ...........       $54.42
J1751..............  Iron dextran 165           ..................  K2................  ...........       $11.82
                      injection.
J1752..............  Iron dextran 267           ..................  K2................  ...........       $10.30
                      injection.
J1756..............  Iron sucrose injection...  ..................  K2................  ...........        $0.36
J1785..............  Injection imiglucerase /   ..................  K2................  ...........        $3.89
                      unit.
J1790..............  Droperidol injection.....  ..................  N1................  ...........  ...........
J1800..............  Propranolol injection....  ..................  N1................  ...........  ...........
J1815..............  Insulin injection........  ..................  N1................  ...........  ...........
J1817..............  Insulin for insulin pump   ..................  N1................  ...........  ...........
                      use.
J1830..............  Interferon beta-1b/.25 MG  ..................  K2................  ...........      $106.57
J1835..............  Itraconazole injection...  ..................  K2................  ...........       $39.68
J1840..............  Kanamycin sulfate 500 MG   ..................  N1................  ...........  ...........
                      inj.
J1850..............  Kanamycin sulfate 75 MG    ..................  N1................  ...........  ...........
                      inj.
J1885..............  Ketorolac tromethamine     ..................  N1................  ...........  ...........
                      inj.
J1890..............  Cephalothin sodium         ..................  N1................  ...........  ...........
                      injection.
J1931..............  Laronidase injection.....  ..................  K2................  ...........       $23.64
J1940..............  Furosemide injection.....  ..................  N1................  ...........  ...........
J1945..............  Lepirudin................  ..................  K2................  ...........      $159.44
J1950..............  Leuprolide acetate /3.75   ..................  K2................  ...........      $452.58
                      MG.
J1956..............  Levofloxacin injection...  ..................  N1................  ...........  ...........
J1960..............  Levorphanol tartrate inj.  ..................  N1................  ...........  ...........
J1980..............  Hyoscyamine sulfate inj..  ..................  N1................  ...........  ...........
J1990..............  Chlordiazepoxide           ..................  N1................  ...........  ...........
                      injection.
J2001..............  Lidocaine injection......  ..................  N1................  ...........  ...........
J2010..............  Lincomycin injection.....  ..................  N1................  ...........  ...........
J2020..............  Linezolid injection......  ..................  K2................  ...........       $25.17
J2060..............  Lorazepam injection......  ..................  N1................  ...........  ...........
J2150..............  Mannitol injection.......  ..................  N1................  ...........  ...........
J2170..............  Mecasermin injection.....  ..................  K2................  ...........       $15.62
J2175..............  Meperidine hydrochl /100   ..................  N1................  ...........  ...........
                      MG.
J2180..............  Meperidine/promethazine    ..................  N1................  ...........  ...........
                      inj.
J2185..............  Meropenem................  CH................  N1................  ...........  ...........
J2210..............  Methylergonovin maleate    ..................  N1................  ...........  ...........
                      inj.
J2248..............  Micafungin sodium          ..................  K2................  ...........        $1.44
                      injection.

[[Page 9928]]

 
J2250..............  Inj midazolam              ..................  N1................  ...........  ...........
                      hydrochloride.
J2260..............  Inj milrinone lactate/5    ..................  N1................  ...........  ...........
                      MG.
J2270..............  Morphine sulfate           ..................  N1................  ...........  ...........
                      injection.
J2271..............  Morphine so4 injection     ..................  N1................  ...........  ...........
                      100mg.
J2275..............  Morphine sulfate           ..................  N1................  ...........  ...........
                      injection.
J2278..............  Ziconotide injection.....  ..................  K2................  ...........        $6.46
J2280..............  Inj, moxifloxacin 100 mg.  ..................  N1................  ...........  ...........
J2300..............  Inj nalbuphine             ..................  N1................  ...........  ...........
                      hydrochloride.
J2310..............  Inj naloxone               ..................  N1................  ...........  ...........
                      hydrochloride.
J2315..............  Naltrexone, depot form...  ..................  K2................  ...........        $1.87
J2320..............  Nandrolone decanoate 50    ..................  N1................  ...........  ...........
                      MG.
J2321..............  Nandrolone decanoate 100   ..................  N1................  ...........  ...........
                      MG.
J2322..............  Nandrolone decanoate 200   ..................  N1................  ...........  ...........
                      MG.
J2323..............  Natalizumab injection....  NI................  K2................  ...........        $7.51
J2325..............  Nesiritide injection.....  ..................  K2................  ...........       $32.95
J2353..............  Octreotide injection,      ..................  K2................  ...........       $99.04
                      depot.
J2354..............  Octreotide inj, non-depot  ..................  N1................  ...........  ...........
J2355..............  Oprelvekin injection.....  ..................  K2................  ...........      $247.02
J2357..............  Omalizumab injection.....  ..................  K2................  ...........       $17.12
J2360..............  Orphenadrine injection...  ..................  N1................  ...........  ...........
