2021-12-31T10:13:00 CPT®2021 American Medical Association.  All Rights Reserved. If a payer is not listed for a medical service, the payer-negotiated rates were either not found within the payer contract or are bundled with other services. Please contact the hospital with any questions. dental & oral diseases & injuries Each 13532.50 9468.01 13532.50 other ear, nose, mouth,throat & cranial/facial diagnoses Each 17095.76 6906.30 10412.93 other respiratory & chest procedures Each 13315.35 13776.12 25114.37 other respiratory & chest procedures Each 16754.17 16754.17 59084.32 respiratory system diagnosis w ventilator support 96+ hours Each 154399.17 53645.79 80884.12 pulmonary edema & respiratory failure Each 28758.05 14411.58 21728.97 pulmonary embolism Each 14649.69 11020.99 14649.69 pulmonary embolism Each 19492.99 19492.99 31362.31 major chest & respiratory trauma Each 32021.23 28396.20 37726.61 respiratory malignancy Each 17663.92 14136.33 18781.23 respiratory malignancy Each 28885.72 28885.72 47656.42 major respiratory infections & inflammations Each 14869.75 10881.80 14869.75 major respiratory infections & inflammations Each 17989.93 16120.95 21417.96 major respiratory infections & inflammations Each 37639.74 37902.57 54274.21 bronchiolitis & rsv pneumonia Each 16048.97 7627.27 11499.97 bronchiolitis & rsv pneumonia Each 19408.34 9857.43 14862.47 other pneumonia Each 12753.39 8033.89 12113.05 other pneumonia Each 18874.09 10608.11 15994.31 other pneumonia Each 18861.32 19078.50 45084.10 chronic obstructive pulmonary disease Each 10916.06 8994.14 11949.43 chronic obstructive pulmonary disease Each 17001.23 11291.55 17001.23 chronic obstructive pulmonary disease Each 9922.66 10036.12 40940.97 interstitial lung disease Each 20708.55 13435.69 20257.58 interstitial lung disease Each 55325.54 43502.17 57796.08 cardiac defibrillator & heart assist implant Each 26063.74 26814.01 83409.13 cardiac valve procedures w/o cardiac catheterization Each 25910.89 26381.34 62847.22 cardiac valve procedures w/o cardiac catheterization Each 25740.77 29146.95 146422.57 other cardiothoracic procedures Each 25143.96 25741.00 59003.29 perm cardiac pacemaker implant w/o ami, heart failure or shock Each 14772.52 14977.91 36149.56 perm cardiac pacemaker implant w/o ami, heart failure or shock Each 21042.26 21042.26 44548.03 other vascular procedures drg med - surg mdc long descriptions Each 25694.76 27232.64 36180.73 other vascular procedures drg med - surg mdc long descriptions Each 33308.08 32989.46 43829.11 other vascular procedures drg med - surg mdc long descriptions Each 21172.50 92412.39 122777.20 other circulatory system procedures Each 28936.07 17813.12 26857.62 acute myocardial infarction Each 15915.99 11505.80 16067.39 acute myocardial infarction Each 30596.75 14987.10 22596.71 acute myocardial infarction Each 19330.76 20579.62 58452.67 acute & subacute endocarditis Each 31012.37 31012.37 92757.15 heart failure Each 15963.89 8911.25 13435.88 heart failure Each 18415.35 12373.78 18514.09 heart failure Each 23877.63 23877.63 60015.18 hypertension Each 24827.99 7076.77 10669.95 hypertension Each 19552.88 14574.23 21974.20 cardiac arrhythmia & conduction disorders Each 18244.68 6763.98 10198.35 cardiac arrhythmia & conduction disorders Each 17267.23 9769.85 14730.43 cardiac arrhythmia & conduction disorders Each 42018.07 39723.72 52776.12 chest pain Each 17302.18 6158.74 9285.80 syncope & collapse Each 18738.34 7198.75 10853.87 other circulatory system diagnoses Each 13221.76 7646.03 11528.26 other circulatory system diagnoses Each 9526.02 11214.91 16909.22 other circulatory system diagnoses Each 12418.15 13651.53 52506.01 craniotomy except for trauma Each 9657.49 12706.79 90008.22 major stomach, esophageal & duodenal procedures Each 46555.67 28857.56 43509.82 major stomach, esophageal & duodenal procedures Each 77190.04 77190.04 147268.23 major small & large bowel procedures Each 23944.48 23944.48 39118.74 major small & large bowel procedures Each 23124.84 23746.03 64440.89 major small & large bowel procedures Each 30359.66 30359.66 137307.26 other small & large bowel procedures Each 19005.06 19005.06 32717.04 other small & large bowel procedures Each 8843.70 9331.07 115910.07 peritoneal adhesiolysis Each 44157.55 25043.15 37758.65 peritoneal adhesiolysis Each 35684.62 35684.62 115704.37 appendectomy Each 25380.66 11260.27 16977.60 anal procedures Each 11271.35 9679.14 12859.50 anal procedures Each 33807.55 23433.87 33910.60 inguinal, femoral & umbilical hernia procedures Each 14610.42 10903.69 14610.42 inguinal, femoral & umbilical hernia procedures Each 13228.60 13484.82 19807.67 other digestive system & abdominal procedures Each 50068.82 50068.82 120238.13 spinal procedures Each 9795.60 15129.93 34096.70 spinal procedures Each 17501.67 33709.36 89270.60 digestive malignancy Each 2915.24 3028.60 14540.44 digestive malignancy Each 27542.78 14846.35 22384.49 digestive malignancy Each 27642.48 27642.48 61791.69 peptic ulcer & gastritis Each 13435.35 13771.90 25820.82 major esophageal disorders Each 15789.97 8640.69 13027.95 inflammatory bowel disease Each 13686.46 9769.85 13686.46 inflammatory bowel disease Each 19894.41 12128.25 18286.29 inflammatory bowel disease Each 17960.10 18558.67 44784.90 intestinal obstruction Each 18905.06 10525.22 15869.34 intestinal obstruction Each 17978.78 17978.78 53102.33 major gastrointestinal & peritoneal infections Each 6108.84 6337.09 12364.99 major gastrointestinal & peritoneal infections Each 7505.70 7731.29 17586.50 major gastrointestinal & peritoneal infections Each 11992.12 12507.14 67248.00 other & unspecified gastrointestinal hemorrhage Each 12080.13 9546.20 12682.89 other & unspecified gastrointestinal hemorrhage Each 25296.45 12750.69 19224.77 other & unspecified gastrointestinal hemorrhage Each 35585.20 35585.20 49158.67 other digestive system diagnoses Each 22443.25 7810.25 11775.85 other digestive system diagnoses Each 20702.06 11286.85 17017.69 other digestive system diagnoses Each 16912.95 17211.36 25195.40 other digestive system diagnoses Each 29240.22 29240.22 54191.10 laparoscopic cholecystectomy Each 26064.51 13834.49 20858.87 laparoscopic cholecystectomy Each 35653.78 18324.52 27628.69 other hepatobiliary, pancreas & abdominal procedures Each 20574.46 20861.21 27715.77 other hepatobiliary, pancreas & abdominal procedures Each 21457.83 21844.69 31418.41 other hepatobiliary, pancreas & abdominal procedures Each 15269.61 15541.14 127880.28 hepatic coma & other major acute liver disorders Each 41580.71 8595.34 12959.57 alcoholic liver disease Each 16138.09 11776.36 16138.09 alcoholic liver disease Each 33305.67 33305.67 70900.77 malignancy of hepatobiliary system & pancreas Each 32427.41 32427.41 50251.59 disorders of pancreas except malignancy Each 15596.35 8632.87 13016.16 disorders of pancreas except malignancy Each 51501.80 21299.11 32113.60 other disorders of the liver Each 14545.45 11687.22 15527.40 disorders of gallbladder & biliary tract Each 18894.40 9033.24 13619.81 disorders of gallbladder & biliary tract Each 17114.40 12943.05 17195.87 disorders of gallbladder & biliary tract Each 47295.05 46357.89 61590.15 hip joint replacement Each 34130.88 28860.69 38343.72 hip joint replacement Each 28202.66 28346.01 52707.55 hip joint replacement Each 21858.98 22592.47 125783.78 amputation of lower limb except toes Each 22113.99 21288.16 28283.01 amputation of lower limb except toes Each 30327.60 29982.03 39833.50 hip & femur procedures for trauma except joint replacement Each 23094.86 20887.80 27751.10 hip & femur procedures for trauma except joint replacement Each 32322.49 28757.47 38206.59 hip & femur procedures for trauma except joint replacement Each 38265.14 38265.14 119864.13 intervertebral disc excision & decompression Each 20224.07 13479.48 20224.07 intervertebral disc excision & decompression Each 28647.13 19111.18 28814.76 intervertebral disc excision & decompression Each 21921.75 23167.85 142167.23 shoulder, upper arm & forearm procedures Each 33136.23 21629.10 32611.14 tendon, muscle & other soft tissue procedures Each 15961.94 15961.94 29814.35 other musculoskeletal system & connective tissue procedures Each 34148.23 16036.50 24178.93 other musculoskeletal system & connective tissue procedures Each 57566.04 25457.59 38383.52 other musculoskeletal system & connective tissue procedures Each 13437.01 13757.00 103964.80 cervical spinal fusion & other back/neck proc exc disc excis/decomp Each 17385.15 17385.15 33903.46 cervical spinal fusion & other back/neck proc exc disc excis/decomp Each 17468.80 17468.80 44612.44 fracture of femur Each 17334.94 8268.48 