J2370..............  Phenylephrine hcl          ..................  N1................  ...........  ...........
                      injection.
J2400..............  Chloroprocaine hcl         ..................  N1................  ...........  ...........
                      injection.
J2405..............  Ondansetron hcl injection  ..................  K2................  ...........        $0.26
J2410..............  Oxymorphone hcl injection  ..................  N1................  ...........  ...........
J2425..............  Palifermin injection.....  ..................  K2................  ...........       $11.24
J2430..............  Pamidronate disodium /30   ..................  K2................  ...........       $28.31
                      MG.
J2440..............  Papaverin hcl injection..  ..................  N1................  ...........  ...........
J2460..............  Oxytetracycline injection  ..................  N1................  ...........  ...........
J2469..............  Palonosetron HCl.........  ..................  K2................  ...........       $16.45
J2501..............  Paricalcitol.............  ..................  N1................  ...........  ...........
J2503..............  Pegaptanib sodium          ..................  K2................  ...........    $1,035.69
                      injection.
J2504..............  Pegademase bovine, 25 iu.  ..................  K2................  ...........      $197.51
J2505..............  Injection, pegfilgrastim   ..................  K2................  ...........    $2,145.12
                      6mg.
J2510..............  Penicillin g procaine inj  ..................  N1................  ...........  ...........
J2513..............  Pentastarch 10% solution.  CH................  K2................  ...........       $21.98
J2515..............  Pentobarbital sodium inj.  ..................  N1................  ...........  ...........
J2540..............  Penicillin g potassium     ..................  N1................  ...........  ...........
                      inj.
J2543..............  Piperacillin/tazobactam..  ..................  N1................  ...........  ...........
J2550..............  Promethazine hcl           ..................  N1................  ...........  ...........
                      injection.
J2560..............  Phenobarbital sodium inj.  ..................  N1................  ...........  ...........
J2590..............  Oxytocin injection.......  ..................  N1................  ...........  ...........
J2597..............  Inj desmopressin acetate.  ..................  N1................  ...........  ...........
J2650..............  Prednisolone acetate inj.  ..................  N1................  ...........  ...........
J2670..............  Totazoline hcl injection.  ..................  N1................  ...........  ...........
J2675..............  Inj progesterone per 50    ..................  N1................  ...........  ...........
                      MG.
J2680..............  Fluphenazine decanoate 25  ..................  N1................  ...........  ...........
                      MG.
J2690..............  Procainamide hcl           ..................  N1................  ...........  ...........
                      injection.
J2700..............  Oxacillin sodium           ..................  N1................  ...........  ...........
                      injeciton.
J2710..............  Neostigmine methylslfte    ..................  N1................  ...........  ...........
                      inj.
J2720..............  Inj protamine sulfate/10   ..................  N1................  ...........  ...........
                      MG.
J2724..............  Protein C concentrate....  NI................  K2................  ...........       $12.08
J2725..............  Inj protirelin per 250     ..................  N1................  ...........  ...........
                      mcg.
J2730..............  Pralidoxime chloride inj.  CH................  K2................  ...........       $35.20
J2760..............  Phentolaine mesylate inj.  ..................  N1................  ...........  ...........
J2765..............  Metoclopramide hcl         ..................  N1................  ...........  ...........
                      injection.
J2770..............  Quinupristin/dalfopristin  ..................  K2................  ...........      $126.44
J2778..............  Ranibizumab injection....  NI................  K2................  ...........    $2,030.23
J2780..............  Ranitidine hydrochloride   ..................  N1................  ...........  ...........
                      inj.
J2783..............  Rasburicase..............  ..................  K2................  ...........      $144.43
J2788..............  Rho d immune globulin 50   ..................  K2................  ...........       $26.41
                      mcg.
J2790..............  Rho d immune globulin inj  ..................  K2................  ...........       $80.79
J2791..............  Rhophylac injection......  NI................  K2................  ...........        $5.29
J2792..............  Rho(D) immune globulin h,  ..................  K2................  ...........       $15.62
                      sd.
J2794..............  Risperidone, long acting.  ..................  K2................  ...........        $4.86
J2795..............  Ropivacaine HCl injection  ..................  N1................  ...........  ...........
J2800..............  Methocarbamol injection..  ..................  N1................  ...........  ...........
J2805..............  Sincalide injection......  ..................  N1................  ...........  ...........
J2810..............  Inj theophylline per 40    ..................  N1................  ...........  ...........
                      MG.

[[Page 9929]]

 
J2820..............  Sargramostim injection...  ..................  K2................  ...........       $24.86
J2850..............  Inj secretin synthetic     ..................  K2................  ...........       $20.12
                      human.
J2910..............  Aurothioglucose injeciton  ..................  N1................  ...........  ...........
J2916..............  Na ferric gluconate        ..................  N1................  ...........  ...........
                      complex.
J2920..............  Methylprednisolone         ..................  N1................  ...........  ...........
                      injection.
J2930..............  Methylprednisolone         ..................  N1................  ...........  ...........
                      injection.
J2940..............  Somatrem injection.......  ..................  K2................  ...........      $168.90
J2941..............  Somatropin injection.....  ..................  K2................  ...........       $48.52
J2950..............  Promazine hcl injection..  ..................  N1................  ...........  ...........
J2993..............  Reteplase injection......  ..................  K2................  ...........      $841.28
J2995..............  Inj streptokinase /250000  ..................  K2................  ...........      $129.75
                      IU.
J2997..............  Alteplase recombinant....  ..................  K2................  ...........       $33.39
J3000..............  Streptomycin injection...  ..................  N1................  ...........  ...........
J3010..............  Fentanyl citrate           ..................  N1................  ...........  ...........
                      injeciton.
J3030..............  Sumatriptan succinate/6    ..................  K2................  ...........       $61.27
                      MG.
J3070..............  Pentazocine injection....  ..................  N1................  ...........  ...........
J3100..............  Tenecteplase injection...  ..................  K2................  ...........    $2,034.65
J3105..............  Terbutaline sulfate inj..  ..................  N1................  ...........  ...........
J3120..............  Testosterone enanthate     ..................  N1................  ...........  ...........
                      inj.
J3130..............  Testosterone enanthate     ..................  N1................  ...........  ...........
                      inj.
J3140..............  Testosterone suspension    ..................  N1................  ...........  ...........
                      inj.
J3150..............  Testosteron propionate     ..................  N1................  ...........  ...........
                      inj.
J3230..............  Chlorpromazine hcl         ..................  N1................  ...........  ...........
                      injection.
J3240..............  Thyrotropin injection....  ..................  K2................  ...........      $834.18
J3243..............  Tigecycline injection....  ..................  K2................  ...........        $0.96
J3246..............  Tirofiban HCl............  ..................  K2................  ...........        $7.56
J3250..............  Trimethobenzamide hcl inj  ..................  N1................  ...........  ...........
J3260..............  Tobramycin sulfate         ..................  N1................  ...........  ...........
                      injection.
J3265..............  Injection torsemide 10 mg/ ..................  N1................  ...........  ...........
                      ml.
J3280..............  Thiethylperazine maleate   ..................  N1................  ...........  ...........
                      inj.
J3285..............  Treprostinil injection...  ..................  K2................  ...........       $55.36
J3301..............  Triamcinolone acetonide    ..................  N1................  ...........  ...........
                      inj.
J3302..............  Triamcinolone diacetate    ..................  N1................  ...........  ...........
                      inj.
J3303..............  Triamcinolone hexacetonl   ..................  N1................  ...........  ...........
                      inj.
J3305..............  Inj trimetrexate           ..................  K2................  ...........      $148.30
                      glucoronate.
J3310..............  Perphenazine injeciton...  ..................  N1................  ...........  ...........
J3315..............  Triptorelin pamoate......  ..................  K2................  ...........      $159.38
J3320..............  Spectinomycn di-hcl inj..  CH................  N1................  ...........  ...........
J3350..............  Urea injection...........  ..................  K2................  ...........       $74.16
J3355..............  Urofollitropin, 75 iu....  ..................  K2................  ...........       $50.22
J3360..............  Diazepam injection.......  ..................  N1................  ...........  ...........
J3364..............  Urokinase 5000 IU          ..................  N1................  ...........  ...........
                      injection.
J3365..............  Urokinase 250,000 IU inj.  ..................  K2................  ...........      $453.41
J3370..............  Vancomycin hcl injection.  ..................  N1................  ...........  ...........
J3396..............  Verteporfin injection....  ..................  K2................  ...........        $8.99
J3400..............  Triflupromazine hcl inj..  ..................  N1................  ...........  ...........
J3410..............  Hydroxyzine hcl injection  ..................  N1................  ...........  ...........
J3411..............  Thiamine hcl 100 mg......  ..................  N1................  ...........  ...........
J3415..............  Pyridoxine hcl 100 mg....  ..................  N1................  ...........  ...........
J3420..............  Vitamin b12 injection....  ..................  N1................  ...........  ...........
J3430..............  Vitamin k phytonadione     ..................  N1................  ...........  ...........
                      inj.
J3465..............  Injection, voriconazole..  ..................  K2................  ...........        $4.93
J3470..............  Hyaluronidase injection..  ..................  N1................  ...........  ...........
J3471..............  Ovine, up to 999 USP       ..................  N1................  ...........  ...........
                      units.
J3472..............  Ovine, 1000 USP units....  ..................  K2................  ...........      $133.77
J3473..............  Hyaluronidase recombinant  ..................  K2................  ...........        $0.40
J3475..............  Inj magnesium sulfate....  ..................  N1................  ...........  ...........