12466.75 fracture of pelvis or dislocation of hip Each 13684.96 8953.48 13499.55 fracture of pelvis or dislocation of hip Each 15317.49 15046.53 19990.51 musculoskeletal malignancy & pathol fracture d/t muscskel malig Each 12011.75 12079.10 17239.51 musculoskeletal malignancy & pathol fracture d/t muscskel malig Each 23602.24 15601.73 23523.41 musculoskeletal malignancy & pathol fracture d/t muscskel malig Each 9207.43 10157.78 80032.70 osteomyelitis, septic arthritis & other musculoskeletal infections Each 11016.60 11470.64 16707.59 osteomyelitis, septic arthritis & other musculoskeletal infections Each 13032.57 13274.53 23890.54 connective tissue disorders Each 7302.87 7302.86 15199.11 connective tissue disorders Each 13565.77 13565.77 19992.59 other back & neck disorders, fractures & injuries Each 17931.15 8587.52 12947.78 other musculoskeletal system & connective tissue diagnoses Each 14504.65 7677.31 11575.42 other musculoskeletal system & connective tissue diagnoses Each 2720.97 2720.97 13272.99 other musculoskeletal system & connective tissue diagnoses Each 13848.55 13900.88 64006.63 breast procedures except mastectomy Each 17913.17 18275.51 31549.32 other skin, subcutaneous tissue & related procedures Each 3204.79 3269.56 15988.67 other skin, subcutaneous tissue & related procedures Each 22108.34 17356.45 23059.42 other skin, subcutaneous tissue & related procedures Each 14920.31 15053.19 110316.64 malignant breast disorders Each 51750.49 45255.33 60125.30 cellulitis & other bacterial skin infections Each 19747.59 7899.39 11910.26 cellulitis & other bacterial skin infections Each 33738.17 33738.17 58045.42 other skin, subcutaneous tissue & breast disorders Each 15783.61 7495.90 11301.89 tracheostomy w long term mechanical ventilation w extensive procedure Each 133546.26 112424.38 149364.73 spinal disorders & injuries Each 19681.27 12760.07 19238.92 spinal disorders & injuries Each 24422.55 25016.56 47716.68 procedures for obesity Each 2171.95 2250.20 23686.92 thyroid, parathyroid & thyroglossal procedures Each 6013.40 6091.65 13888.02 thyroid, parathyroid & thyroglossal procedures Each 5693.53 5736.47 18039.46 thyroid, parathyroid & thyroglossal procedures Each 5265.70 5265.70 55408.69 other procedures for endocrine, nutritional & metabolic disorders Each 2287.45 2365.70 35189.62 other procedures for endocrine, nutritional & metabolic disorders Each 6011.05 6101.65 174287.94 nervous system malignancy Each 16332.55 16495.35 30624.69 degenerative nervous system disorders exc mult sclerosis Each 33711.28 9965.34 15025.18 degenerative nervous system disorders exc mult sclerosis Each 34967.74 13804.77 20814.07 diabetes Each 4060.25 4139.17 9466.46 diabetes Each 17057.39 9869.94 14881.34 diabetes Each 23562.19 23562.19 52776.12 malnutrition, failure to thrive & other nutritional disorders Each 18400.57 9774.54 14737.50 malnutrition, failure to thrive & other nutritional disorders Each 3761.50 3839.75 28831.55 inborn errors of metabolism Each 11392.76 9608.76 12766.00 other endocrine disorders Each 22204.40 7802.43 11764.06 other endocrine disorders Each 22078.53 11876.45 17906.65 other endocrine disorders Each 40602.79 40602.79 57827.25 multiple sclerosis & other demyelinating diseases Each 17230.65 16809.08 22332.19 multiple sclerosis & other demyelinating diseases Each 20748.61 21450.02 122957.97 intracranial hemorrhage Each 21872.34 15640.82 21872.34 intracranial hemorrhage Each 26287.47 22881.80 30400.29 intracranial hemorrhage Each 38142.13 38142.13 57735.83 kidney & urinary tract procedures for nonmalignancy Each 19146.01 16773.11 22284.40 kidney & urinary tract procedures for nonmalignancy Each 47151.90 18640.43 28105.00 kidney & urinary tract procedures for nonmalignancy Each 24287.97 24287.97 105298.75 other bladder procedures Each 22369.78 19847.78 26369.36 other bladder procedures Each 32172.19 32172.19 50897.79 other kidney, urinary tract & related procedures Each 87452.42 87452.42 158548.61 nonspecific cva & precerebral occlusion w/o infarct Each 19082.40 9876.19 14890.77 renal failure Each 24013.70 9241.24 12277.72 renal failure Each 20680.45 11044.45 14673.42 renal failure Each 24682.82 38835.41 51595.93 kidney & urinary tract malignancy Each 28704.82 28704.82 48373.26 kidney & urinary tract infections Each 13302.55 7771.15 11716.90 kidney & urinary tract infections Each 22803.21 22803.21 45316.82 urinary stones & acquired upper urinary tract obstruction Each 47735.50 7009.52 10568.56 malfunction, reaction, complic of genitourinary device or proc Each 18304.59 10914.64 16456.48 malfunction, reaction, complic of genitourinary device or proc Each 63028.49 36403.51 54887.17 other kidney & urinary tract diagnoses, signs & symptoms Each 16161.68 11368.18 16161.68 other kidney & urinary tract diagnoses, signs & symptoms Each 12915.49 12915.49 58359.17 transient ischemia Each 16342.43 8029.20 12105.97 peripheral, cranial & autonomic nerve disorders Each 18194.44 8661.02 13058.60 peripheral, cranial & autonomic nerve disorders Each 15532.03 11562.10 15532.03 penis procedures Each 27482.54 11605.89 17498.72 transurethral prostatectomy Each 22933.39 9461.75 14265.90 transurethral prostatectomy Each 27235.12 13258.96 19991.12 testes & scrotal procedures Each 71138.27 20033.89 30205.98 malignancy, male reproductive system Each 12501.10 6598.20 9948.40 malignancy, male reproductive system Each 16804.42 14743.13 19587.42 malignancy, male reproductive system Each 14698.87 14698.87 38268.92 male reproductive system diagnoses except malignancy Each 9870.53 9870.53 23327.46 uterine & adnexa procedures for non-ovarian & non-adnexal malig Each 12041.78 12041.78 28187.43 other female reproductive system & related procedures Each 11426.83 11666.40 15706.09 nontraumatic stupor & coma Each 47790.23 15675.23 23634.23 female reproductive system malignancy Each 8368.85 8417.80 12678.74 female reproductive system malignancy Each 7115.23 7145.78 16254.63 female reproductive system malignancy Each 8106.01 8134.06 52092.52 female reproductive system infections Each 8804.63 8804.62 15174.17 female reproductive system infections Each 15698.17 15698.17 27050.88 menstrual & other female reproductive system disorders Each 7493.24 7493.24 11608.67 vaginal delivery w complicating procedures exc sterilization &/or d&c Each 8200.53 8239.30 12364.99 head trauma w coma >1 hr or hemorrhage Each 11203.10 11203.10 18232.70 vaginal delivery Each 10978.34 8280.99 11096.12 postpartum & post abortion diagnoses w/o procedure Each 8045.23 5927.28 8504.16 other disorders of nervous system Each 14415.98 12243.98 16267.10 neonate, transferred <5 days old, not born here Each 3074.40 3113.43 6335.21 neonate birthwt 1500-1999g w congenital/perinatal infection Each 14738.20 14833.56 83685.47 neonate birthwt >2499g, normal newborn or neonate w other problem Each 3560.75 N/A N/A other procedures of blood & blood-forming organs Each 55755.10 55755.10 78372.54 major hematologic/immunologic diag exc sickle cell crisis & coagul Each 10046.32 10091.26 14488.50 major hematologic/immunologic diag exc sickle cell crisis & coagul Each 15465.78 14073.77 18698.12 major hematologic/immunologic diag exc sickle cell crisis & coagul Each 24282.78 24282.78 103432.88 other anemia & disorders of blood & blood-forming organs Each 17734.65 8027.63 12103.61 other anemia & disorders of blood & blood-forming organs Each 34480.08 17365.83 26183.23 other o.r. procedures for lymphatic/hematopoietic/other neoplasms Each 41403.05 41403.05 79357.42 acute leukemia Each 33671.16 20905.00 31519.39 acute leukemia Each 31983.70 31983.70 56489.15 lymphoma, myeloma & non-acute leukemia Each 59418.00 15994.27 24115.27 lymphoma, myeloma & non-acute leukemia Each 30986.14 23208.66 30986.14 chemotherapy Each 63076.10 100366.51 133344.89 lymphatic & other malignancies & neoplasms of uncertain neoplasms Each 21342.72 15349.93 21342.72 lymphatic & other malignancies & neoplasms of uncertain neoplasms Each 17314.01 17314.01 70258.73 orbital procedures Each 8886.36 9336.15 16709.67 orbital procedures Each 12054.90 12054.90 42364.26 infectious & parasitic diseases including hiv w o.r. procedure Each 33842.21 26056.57 34618.23 infectious & parasitic diseases including hiv w o.r. procedure Each 44637.96 44637.96 131325.27 post-op, post-trauma, other device infections w o.r. procedure Each 15115.03 15621.99 125413.93 septicemia & disseminated infections Each 22650.48 9452.37 14251.75 septicemia & disseminated infections Each 102957.44 13038.45 19658.65 septicemia & disseminated infections Each 37567.69 38343.15 66495.83 post-operative, post-traumatic, other device infections Each 11865.19 