J3480..............  Inj potassium chloride...  ..................  N1................  ...........  ...........
J3485..............  Zidovudine...............  ..................  N1................  ...........  ...........
J3486..............  Ziprasidone mesylate.....  ..................  N1................  ...........  ...........
J3487..............  Zoledronic acid..........  ..................  K2................  ...........      $205.76
J3488..............  Reclast injection........  NI................  K2................  ...........      $220.81
J3490..............  Drugs unclassified         ..................  N1................  ...........  ...........
                      injection.
J3530..............  Nasal vaccine inhalation.  ..................  N1................  ...........  ...........
J3590..............  Unclassified biologics...  ..................  N1................  ...........  ...........
J7030..............  Normal saline solution     ..................  N1................  ...........  ...........
                      infus.
J7040..............  Normal saline solution     ..................  N1................  ...........  ...........
                      infus.
J7042..............  5% dextrose/normal saline  ..................  N1................  ...........  ...........

[[Page 9930]]

 
J7050..............  Normal saline solution     ..................  N1................  ...........  ...........
                      infus.
J7060..............  5% dextrose/water........  ..................  N1................  ...........  ...........
J7070..............  D5w infusion.............  ..................  N1................  ...........  ...........
J7100..............  Dextran 40 infusion......  ..................  N1................  ...........  ...........
J7110..............  Dextran 75 infusion......  ..................  N1................  ...........  ...........
J7120..............  Ringers lactate infusion.  ..................  N1................  ...........  ...........
J7130..............  Hypertonic saline          ..................  N1................  ...........  ...........
                      solution.
J7187..............  Humate-P, inj............  ..................  K2................  ...........        $0.88
J7189..............  Factor viia..............  ..................  K2................  ...........        $1.15
J7190..............  Factor viii..............  ..................  K2................  ...........        $0.75
J7191..............  Factor VIII (porcine)....  CH................  N1................  ...........  ...........
J7192..............  Factor viii recombinant..  ..................  K2................  ...........        $1.07
J7193..............  Factor IX non-recombinant  ..................  K2................  ...........        $0.89
J7194..............  Factor ix complex........  ..................  K2................  ...........        $0.80
J7195..............  Factor IX recombinant....  ..................  K2................  ...........        $0.99
J7197..............  Antithrombin iii           ..................  K2................  ...........        $1.82
                      injection.
J7198..............  Anti-inhibitor...........  ..................  K2................  ...........        $1.42
J7308..............  Aminolevulinic acid hcl    ..................  K2................  ...........      $109.92
                      top.
J7310..............  Ganciclovir long act       ..................  K2................  ...........    $4,707.90
                      implant.
J7311..............  Fluocinolone acetonide     ..................  K2................  ...........   $19,162.50
                      implt.
J7321..............  Hyalgan/supartz inj per    NI................  K2................  ...........      $101.81
                      dose.
J7322..............  Synvisc inj per dose.....  NI................  K2................  ...........      $178.11
J7323..............  Euflexxa inj per dose....  NI................  K2................  ...........      $110.95
J7324..............  Orthovisc inj per dose...  NI................  K2................  ...........      $174.50
J7340..............  Metabolic active D/E       ..................  K2................  ...........       $28.45
                      tissue.
J7341..............  Non-human, metabolic       CH................  N1................  ...........  ...........
                      tissue.
J7342..............  Metabolically active       ..................  K2................  ...........       $36.40
                      tissue.
J7343..............  Nonmetabolic act d/e       ..................  K2................  ...........       $20.22
                      tissue.
J7344..............  Nonmetabolic active        ..................  K2................  ...........       $94.53
                      tissue.
J7345..............  Non-human, non-metab       CH................  D5................  ...........  ...........
                      tissue.
J7346..............  Injectable human tissue..  ..................  K2................  ...........      $774.46
J7347..............  Integra matrix tissue....  NI................  K2................  ...........       $33.14
J7348..............  Tissuemend tissue........  NI................  K2................  ...........       $67.96
J7349..............  Primatrix tissue.........  NI................  K2................  ...........       $67.96
J7500..............  Azathioprine oral 50mg...  ..................  N1................  ...........  ...........
J7501..............  Azathioprine parenteral..  ..................  K2................  ...........       $47.88
J7502..............  Cyclosporine oral 100 mg.  ..................  K2................  ...........        $3.52
J7504..............  Lymphocyte immune          ..................  K2................  ...........      $336.10
                      globulin.
J7505..............  Monoclonal antibodies....  ..................  K2................  ...........      $977.75
J7506..............  Prednisone oral..........  ..................  N1................  ...........  ...........
J7507..............  Tacrolimus oral per 1 MG.  ..................  K2................  ...........        $3.69
J7509..............  Methylprednisolone oral..  ..................  N1................  ...........  ...........
J7510..............  Prednisolone oral per 5    ..................  N1................  ...........  ...........
                      mg.
J7511..............  Antithymocyte globuln      ..................  K2................  ...........      $337.82
                      rabbit.
J7513..............  Daclizumab, parenteral...  ..................  K2................  ...........      $322.28
J7515..............  Cyclosporine oral 25 mg..  ..................  N1................  ...........  ...........
J7516..............  Cyclosporin parenteral     ..................  N1................  ...........  ...........
                      250mg.
J7517..............  Mycophenolate mofetil      ..................  K2................  ...........        $2.66
                      oral.
J7518..............  Mycophenolic acid........  ..................  K2................  ...........        $2.41
J7520..............  Sirolimus, oral..........  ..................  K2................  ...........        $7.50
J7525..............  Tacrolimus injection.....  ..................  K2................  ...........      $138.64
J7599..............  Immunosuppressive drug     ..................  N1................  ...........  ...........
                      noc.
J7674..............  Methacholine chloride,     ..................  N1................  ...........  ...........
                      neb.
J7799..............  Non-inhalation drug for    ..................  N1................  ...........  ...........
                      DME.
J8501..............  Oral aprepitant..........  ..................  K2................  ...........        $4.99
J8510..............  Oral busulfan............  ..................  K2................  ...........        $2.26
J8520..............  Capecitabine, oral, 150    ..................  K2................  ...........        $4.28
                      mg.
J8521..............  Capecitabine, oral, 500    CH................  K2................  ...........       $14.19
                      mg.
J8530..............  Cyclophosphamide oral 25   ..................  N1................  ...........  ...........
                      MG.
J8540..............  Oral dexamethasone.......  ..................  N1................  ...........  ...........
J8560..............  Etoposide oral 50 MG.....  ..................  K2................  ...........       $29.46
J8597..............  Antiemetic drug oral NOS.  ..................  N1................  ...........  ...........
J8600..............  Melphalan oral 2 MG......  CH................  K2................  ...........        $4.14
J8610..............  Methotrexate oral 2.5 MG.  ..................  N1................  ...........  ...........
J8650..............  Nabilone oral............  ..................  K2................  ...........       $16.80
J8700..............  Temozolomide.............  ..................  K2................  ...........        $7.49
J9000..............  Doxorubic hcl 10 MG vl     CH................  N1................  ...........  ...........
                      chemo.
J9001..............  Doxorubicin hcl liposome   ..................  K2................  ...........      $396.15
                      inj.

[[Page 9931]]

 
J9010..............  Alemtuzumab injection....  ..................  K2................  ...........      $549.77
J9015..............  Aldesleukin/single use     ..................  K2................  ...........      $788.84
                      vial.
J9017..............  Arsenic trioxide.........  ..................  K2................  ...........       $34.44
J9020..............  Asparaginase injection...  ..................  K2................  ...........       $54.26
J9025..............  Azacitidine injection....  ..................  K2................  ...........        $4.35
J9027..............  Clofarabine injection....  ..................  K2................  ...........      $114.41
J9031..............  Bcg live intravesical vac  ..................  K2................  ...........      $113.75
J9035..............  Bevacizumab injection....  ..................  K2................  ...........       $56.93
J9040..............  Bleomycin sulfate          ..................  K2................  ...........       $42.93
                      injection.
J9041..............  Bortezomib injection.....  ..................  K2................  ...........       $33.20
J9045..............  Carboplatin injection....  ..................  K2................  ...........        $7.44
J9050..............  Carmus bischl nitro inj..  ..................  K2................  ...........      $152.24
J9055..............  Cetuximab injection......  ..................  K2................  ...........       $49.43
J9060..............  Cisplatin 10 MG injection  ..................  N1................  ...........  ...........
J9062..............  Cisplatin 50 MG injection  CH................  N1................  ...........  ...........
J9065..............  Inj cladribine per 1 MG..  ..................  K2................  ...........       $32.04
J9070..............  Cyclophosphamide 100 MG    ..................  N1................  ...........  ...........
                      inj.
J9080..............  Cyclophosphamide 200 MG    CH................  N1................  ...........  ...........
                      inj.
J9090..............  Cyclophosphamide 500 MG    CH................  N1................  ...........  ...........
                      inj.
J9091..............  Cyclophosphamide 1.0 grm   CH................  N1................  ...........  ...........
                      inj.
J9092..............  Cyclophosphamide 2.0 grm   CH................  N1................  ...........  ...........
                      inj.
J9093..............  Cyclophosphamide           CH................  N1................  ...........  ...........
                      lyophilized.
J9094..............  Cyclophosphamide           CH................  N1................  ...........  ...........
                      lyophilized.
J9095..............  Cyclophosphamide           CH................  N1................  ...........  ...........
                      lyophilized.
J9096..............  Cyclophosphamide           CH................  N1................  ...........  ...........
                      lyophilized.