10068.56 13376.88 post-operative, post-traumatic, other device infections Each 9829.50 9931.94 29745.78 fever Each 11720.70 8029.20 12105.97 o.r. procedure for other complications of treatment Each 8986.04 8986.04 17619.74 o.r. procedure for other complications of treatment Each 23914.14 23914.14 137357.12 acute major eye infections Each 7682.84 7715.43 11421.67 poisoning of medicinal agents Each 8190.73 6404.28 8508.59 poisoning of medicinal agents Each 21385.19 14388.12 21385.19 eye disorders except major infections Each 17901.22 7655.42 11542.41 procedure w diag of rehab, aftercare or oth contact w health service Each 11194.14 11378.51 24125.34 procedure w diag of rehab, aftercare or oth contact w health service Each 50026.80 25926.77 39090.92 procedure w diag of rehab, aftercare or oth contact w health service Each 7034.85 7249.76 158467.57 signs, symptoms & other factors influencing health status Each 51870.01 7040.79 10615.72 other aftercare & convalescence Each 61015.16 8008.87 12075.32 other aftercare & convalescence Each 34793.65 19209.70 28963.31 major cranial/facial bone procedures Each 10460.79 10460.79 28328.73 other major head & neck procedures Each 89626.25 20872.16 31469.87 sinus & mastoid procedures Each 22856.05 14028.42 21151.26 nonextensive procedure unrelated to principal diagnosis Each 15221.72 15221.72 24854.64 nonextensive procedure unrelated to principal diagnosis Each 46592.23 46592.23 123246.78 other ear, nose, mouth & throat procedures Each 16278.08 10708.20 16145.23 other ear, nose, mouth & throat procedures Each 17157.06 17364.53 38715.65 Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; first dose 1.0000 each 44.05 27.5900 30.84 39.53 Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5mL dosage; second dose 1.0000 each 73.85 46.2500 36.94 59.08 Cerebral perfusion analysis using computed tomography with contrast administration, including post-processing of parametric maps with determination of cerebral blood flow, cerebral blood volume, and mean transit time 1.0000 each 15.60 9.7700 6.07 12.48 Excision of rectal tumor, transanal endoscopic microsurgical approach (ie, TEMS), including muscularis propria (ie, full thickness) 1.0000 each 12199.50 7640.5500 1575.00 9759.60 Unlisted anesthesia procedure(s) 15.0000 Minutes 44.30 27.7500 31.01 35.44 Injection(s), platelet rich plasma, any site, including image guidance, harvesting and preparation when performed 4.0000 Each 2173.79 1361.4400 249.56 1739.03 Infectious disease (viral respiratory tract infection), pathogen-specific RNA, 4 targets (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2], influenza A, influenza B, respiratory syncytial virus [RSV]), upper respiratory specimen, each pathogen reported as detected or not detected 1.0000 each 216.80 135.7800 60.27 162.60 Urinary incontinence plan of care documented (GER) 1.0000 each 0.01 0.0100 0.01 0.01 Falls plan of care documented (GER) 1.0000 each 0.01 0.0100 0.01 0.01 Fine needle aspiration biopsy, including ultrasound guidance; first lesion Each 542.70 339.8900 379.89 1050.00 Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure) 1.0000 each 137.60 86.1800 96.32 1050.00 Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion Each 542.70 339.8900 379.89 1050.00 Fine needle aspiration biopsy, including CT guidance; first lesion Each 846.25 530.0100 574.43 1050.00 Fine needle aspiration biopsy, including CT guidance; each additional lesion (List separately in addition to code for primary procedure) 1.0000 each 846.25 530.0100 592.38 1050.00 Fine needle aspiration biopsy, without imaging guidance; first lesion Each 687.45 430.5500 319.40 1050.00 Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) Each 454.25 284.5000 165.83 1050.00 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single Each 293.30 183.6900 165.83 1050.00 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple Each 339.05 212.3500 237.34 1050.00 Incision and drainage of pilonidal cyst; simple Each 293.00 183.5100 205.10 1050.00 Incision and drainage of pilonidal cyst; complicated Each 639.60 400.5800 447.72 1050.00 Incision and removal of foreign body, subcutaneous tissues; simple Each 447.20 280.0800 313.04 1050.00 Incision and removal of foreign body, subcutaneous tissues; complicated Each 447.20 280.0800 313.04 1390.41 Incision and drainage of hematoma, seroma or fluid collection Each 241.30 151.1300 168.91 1390.41 Puncture aspiration of abscess, hematoma, bulla, or cyst Each 213.20 133.5300 149.24 1050.00 Current tobacco non-user (CAD, CAP, COPD, PV) (DM) (IBD) 1.0000 each 0.01 0.0100 0.01 0.01 Presence or absence of urinary incontinence assessed (GER) 1.0000 each 0.01 0.0100 0.01 0.01 Debridement of extensive eczematous or infected skin; up to 10% of body surface Each 109.20 68.3900 76.44 1050.00 Patient screened for future fall risk; documentation of 2 or more falls in the past year or any fall with injury in the past year (GER) 1.0000 each 0.01 0.0100 0.01 0.01 Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and subcutaneous tissues Each 1690.80 1058.9500 574.43 1690.80 Patient screened for future fall risk; documentation of no falls in the past year or only 1 fall without injury in the past year (GER) 1.0000 each 0.01 0.0100 0.01 0.01 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less Each 649.18 406.5800 319.40 1300.00 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less Each 1691.35 1059.2900 484.10 1691.35 Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less Each 4154.20 2601.7800 1299.45 4154.20 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 1.0000 each 3131.83 1961.4600 1050.00 3131.83 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion Each 495.90 310.5800 165.83 1050.00 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesions Each 514.80 322.4200 165.83 1050.00 Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than 4 lesions Each 531.45 332.8500 165.83 1050.00 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion Each 508.40 318.4100 165.83 1050.00 Punch biopsy of skin (including simple closure, when performed); single lesion Each 454.25 284.5000 317.98 1050.00 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion Each 549.10 343.9000 384.37 1050.00 Discharge medications reconciled with the current medication list in outpatient medical record (COA) (GER) 1.0000 each 0.01 0.0100 0.01 0.01 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions Each 385.83 241.6400 165.83 1050.00 Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) 1.0000 each 143.50 89.8700 100.45 1050.00 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less Each 290.15 181.7200 203.10 1050.00 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm Each 290.15 181.7200 165.83 1050.00 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm Each 275.30 172.4200 165.83 1050.00 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less Each 343.20 214.9500 165.83 1050.00 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm Each 392.10 245.5700 165.83 1050.00 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm Each 290.15 181.7200 165.83 1050.00 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cm Each 533.50 334.1300 319.40 1050.00 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less Each 621.90 389.5000 165.83 1050.00 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm Each 539.80 338.0800 165.83 1050.00 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm Each 562.65 352.3900 319.40 1050.00 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm Each 702.00 439.6600 319.40 1050.00 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less Each 1585.85 993.2200 325.00 1585.85 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm Each 733.20 459.2000 319.40 1050.00 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm Each 966.50 605.3200 574.43 1050.00 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm Each 966.50 605.3200 574.43 1050.00 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm Each 966.50 605.3200 715.21 2323.00 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm Each 966.50 605.3200 676.55 1390.41 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less Each 2445.05 1531.3300 1077.00 2445.05 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm Each 1200.15 751.6500 574.43 1300.00 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm Each 1754.15 1098.6200 1050.00 1754.15 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm Each 962.45 602.7800 673.72 1390.41 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Each 981.53 614.7300 687.07 1390.41 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Each 