J9097..............  Cyclophosphamide           CH................  N1................  ...........  ...........
                      lyophilized.
J9098..............  Cytarabine liposome......  ..................  K2................  ...........      $412.21
J9100..............  Cytarabine hcl 100 MG inj  ..................  N1................  ...........  ...........
J9110..............  Cytarabine hcl 500 MG inj  CH................  N1................  ...........  ...........
J9120..............  Dactinomycin actinomycin   ..................  K2................  ...........      $488.78
                      d.
J9130..............  Dacarbazine 100 mg inj...  CH................  N1................  ...........  ...........
J9140..............  Dacarbazine 200 MG inj...  CH................  N1................  ...........  ...........
J9150..............  Daunorubicin.............  ..................  K2................  ...........       $19.33
J9151..............  Daunorubicin citrate       ..................  K2................  ...........       $55.23
                      liposom.
J9160..............  Denileukin diftitox, 300   ..................  K2................  ...........    $1,386.59
                      mcg.
J9165..............  Diethylstilbestrol         ..................  N1................  ...........  ...........
                      injection.
J9170..............  Docetaxel................  ..................  K2................  ...........      $310.85
J9175..............  Elliotts b solution per    ..................  N1................  ...........  ...........
                      ml.
J9178..............  Inj, epirubicin hcl, 2 mg  ..................  K2................  ...........       $19.79
J9181..............  Etoposide 10 MG inj......  ..................  N1................  ...........  ...........
J9182..............  Etoposide 100 MG inj.....  CH................  N1................  ...........  ...........
J9185..............  Fludarabine phosphate inj  ..................  K2................  ...........      $226.67
J9190..............  Fluorouracil injection...  ..................  N1................  ...........  ...........
J9200..............  Floxuridine injection....  ..................  K2................  ...........       $54.63
J9201..............  Gemcitabine HCl..........  ..................  K2................  ...........      $127.31
J9202..............  Goserelin acetate implant  ..................  K2................  ...........      $192.29
J9206..............  Irinotecan injection.....  ..................  K2................  ...........      $124.61
J9208..............  Ifosfomide injection.....  ..................  K2................  ...........       $38.13
J9209..............  Mesna injection..........  ..................  K2................  ...........        $7.97
J9211..............  Idarubicin hcl injection.  ..................  K2................  ...........      $302.42
J9212..............  Interferon alfacon-1.....  ..................  K2................  ...........        $4.62
J9213..............  Interferon alfa-2a inj...  ..................  K2................  ...........       $41.37
J9214..............  Interferon alfa-2b inj...  ..................  K2................  ...........       $13.92
J9215..............  Interferon alfa-n3 inj...  ..................  K2................  ...........        $9.03
J9216..............  Interferon gamma 1-b inj.  ..................  K2................  ...........      $306.66
J9217..............  Leuprolide acetate         ..................  K2................  ...........      $236.06
                      suspnsion.
J9218..............  Leuprolide acetate         ..................  K2................  ...........        $7.98
                      injeciton.
J9219..............  Leuprolide acetate         ..................  K2................  ...........    $1,648.41
                      implant.
J9225..............  Vantas implant...........  ..................  K2................  ...........    $1,412.46
J9226..............  Supprelin LA implant.....  NI................  K7................  ...........  ...........
J9230..............  Mechlorethamine hcl inj..  ..................  K2................  ...........      $143.08
J9245..............  Inj melphalan hydrochl 50  ..................  K2................  ...........    $1,548.88
                      MG.
J9250..............  Methotrexate sodium inj..  ..................  N1................  ...........  ...........
J9260..............  Methotrexate sodium inj..  CH................  N1................  ...........  ...........
J9261..............  Nelarabine injection.....  ..................  K2................  ...........       $86.84
J9263..............  Oxaliplatin..............  ..................  K2................  ...........        $9.15
J9264..............  Paclitaxel protein bound.  ..................  K2................  ...........        $8.79
J9265..............  Paclitaxel injection.....  ..................  K2................  ...........       $14.57

[[Page 9932]]

 
J9266..............  Pegaspargase/singl dose    ..................  K2................  ...........    $2,080.19
                      vial.
J9268..............  Pentostatin injection....  ..................  K2................  ...........    $2,051.68
J9270..............  Plicamycin (mithramycin)   ..................  K2................  ...........      $172.41
                      inj.
J9280..............  Mitomycin 5 MG inj.......  ..................  K2................  ...........       $14.39
J9290..............  Mitomycin 20 MG inj......  CH................  K2................  ...........       $57.56
J9291..............  Mitomycin 40 MG inj......  CH................  K2................  ...........      $115.11
J9293..............  Mitoxantrone hydrochl/5    ..................  K2................  ...........      $107.96
                      MG.
J9300..............  Gemtuzumab ozogamicin....  ..................  K2................  ...........    $2,411.98
J9303..............  Panitumumab injection....  NI................  K2................  ...........       $83.15
J9305..............  Pemetrexed injection.....  ..................  K2................  ...........       $44.49
J9310..............  Rituximab cancer           ..................  K2................  ...........      $504.40
                      treatment.
J9320..............  Streptozocin injection...  ..................  K2................  ...........      $146.93
J9340..............  Thiotepa injection.......  ..................  K2................  ...........       $41.12
J9350..............  Topotecan................  ..................  K2................  ...........      $859.62
J9355..............  Trastuzumab..............  ..................  K2................  ...........       $58.51
J9357..............  Valrubicin, 200 mg.......  ..................  K2................  ...........       $77.96
J9360..............  Vinblastine sulfate inj..  ..................  N1................  ...........  ...........
J9370..............  Vincristine sulfate 1 MG   ..................  N1................  ...........  ...........
                      inj.
J9375..............  Vincristine sulfate 2 MG   CH................  N1................  ...........  ...........
                      inj.
J9380..............  Vincristine sulfate 5 MG   CH................  N1................  ...........  ...........
                      inj.
J9390..............  Vinorelbine tartrate/10    ..................  K2................  ...........       $21.41
                      mg.
J9395..............  Injection, Fulvestrant...  ..................  K2................  ...........       $80.60
J9600..............  Porfimer sodium..........  ..................  K2................  ...........    $2,532.53
J9999..............  Chemotherapy drug........  ..................  N1................  ...........  ...........
L8600..............  Implant breast silicone/   ..................  N1................  ...........  ...........
                      eq.
L8603..............  Collagen imp urinary 2.5   ..................  N1................  ...........  ...........
                      ml.
L8606..............  Synthetic implnt urinary   ..................  N1................  ...........  ...........
                      1ml.
L8609..............  Artificial cornea........  ..................  N1................  ...........  ...........
L8610..............  Ocular implant...........  ..................  N1................  ...........  ...........
L8612..............  Aqueous shunt prosthesis.  ..................  N1................  ...........  ...........
L8613..............  Ossicular implant........  ..................  N1................  ...........  ...........
L8614..............  Cochlear device..........  ..................  N1................  ...........  ...........
L8630..............  Metacarpophalangeal        ..................  N1................  ...........  ...........
                      implant.
L8631..............  MCP joint repl 2 pc or     ..................  N1................  ...........  ...........
                      more.
L8641..............  Metatarsal joint implant.  ..................  N1................  ...........  ...........
L8642..............  Hallux implant...........  ..................  N1................  ...........  ...........
L8658..............  Interphalangeal joint      ..................  N1................  ...........  ...........
                      spacer.
L8659..............  Interphalangeal joint      ..................  N1................  ...........  ...........
                      repl.
L8670..............  Vascular graft, synthetic  ..................  N1................  ...........  ...........
L8682..............  Implt neurostim radiofq    ..................  N1................  ...........  ...........
                      rec.
L8690..............  Aud osseo dev, int/ext     ..................  J7................  ...........  ...........
                      comp.
L8699..............  Prosthetic implant NOS...  ..................  N1................  ...........  ...........
P9041..............  Albumin (human),5%, 50ml.  CH................  K2................       0.3413       $21.74
P9045..............  Albumin (human), 5%, 250   CH................  K2................       1.0987       $69.98
                      ml.
P9046..............  Albumin (human), 25%, 20   CH................  K2................       0.4118       $26.23
                      ml.
P9047..............  Albumin (human), 25%,      CH................  K2................       1.1362       $72.37
                      50ml.
Q0163..............  Diphenhydramine HCl 50mg.  ..................  N1................  ...........  ...........
Q0164..............  Prochlorperazine maleate   ..................  N1................  ...........  ...........
                      5mg.
Q0166..............  Granisetron HCl 1 mg oral  ..................  K2................  ...........       $49.96
Q0167..............  Dronabinol 2.5mg oral....  ..................  N1................  ...........  ...........
Q0169..............  Promethazine HCl 12.5mg    ..................  N1................  ...........  ...........
                      oral.
Q0171..............  Chlorpromazine HCl 10mg    ..................  N1................  ...........  ...........
                      oral.
Q0173..............  Trimethobenzamide HCl      ..................  N1................  ...........  ...........
                      250mg.
Q0174..............  Thiethylperazine maleate   ..................  N1................  ...........  ...........
                      10mg.
Q0175..............  Perphenazine 4mg oral....  ..................  N1................  ...........  ...........
Q0177..............  Hydroxyzine pamoate 25mg.  ..................  N1................  ...........  ...........
Q0179..............  Ondansetron HCl 8mg oral.  ..................  K2................  ...........       $18.37
Q0180..............  Dolasetron mesylate oral.  ..................  K2................  ...........       $43.77
Q0515..............  Sermorelin acetate         ..................  K2................  ...........        $1.74
                      injection.