966.50 605.3200 676.55 2342.07 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less Each 1078.50 675.4600 574.43 1300.00 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm Each 1131.50 708.6600 574.43 1300.00 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm Each 2013.45 1261.0200 574.43 2013.45 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm Each 1585.90 993.2500 1050.00 1585.90 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm Each 5987.35 3749.8800 1050.00 5000.00 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm Each 610.11 382.1100 427.08 2342.07 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less Each 345.30 216.2600 241.71 1050.00 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm Each 284.95 178.4600 199.46 1050.00 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm Each 626.25 392.2200 319.40 1050.00 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm Each 966.50 605.3200 574.43 1050.00 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm Each 954.00 597.4900 574.43 1300.00 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm Each 962.45 602.7800 673.72 1390.41 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less Each 2145.80 1343.9100 325.00 2145.80 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm Each 283.90 177.8100 198.73 1050.00 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm Each 4901.63 3069.8900 574.43 4901.63 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm Each 405.34 253.8700 283.74 1390.41 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm Each 958.40 600.2500 670.88 1390.41 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm Each 958.40 600.2500 670.88 2342.07 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or less Each 1542.35 965.9800 325.00 1542.35 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cm Each 1287.50 806.3600 325.00 1300.00 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm Each 966.50 605.3200 574.43 1300.00 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm Each 966.50 605.3200 676.55 1390.41 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cm Each 2309.85 1446.6600 1299.45 2309.85 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm Each 966.50 605.3200 676.55 2342.07 Trimming of nondystrophic nails, any number Each 163.10 102.1500 51.41 1050.00 Debridement of nail(s) by any method(s); 1 to 5 1.0000 each 181.05 113.3900 51.41 1050.00 Debridement of nail(s) by any method(s); 6 or more 1.0000 each 229.00 143.4200 51.41 1050.00 Avulsion of nail plate, partial or complete, simple; single Each 151.85 95.1000 106.30 1050.00 Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure) 1.0000 each 5577.65 3493.2800 325.00 4127.46 Evacuation of subungual hematoma Each 364.35 228.1900 103.39 1050.00 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal; Each 667.65 418.1500 319.40 1050.00 Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure) Each 1585.85 993.2200 325.00 1585.85 Repair of nail bed Each 638.60 399.9600 447.02 1050.00 Wedge excision of skin of nail fold (eg, for ingrown toenail) Each 899.20 563.1700 319.40 1050.00 Excision of pilonidal cyst or sinus; simple Each 5762.04 3608.7600 1575.00 5000.00 Excision of pilonidal cyst or sinus; extensive Each 6506.90 4075.2700 1575.00 5000.00 Excision of pilonidal cyst or sinus; complicated Each 5315.45 3329.0700 1575.00 5000.00 Injection, intralesional; up to and including 7 lesions Each 454.25 284.5000 154.00 1050.00 Removal, implantable contraceptive capsules Each 859.05 538.0200 325.00 1050.00 Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin) Each 221.50 138.7300 154.00 1050.00 Insertion, non-biodegradable drug delivery implant Each 239.20 149.8100 103.39 1050.00 Removal, non-biodegradable drug delivery implant Each 360.90 226.0300 154.00 1050.00 Removal with reinsertion, non-biodegradable drug delivery implant Each 408.70 255.9700 154.00 1050.00 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less Each 316.15 198.0000 165.83 1050.00 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm Each 324.50 203.2300 165.83 1050.00 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm Each 319.30 199.9800 165.83 1050.00 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm Each 659.88 413.2800 319.40 1300.00 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Each 616.70 386.2400 165.83 1050.00 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Each 322.40 201.9200 165.83 1050.00 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm Each 711.50 445.6100 165.83 1050.00 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm Each 685.15 429.1100 165.83 1050.00 Treatment of superficial wound dehiscence; simple closure Each 1776.75 1112.7800 484.10 2323.00 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less Each 533.50 334.1300 319.40 1050.00 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm Each 865.30 541.9400 319.40 1050.00 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm Each 830.65 520.2400 319.40 1300.00 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm Each 608.40 381.0400 319.40 1300.00 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less Each 638.80 400.0800 319.40 1050.00 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm Each 871.50 545.8200 319.40 1050.00 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm Each 1185.10 742.2300 484.10 1300.00 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less Each 733.20 459.2000 319.40 1050.00 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm Each 792.50 496.3400 319.40 1050.00 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm Each 819.50 513.2500 319.40 1050.00 Repair, complex, trunk; 2.6 cm to 7.5 cm Each 2670.78 1672.7100 484.10 2670.78 Repair, complex, trunk; each additional 5 cm or less (List separately in addition to code for primary procedure) 1.0000 Each 2670.78 1672.7100 325.00 2670.78 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm Each 1324.95 829.8200 484.10 1575.00 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm Each 1437.30 900.1800 484.10 1575.00 Secondary closure of surgical wound or dehiscence, extensive or complicated Each 6267.00 3925.0200 1300.00 5000.00 Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm Each 2965.15 1857.0700 1575.00 2965.15 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less Each 3807.45 2384.6100 1300.00 3807.45 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm Each 2691.50 1685.6900 1575.00 2691.50 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less Each 6478.51 4057.4900 1575.00 5000.00 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm Each 2691.50 1685.6900 1575.00 2691.50 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children Each 1977.80 1238.7000 484.10 1977.80 Harvest of skin for tissue cultured skin autograft, 100 sq cm or less Each 4537.85 2842.0600 1300.00 4537.85 Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) Each 3798.10 2378.7500 1300.00 3798.10 Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) Each 5920.70 3708.1300 1300.00 5000.00 Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or less Each 2416.40 1513.3900 1300.00 2416.40 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less Each 2531.20 1585.2900 1575.00 2531.20 Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less Each 2691.50 1685.6900 1300.00 2691.50 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area Each 3427.15 2146.4200 1300.00 3427.15 Excision, excessive skin and subcutaneous tissue (includes lipectomy); other area Each 6028.40 3775.5900 1575.00 5000.00 Initial treatment, first degree burn, when no more than local treatment is required Each 128.95 80.7600 90.26 1050.00 Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area) Each 149.80 93.8200 104.86 1050.00 Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5% to 10% total body surface area) Each 635.95 398.3000 165.83 1300.00 Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (eg, more than 1 extremity, or greater than 10% total body surface area) Each 645.35 404.1800 319.40 1300.00 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion Each 137.30 85.9900 96.11 1050.00 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) 1.0000 Each 30.15 18.8800 21.10 1050.00 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions Each 533.50 334.1300 319.40 1050.00 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions Each 171.60 107.4700 120.12 1050.00 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesions Each 446.15 279.4200 165.83 1050.00 Chemical cauterization of granulation tissue (ie, proud flesh) Each 132.10 82.7300 92.47 1050.00 Puncture aspiration of cyst of breast; Each 696.80 436.4100 154.00 1050.00 Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primary procedure) 1.0000 each 72.00 45.0900 50.40 1050.00 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance Each 6283.00 3935.0400 1299.45 5000.00 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance Each 589.00 368.8900 412.30 1390.41 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) 1.0000 each 421.64 264.0700 295.15 1050.00 Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) Each 616.40 386.0500 456.14 2323.00 Biopsy of breast; open, incisional Each 4988.31 3124.1800 1300.00 4988.31 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions Each 5915.83 3705.0800 1575.00 5000.00 Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion Each 5617.60 3518.3000 1575.00 5000.00 Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker (List separately in addition to code for primary procedure) 1.0000 each 2959.38 1853.4600 1575.00 2959.38 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance Each 1186.50 743.1000 574.43 1300.00 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure) 1.0000 each 416.84 261.0700 291.79 1050.00 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance Each 1033.80 647.4700 574.43 1300.00 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure) 1.0000 each 511.70 320.4800 358.19 1050.00 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidance Each 169.40 106.1000 118.58 1300.00 Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure) 1.0000 each 511.70 320.4800 358.19 1050.00 Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidance Each 1033.80 647.4700 574.43 1575.00 Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure) 1.0000 each 511.70 320.4800 358.19 1050.00 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); Each 5465.43 3423.0000 1575.00 5000.00 Mastectomy, simple, complete Each 6638.30 4157.5700 1871.00 6638.30 Mastectomy, radical, including pectoral muscles, axillary lymph nodes Each 3443.10 2156.4200 1050.00 3443.10 Biopsy, muscle; superficial Each 958.40 600.2500 670.88 1390.41 Biopsy, muscle; deep Each 6825.74 4274.9600 1575.00 5051.05 Biopsy, muscle, percutaneous needle Each 1627.80 1019.4900 1050.00 2323.00 Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs) Each 1699.80 1064.5800 1050.00 2323.00 Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur) Each 1777.98 1113.5500 1244.59 1777.98 Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy (DM) 1.0000 each 0.01 0.0100 0.01 0.01 Dilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; without evidence of retinopathy (DM) 1.0000 each 0.01 0.0100 0.01 0.01 Removal of foreign body in muscle or tendon sheath; simple Each 4944.79 3096.9200 1077.00 4944.79 Removal of foreign body in muscle or tendon sheath; deep or complicated Each 5693.00 3565.5300 1575.00 5000.00 Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnel Each 827.50 518.2600 154.00 1050.00 Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia") Each 115.45 72.3100 80.82 1050.00 Injection(s); single tendon origin/insertion Each 391.00 244.8800 154.00 1050.00 Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) Each 383.00 239.8700 154.00 1050.00 Injection(s); single or multiple trigger point(s), 3 or more muscles Each 395.00 247.3900 154.00 1050.00 Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance Each 115.45 72.3100 80.82 1050.00 Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance Each 149.80 93.8200 104.86 1050.00 Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance Each 339.05 212.3500 154.00 1050.00 Aspiration and/or injection of ganglion cyst(s) any location Each 787.30 493.0900 154.00 1050.00 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) Each 6153.50 3853.9400 1575.00 5000.00 Removal, under anesthesia, of external fixation system Each 4040.18 2530.3600 1050.00 4040.18 Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure) 1.0000 each 3390.62 2123.5500 154.00 3390.62 Bone graft, any donor area; major or large Each 3057.50 1914.9100 1871.00 6191.08 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 1.0000 each 2840.57 1779.0500 154.00 2840.57 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) 1.0000 each 4085.76 2558.9100 1050.00 4085.76 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) 1.0000 each 2092.76 1310.7000 1050.00 2092.76 Unlisted procedure, musculoskeletal system, general Each 4004.59 2508.0700 190.43 4004.59 Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm Each 2360.80 1478.5700 1050.00 2360.80 Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater Each 2145.80 1343.9100 1050.00 2145.80 Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); less than 2 cm Each 2981.70 1867.4400 1050.00 2981.70 Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); 2 cm or greater Each 4858.90 3043.1300 1050.00 4858.90 Excision of bone (eg, for osteomyelitis or bone abscess); mandible Each 4533.67 2839.4400 1300.00 5026.08 Excision of torus mandibularis Each 2155.02 1349.6900 1050.00 2704.13 Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion[s]) Each 6448.40 4038.6300 1300.00 5026.08 Application of interdental fixation device for conditions other than fracture or dislocation, includes removal Each 4786.10 2997.5300 325.00 3541.71 Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Each 7445.35 4663.0200 2698.00 7216.00 Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft) Each 7183.70 4499.1500 1871.00 5315.94 Closed treatment of nasal bone fracture; without stabilization Each 3507.90 2197.0000 1249.38 3507.90 Closed treatment of nasal bone fracture; with stabilization Each 5566.36 3486.2100 1300.00 5000.00 Open treatment of palatal or maxillary fracture (LeFort I type); Each 6397.58 4006.8000 2035.00 5026.08 Open treatment of mandibular fracture; without interdental fixation Each 9831.50 6157.4700 1871.00 7275.31 Open treatment of mandibular fracture; with interdental fixation Each 7772.80 4868.1000 2035.00 5751.87 Biopsy, soft tissue of neck or thorax Each 6876.50 4306.7500 1050.00 5088.61 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater Each 4611.35 2888.0900 1575.00 4611.35 Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greater Each 7077.61 4432.7100 1575.00 5237.43 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm Each 3826.84 2396.7500 1299.45 3826.84 Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm Each 3242.43 2030.7300 1300.00 3242.42 Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater Each 961.95 602.4700 673.36 1575.00 Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); 5 cm or greater Each 4988.00 3123.9800 1575.00 4988.00 Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); lumbar Each 3448.54 2159.8200 1050.00 9357.00 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar Each 8530.65 5342.7500 1050.00 9357.00 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to primary procedure) 1.0000 each 4047.81 2535.1400 1050.00 9357.00 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical Each 1389.26 870.0900 1028.05 9357.00 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar Each 2840.57 1779.0500 1050.00 9357.00 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure) 1.0000 each 1456.08 911.9400 1050.00 9357.00 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar Each 3148.05 1971.6200 1575.00 12169.56 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar Each 11362.05 7116.0500 1575.00 11362.05 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 Each 1389.26 870.0900 1028.05 12169.56 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure) 1.0000 each 1369.58 857.7700 958.71 1369.58 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2 Each 1815.87 1137.2800 1343.74 12169.56 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar Each 2828.99 1771.7900 1050.00 15681.03 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure) 1.0000 each 2565.67 1606.8800 1050.00 2565.67 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment Each 2130.40 1334.2700 1050.00 15681.03 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed) Each 2230.10 1396.7100 1050.00 15681.03 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) Each 2023.57 1267.3600 1497.45 12169.56 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 1.0000 each 1793.85 1123.4900 1050.00 1793.85 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar Each 16317.15 10219.4300 2258.00 14000.00 Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure) 1.0000 each 4047.81 2535.1400 1050.00 9357.00 Exploration of spinal fusion Each 3904.78 2445.5700 1050.00 12169.56 Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) 