Q1003..............  Ntiol category 3.........  ..................  L6................  ...........       $50.00
Q2004..............  Bladder calculi irrig sol  ..................  N1................  ...........  ...........
Q2009..............  Fosphenytoin, 50 mg......  ..................  K2................  ...........        $5.76
Q2017..............  Teniposide, 50 mg........  ..................  K2................  ...........      $280.26
Q3025..............  IM inj interferon beta 1-  ..................  K2................  ...........      $118.84
                      a.
Q4079..............  Natalizumab injection....  CH................  D5................  ...........  ...........
Q4083..............  Hyalgan/supartz inj per    CH................  D5................  ...........  ...........
                      dose.
Q4084..............  Synvisc inj per dose.....  CH................  D5................  ...........  ...........
Q4085..............  Euflexxa inj per dose....  CH................  D5................  ...........  ...........

[[Page 9933]]

 
Q4086..............  Orthovisc inj per dose...  CH................  D5................  ...........  ...........
Q4087..............  Octagam injection........  CH................  D5................  ...........  ...........
Q4088..............  Gammagard liquid           CH................  D5................  ...........  ...........
                      injection.
Q4089..............  Rhophylac injection......  CH................  D5................  ...........  ...........
Q4090..............  Hepagam B IM injection...  CH................  D5................  ...........  ...........
Q4091..............  Flebogamma injection.....  CH................  D5................  ...........  ...........
Q4092..............  Gamunex injection........  CH................  D5................  ...........  ...........
Q4095..............  Reclast injection........  CH................  D5................  ...........  ...........
Q9945..............  LOCM <=149 mg/ml iodine,   CH................  D5................  ...........  ...........
                      1ml.
Q9946..............  LOCM 150-199mg/ml          CH................  D5................  ...........  ...........
                      iodine,1ml.
Q9947..............  LOCM 200-249mg/ml          CH................  D5................  ...........  ...........
                      iodine,1ml.
Q9948..............  LOCM 250-299mg/ml          CH................  D5................  ...........  ...........
                      iodine,1ml.
Q9949..............  LOCM 300-349mg/ml          CH................  D5................  ...........  ...........
                      iodine,1ml.
Q9950..............  LOCM 350-399mg/ml          CH................  D5................  ...........  ...........
                      iodine,1ml.
Q9951..............  LOCM >= 400 mg/ml          CH................  N1................  ...........  ...........
                      iodine,1ml.
Q9952..............  Inj Gad-base MR            CH................  D5................  ...........  ...........
                      contrast,1ml.
Q9953..............  Inj Fe-based MR            CH................  N1................  ...........  ...........
                      contrast,1ml.
Q9954..............  Oral MR contrast, 100 ml.  CH................  N1................  ...........  ...........
Q9955..............  Inj perflexane lip         CH................  N1................  ...........  ...........
                      micros,ml.
Q9956..............  Inj octafluoropropane      CH................  N1................  ...........  ...........
                      mic,ml.
Q9957..............  Inj perflutren lip         CH................  N1................  ...........  ...........
                      micros,ml.
Q9958..............  HOCM <=149 mg/ml iodine,   ..................  N1................  ...........  ...........
                      1ml.
Q9959..............  HOCM 150-199mg/ml          ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9960..............  HOCM 200-249mg/ml          ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9961..............  HOCM 250-299mg/ml          ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9962..............  HOCM 300-349mg/ml          ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9963..............  HOCM 350-399mg/ml          ..................  N1................  ...........  ...........
                      iodine,1ml.
Q9964..............  HOCM>= 400mg/ml iodine,    ..................  N1................  ...........  ...........
                      1ml.
Q9965..............  LOCM 100-199mg/ml          NI................  N1................  ...........  ...........
                      iodine,1ml.
Q9966..............  LOCM 200-299mg/ml          NI................  N1................  ...........  ...........
                      iodine,1ml.
Q9967..............  LOCM 300-399mg/ml          NI................  N1................  ...........  ...........
                      iodine,1ml.
V2630..............  Anter chamber intraocul    ..................  N1................  ...........  ...........
                      lens.
V2631..............  Iris support intraoclr     ..................  N1................  ...........  ...........
                      lens.
V2632..............  Post chmbr intraocular     ..................  N1................  ...........  ...........
                      lens.
V2785..............  Corneal tissue processing  ..................  F4................  ...........  ...........
V2790..............  Amniotic membrane........  ..................  N1................  ...........  ...........
----------------------------------------------------------------------------------------------------------------
Note: The Medicare program payment is 80 percent of the total payment amount and beneficiary coinsurance is 20
  percent of the total payment amount, except for screening flexible sigmoidoscopies and screening colonoscopies
  for which the program payment is 75 percent and the beneficiary coinsurance is 25 percent.

[FR Doc. 08-671 Filed 2-19-08; 8:45 am]
BILLING CODE 4120-01-P