1.0000 each 3148.05 1971.6200 1050.00 3148.05 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 1.0000 each 5848.21 3662.7400 1050.00 5848.21 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) 1.0000 each 1974.67 1236.7300 1050.00 1974.67 Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) 1.0000 each 1552.43 972.2900 1050.00 9357.00 Reinsertion of spinal fixation device Each 2718.75 1702.7500 1050.00 15681.03 Removal of posterior segmental instrumentation Each 7192.20 4504.4700 1050.00 12169.56 Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure) 1.0000 each 2841.62 1779.7000 1050.00 2841.62 Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical Each 10784.98 6754.6300 2258.00 15681.03 Excision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm or greater Each 3725.68 2333.3900 1575.00 3725.68 Excision, tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greater Each 954.00 597.4900 667.80 1575.00 Claviculectomy; partial Each 6124.25 3835.6200 2035.00 5000.00 Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography Each 20.31 12.7200 14.22 1050.00 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute Each 2071.04 1297.0900 1449.73 6191.08 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic Each 2781.44 1742.0200 1947.01 6191.08 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) Each 2104.90 1318.3000 1473.43 6191.08 Tenodesis of long tendon of biceps Each 2697.22 1689.2700 1871.00 6191.08 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) Each 8676.65 5434.1800 1050.00 12169.56 Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion (includes obtaining graft and/or necessary fixation) Each 8037.05 5033.6000 2698.00 12169.56 Open treatment of clavicular fracture, includes internal fixation, when performed Each 7684.65 4812.9000 1575.00 7684.65 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation Each 636.10 398.3900 190.43 1050.00 Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed; Each 7885.27 4938.5400 1871.00 12169.56 Open treatment of greater humeral tuberosity fracture, includes internal fixation, when performed Each 3885.48 2433.4800 2035.00 6191.08 Closed treatment of shoulder dislocation, with manipulation; without anesthesia Each 635.05 397.7300 190.43 2323.00 Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulation Each 635.00 397.7000 444.50 1375.93 Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; 3 cm or greater Each 479.20 300.1200 335.44 2342.07 Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); less than 5 cm Each 5381.25 3370.2800 1300.00 5000.00 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), humerus Each 5579.55 3494.4700 1575.00 5000.00 Tenodesis of biceps tendon at elbow (separate procedure) Each 6578.05 4119.8300 1575.00 6578.05 Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graft Each 6342.10 3972.0600 1575.00 6342.10 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open Each 5479.54 3431.8400 1575.00 5000.00 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment Each 5638.20 3531.2000 1575.00 5000.00 Arthroplasty, radial head; with implant Each 3228.78 2022.1800 2035.00 12169.56 Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius); Each 10492.79 6571.6300 1871.00 12169.56 Treatment of closed elbow dislocation; without anesthesia Each 635.00 397.7000 190.43 2323.00 Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation Each 637.45 399.2300 154.00 1050.00 Closed treatment of radial head or neck fracture; without manipulation Each 668.28 418.5400 154.00 1050.00 Closed treatment of radial head or neck fracture; with manipulation Each 635.10 397.7600 469.97 2323.00 Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed; Each 6561.70 4109.5900 1871.00 6561.70 Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); with manipulation Each 2931.18 1835.7900 1050.00 2931.18 Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when performed Each 7204.45 4512.1500 1575.00 7204.45 Incision, extensor tendon sheath, wrist (eg, deQuervains disease) Each 4929.54 3087.3700 1285.92 4929.54 Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; 3 cm or greater Each 966.50 605.3200 676.55 1575.00 Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cm Each 4815.65 3016.0400 1299.45 4815.65 Excision of tendon, forearm and/or wrist, flexor or extensor, each Each 4944.40 3096.6800 1871.00 4944.40 Excision of ganglion, wrist (dorsal or volar); primary Each 5577.18 3492.9800 1285.92 5000.00 Excision of ganglion, wrist (dorsal or volar); recurrent Each 5978.65 3744.4300 1285.92 5000.00 Carpectomy; all bones of proximal row Each 7025.45 4400.0400 1871.00 5198.83 Excision distal ulna partial or complete (eg, Darrach type or matched resection) Each 6156.55 3855.8500 1871.00 5000.00 Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscle Each 2687.50 1683.1800 1871.00 2797.03 Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle Each 4486.64 2809.9800 1871.00 4486.64 Osteotomy, radius; distal third Each 6895.15 4318.4300 1575.00 6895.15 Osteoplasty, radius OR ulna; shortening Each 7159.55 4484.0300 1575.00 7159.55 Arthroplasty, interposition, intercarpal or carpometacarpal joints Each 6142.65 3847.1400 2035.00 5000.00 Closed treatment of radial shaft fracture; with manipulation Each 5288.65 3312.2800 1050.00 5000.00 Open treatment of radial shaft fracture, includes internal fixation, when performed Each 6126.60 3837.0900 1575.00 6191.08 Closed treatment of ulnar shaft fracture; with manipulation Each 3537.45 2215.5000 190.43 3537.45 Open treatment of ulnar shaft fracture, includes internal fixation, when performed Each 6478.75 4057.6400 1575.00 6478.75 Closed treatment of radial and ulnar shaft fractures; without manipulation Each 639.15 400.3000 154.00 1050.00 Closed treatment of radial and ulnar shaft fractures; with manipulation Each 649.10 406.5300 454.37 1375.93 Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius AND ulna Each 6873.10 4304.6200 1575.00 6873.10 Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation Each 636.05 398.3600 154.00 1050.00 Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation Each 639.95 400.8000 447.96 1575.00 Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation Each 5492.16 3439.7400 1575.00 5000.00 Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation Each 6526.65 4087.6400 2035.00 6526.65 Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments Each 6313.60 3954.2100 2035.00 6313.60 Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments Each 6869.48 4302.3600 2035.00 6869.48 Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performed Each 5670.63 3551.5200 1575.00 6191.08 Arthrodesis, distal radioulnar joint with segmental resection of ulna, with or without bone graft (eg, Sauve-Kapandji procedure) Each 5472.95 3427.7100 2035.00 6191.08 Drainage of finger abscess; simple Each 2629.49 1646.8500 154.00 2194.00 Fasciotomy, palmar (eg, Dupuytren's contracture); open, partial Each 5961.25 3733.5300 1575.00 5000.00 Tendon sheath incision (eg, for trigger finger) Each 4929.32 3087.2300 1285.92 4929.32 Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; 1.5 cm or greater Each 5001.60 3132.5000 1299.45 5000.00 Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; less than 1.5 cm Each 4929.40 3087.2800 1299.45 4929.40 Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft) Each 5162.58 3233.3200 1871.00 5000.00 Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger Each 4793.85 3002.3900 1285.92 4793.85 Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; Each 5610.84 3514.0700 1285.92 5000.00 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpal Each 1504.05 941.9900 1052.84 2797.03 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); distal phalanx of finger Each 4997.25 3129.7800 1285.92 4997.25 Removal of implant from finger or hand Each 3626.49 2271.2700 1299.45 3626.48 Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); primary or secondary without free graft, each tendon Each 6252.28 3915.8000 1050.00 5000.00 Repair or advancement of profundus tendon, with intact superficialis tendon; primary, each tendon Each 1343.75 841.5900 940.62 2797.03 Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon Each 3236.63 2027.1000 1285.92 3236.63 Tenotomy, flexor, finger, open, each tendon Each 4985.15 3122.2000 1285.92 4985.15 Capsulectomy or capsulotomy; interphalangeal joint, each joint Each 2883.19 1805.7400 1285.92 2883.19 Repair and reconstruction, finger, volar plate, interphalangeal joint Each 6456.20 4043.5200 1871.00 5000.00 Osteotomy; phalanx of finger, each Each 6095.98 3817.9100 2035.00 5000.00 Closed treatment of metacarpal fracture, single; without manipulation, each bone Each 635.05 397.7300 154.00 1050.00 Closed treatment of metacarpal fracture, single; with manipulation, each bone Each 639.10 400.2700 190.43 1300.00 Percutaneous skeletal fixation of metacarpal fracture, each bone Each 6089.58 3813.9000 1871.00 5000.00 Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia Each 640.60 401.2100 190.43 1050.00 Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesia Each 640.50 401.1500 448.35 1375.93 Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each Each 5082.15 3182.9500 190.43 3760.79 Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, each Each 2856.80 1789.2100 1999.76 2856.80 Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation, when performed, each Each 5675.75 3554.7200 1871.00 5000.00 Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation, each Each 641.25 401.6100 190.43 1050.00 Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each Each 2856.80 1789.2100 1300.00 2856.80 Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each Each 5726.42 3586.4600 1871.00 5000.00 Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia Each 649.10 406.5300 190.43 1050.00 Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure Each 5577.10 3492.9400 1300.00 5000.00 Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps (V-Y, hood) Each 5613.01 3515.4300 1871.00 5000.00 Unlisted procedure, hands or fingers Each 5811.80 3639.9300 190.43 5000.00 Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or greater Each 966.50 605.3200 676.55 2342.07 Injection procedure for hip arthrography; without anesthesia Each 1579.10 988.9900 154.00 1579.10 Injection procedure for hip arthrography; with anesthesia Each 930.40 582.7100 651.28 1050.00 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed Each 2424.10 1518.2100 154.00 2424.10 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft Each 7463.82 4674.5900 2258.00 12169.56 Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft Each 8762.12 5487.7200 1050.00 12169.56 Open treatment of hip dislocation, traumatic, without internal fixation Each 5758.12 3606.3100 1050.00 5000.00 Closed treatment of post hip arthroplasty dislocation; without anesthesia Each 635.00 397.7000 190.43 2323.00 Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia Each 1450.50 908.4500 1015.35 1450.50 Closed treatment of femoral fracture, proximal end, head; with manipulation Each 787.80 493.4000 551.46 2797.03 Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device Each 11491.25 7196.9700 2035.00 15681.03 Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg, infection) Each 4204.20 2633.0900 1871.00 4204.20 Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodies Each 6487.90 4063.3700 1871.00 5000.00 Removal of foreign body, deep, thigh region or knee area Each 647.90 405.7800 453.53 2698.00 Suture of quadriceps or hamstring muscle rupture; primary Each 6947.60 4351.2800 1575.00 6947.60 Anterior tibial tubercleplasty (eg, Maquet type procedure) Each 6150.10 3851.8100 1575.00 6191.08 Ligamentous reconstruction (augmentation), knee; extra-articular Each 11560.30 7240.2200 1575.00 8554.62 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment Each 3944.21 2470.2600 2035.00 12169.56 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) Each 9066.80 5678.5300 2258.00 12169.56 Revision of total knee arthroplasty, with or without allograft; 1 component Each 5928.89 3713.2600 1050.00 12169.56 Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal traction Each 1881.70 1178.5100 1285.92 1881.70 Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repair Each 6173.35 3866.3700 1575.00 6191.08 Closed treatment of tibial fracture, proximal (plateau); without manipulation Each 637.45 399.2300 190.43 2323.00 Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, includes internal fixation, when performed Each 6804.35 4261.5600 1050.00 6191.08 Closed treatment of knee dislocation; without anesthesia Each 635.00 397.7000 190.43 2323.00 Closed treatment of patellar dislocation; without anesthesia Each 635.00 397.7000 190.43 2323.00 Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices) Each 4929.15 3087.1300 1050.00 4929.15 Unlisted procedure, femur or knee Each 5146.74 3223.4000 190.43 5000.00 Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm Each 6500.65 4071.3600 1299.45 5000.00 Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body Each 6194.45 3879.5800 1871.00 5000.00 Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankle Each 5152.90 3227.2600 1575.00 5000.00 Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); fibula Each 6733.00 4216.8800 1300.00 5000.00 Repair, primary, open or percutaneous, ruptured Achilles tendon; Each 6153.63 3854.0200 1575.00 6191.08 Repair, flexor tendon, leg; primary, without graft, each tendon Each 3305.86 2070.4600 1050.00 3305.86 Gastrocnemius recession (eg, Strayer procedure) Each 4523.37 2832.9900 1575.00 4523.37 Repair, primary, disrupted ligament, ankle; collateral Each 3532.08 2212.1400 1300.00 6191.08 Repair, primary, disrupted ligament, ankle; both collateral ligaments Each 5976.35 3742.9900 1300.00 6191.08 Arthroplasty, ankle; Each 6653.10 4166.8400 2035.00 6653.10 Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation Each 635.55 398.0400 190.43 2323.00 Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction Each 6652.97 4166.7500 1050.00 5000.00 Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclage Each 11019.32 6901.4000 1871.00 12169.56 Open treatment of medial malleolus fracture, includes internal fixation, when performed Each 6840.80 4284.3900 1575.00 6840.80 Closed treatment of posterior malleolus fracture; without manipulation Each 635.00 397.7000 190.43 1050.00 Open treatment of posterior malleolus fracture, includes internal fixation, when performed Each 6136.35 3843.2000 1575.00 6191.08 Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performed Each 7062.60 4423.3100 1575.00 7062.60 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation Each 635.00 397.7000 190.43 2323.00 Closed treatment of distal fibular fracture (lateral malleolus); with manipulation Each 635.80 398.2000 190.43 2323.00 Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performed Each 6974.78 4368.3000 1575.00 6974.77 Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation Each 635.00 397.7000 190.43 2323.00 Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation Each 639.95 400.8000 473.56 2323.00 Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performed Each 6961.66 4360.0900 1575.00 6961.66 Closed treatment of trimalleolar ankle fracture; with manipulation Each 635.65 398.1100 470.38 2323.00 Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lip Each 9412.25 5894.8900 1575.00 8127.00 Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lip Each 3924.30 2457.7900 1575.00 6191.08 Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation Each 639.95 400.8000 190.43 2323.00 Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula only Each 9391.17 5881.6900 1575.00 8127.00 Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia only Each 3643.03 2281.6300 1575.00 12169.56 Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performed Each 6516.70 4081.4100 1300.00 6516.70 Unlisted procedure, leg or ankle Each 3532.08 2212.1400 190.43 3532.08 Fasciotomy, foot and/or toe Each 5518.80 3456.4200 1575.00 5000.00 Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm Each 4955.93 3103.9000 1299.45 4955.92 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot Each 5574.90 3491.5600 1285.92 5000.00 Excision or curettage of bone cyst or benign tumor, talus or calcaneus; Each 1933.09 1210.6900 1300.00 2797.03 Excision or curettage of bone cyst or benign tumor, phalanges of foot Each 4543.39 2845.5300 1077.00 4543.39 Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure) Each 6154.88 3854.8000 1575.00 5000.00 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe Each 4997.16 3129.7200 1077.00 4997.16 Removal of foreign body, foot; subcutaneous Each 970.30 607.7000 325.00 1300.00 Removal of foreign body, foot; deep Each 6478.50 4057.4800 1299.45 5000.00 Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon Each 6063.65 3797.6600 1575.00 5000.00 Repair, tendon, extensor, foot; primary or secondary, each tendon Each 6597.43 4131.9700 1575.00 5000.00 Tenotomy, open, tendon flexor; toe, single tendon (separate procedure) Each 2257.51 1413.8800 1077.00 2257.51 Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, Kidner type procedure) Each 6176.55 3868.3700 1575.00 6191.08 Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure) Each 2471.30 1547.7800 1077.00 2797.03 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) Each 6142.86 3847.2700 1575.00 5000.00 Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head Each 2131.90 1335.2100 1492.33 2797.03 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant Each 5607.88 3512.2100 1575.00 5000.00 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method Each 6455.58 4043.1300 1575.00 5000.00 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method Each 2615.57 1638.1300 1575.00 6191.08 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method Each 9150.90 5731.2100 2035.00 7000.00 Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation Each 4666.39 2922.5600 1300.00 6191.08 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each Each 4709.18 2949.3600 1300.00 4709.18 Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, fifth toe, curly toes) Each 3016.55 1889.2600 1300.00 3016.55 Sesamoidectomy, first toe (separate procedure) Each 2326.82 1457.2900 1628.77 2797.03 Open treatment of calcaneal fracture, includes internal fixation, when performed; Each 6732.85 4216.7800 1575.00 6732.85 Closed treatment of metatarsal fracture; without manipulation, each Each 635.10 397.7600 154.00 1050.00 Percutaneous skeletal fixation of metatarsal fracture, with manipulation, each Each 3257.15 2039.9500 1300.00 3257.15 Open treatment of metatarsal fracture, includes internal fixation, when performed, each Each 7623.25 4774.4400 1871.00 7623.25 Closed treatment of fracture great toe, phalanx or phalanges; without manipulation Each 635.00 397.7000 154.00 1050.00 Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each Each 635.00 397.7000 154.00 1050.00 Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation, when performed, each Each 5687.15 3561.8600 1575.00 5000.00 Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; Each 5719.09 3581.8700 1871.00 12169.56 Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; with osteotomy (eg, flatfoot correction) Each 5933.29 3716.0200 1871.00 12169.56 Arthrodesis, midtarsal or tarsometatarsal, single joint Each 2724.53 1706.3800 1871.00 6191.08 Arthrodesis, great toe; metatarsophalangeal joint Each 5908.10 3700.2400 1871.00 6191.08 Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint (eg, Jones type procedure) Each 2326.82 1457.2900 1628.77 6191.08 Amputation, metatarsal, with toe, single Each 5550.90 3476.5300 1300.00 5000.00 Amputation, toe; interphalangeal joint Each 6279.83 3933.0600 1300.00 5000.00 Unlisted procedure, foot or toes Each 3604.63 2257.5800 190.43 3604.62 Application of long arm splint (shoulder to hand) Each 196.55 123.1000 130.39 1050.00 Application of short arm splint (forearm to hand); static Each 196.55 123.1000 103.39 1050.00 Application of short arm splint (forearm to hand); dynamic Each 196.55 123.1000 103.39 1050.00 Application of finger splint; static Each 196.55 123.1000 103.39 1050.00 Application of finger splint; dynamic Each 196.55 123.1000 51.41 1050.00 Strapping; thorax Each 196.55 123.1000 130.39 1050.00 Strapping; shoulder (eg, Velpeau) Each 196.55 123.1000 103.39 1050.00 Strapping; elbow or wrist Each 196.55 123.1000 51.41 1050.00 Strapping; hand or finger Each 196.55 123.1000 51.41 1050.00 Application of short leg cast (below knee to toes); Each 597.50 374.2100 154.00 1050.00 Application of long leg splint (thigh to ankle or toes) Each 196.55 123.1000 130.39 1050.00 Application of short leg splint (calf to foot) Each 196.55 123.1000 130.39 1050.00 Strapping; hip Each 196.55 123.1000 103.39 1050.00 Strapping; knee Each 196.55 123.1000 103.39 1050.00 Strapping; ankle and/or foot Each 196.55 123.1000 130.39 1050.00 Strapping; toes Each 196.55 123.1000 51.41 1050.00 Strapping; Unna boot Each 418.40 262.0400 130.39 1050.00 Unlisted procedure, casting or strapping Each 196.55 123.1000 130.39 1050.00 Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure) Each 4981.07 3119.6500 1575.00 4981.07 Arthroscopy, shoulder, surgical; capsulorrhaphy Each 9127.85 5716.7700 1575.00 8127.00 Arthroscopy, shoulder, surgical; repair of SLAP lesion Each 9767.15 6117.1700 1575.00 8127.00 Arthroscopy, shoulder, surgical; with removal of loose body or foreign body Each 3546.90 2221.4200 1575.00 3546.90 Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies]) Each 7114.75 4455.9700 1575.00 5264.92 Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies]) Each 7541.50 4723.2400 1575.00 5580.71 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) Each 6367.50 3987.9700 2035.00 5000.00 Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation Each 7411.50 4641.8200 1575.00 5484.51 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure) 1.0000 each 3524.49 2207.3900 1575.00 3524.49 Arthroscopy, shoulder, surgical; with rotator cuff repair Each 8629.25 5404.5000 2035.00 8127.00 Arthroscopy, shoulder, surgical; biceps tenodesis Each 2874.60 1800.3600 1575.00 6191.08 Arthroscopy, elbow, surgical; synovectomy, partial Each 3626.55 2271.3100 1575.00 3626.55 Endoscopy, wrist, surgical, with release of transverse carpal ligament Each 5911.64 3702.4600 1285.92 5000.00 Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation) Each 5455.45 3416.7500 1575.00 5000.00 Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure) Each 6036.38 3780.5800 1871.00 5000.00 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) Each 5454.10 3415.9000 1871.00 5000.00 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed Each 5459.49 3419.2800 1871.00 5000.00 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed Each 5804.66 3635.4600 1871.00 5000.00 Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) Each 14151.05 8862.8000 1575.00 10471.78 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction Each 10937.25 6850.0000 1575.00 8127.00 Arthroscopy, ankle, surgical, excision of osteochondral defect of talus and/or tibia, including drilling of the defect Each 2973.64 1862.3900 1575.00 2973.64 Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy) Each 2661.06 1666.6200 1575.00 6191.08 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body Each 4174.38 2614.4200 1575.00 4174.38 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial Each 6649.45 4164.5500 1575.00 5000.00 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited Each 7323.26 4586.5600 1575.00 5419.21 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive Each 3869.15 2423.2500 1575.00 3869.15 Unlisted procedure, arthroscopy Each 11531.75 7222.3400 190.43 8533.50 Biopsy, intranasal Each 1420.65 889.7500 325.00 1420.65 Excision, nasal polyp(s), simple Each 2253.70 1411.4900 325.00 2253.70 Excision or destruction (eg, laser), intranasal lesion; internal approach Each 5205.27 3260.0600 1575.00 5000.00 Excision inferior turbinate, partial or complete, any method Each 2284.13 1430.5500 1575.00 2704.13 Removal foreign body, intranasal; office type procedure Each 586.55 367.3600 103.39 1050.00 Removal foreign body, intranasal; requiring general anesthesia Each 5646.85 3536.6200 1050.00 5000.00 Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip Each 7261.10 4547.6300 2035.00 5373.21 Rhinoplasty, primary; including major septal repair Each 3870.60 2424.1600 2035.00 5026.08 Most recent hemoglobin A1c (HbA1c) level less than 7.0% (DM) 1.0000 each 0.01 0.0100 0.01 0.01 Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction) Each 2255.48 1412.6100 1578.84 5026.08 Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s) Each 2365.22 1481.3400 1655.65 5026.08 Most recent hemoglobin A1c level greater than 9.0% (DM) 1.0000 each 0.01 0.0100 0.01 0.01 Most recent hemoglobin A1c (HbA1c) level greater than or equal to 7.0% and less than 8.0% (DM) 1.0000 each 0.01 0.0100 0.01 0.01 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft Each 6518.90 4082.7900 1871.00 5000.00 Most recent hemoglobin A1c (HbA1c) level greater than or equal to 8.0% and less than or equal to 9.0% (DM) 1.0000 each 0.01 0.0100 0.01 0.01 Lysis intranasal synechia Each 1130.90 708.2800 417.78 1300.00 Most recent systolic blood pressure less than 130 mm Hg (DM), (HTN, CKD, CAD) 1.0000 each 0.01 0.0100 0.01 0.01 Most recent systolic blood pressure 130-139 mm Hg (DM) (HTN, CKD, CAD) 1.0000 each 0.01 0.0100 0.01 0.01 Most recent systolic blood pressure greater than or equal to 140 mm Hg (HTN, CKD, CAD) (DM) 1.0000 each 0.01 0.0100 0.01 0.01 Most recent diastolic blood pressure less than 80 mm Hg (HTN, CKD, CAD) (DM) 1.0000 each 0.01 0.0100 0.01 0.01 Most recent diastolic blood pressure 80-89 mm Hg (HTN, CKD, CAD) (DM) 1.0000 each 0.01 0.0100 0.01 0.01 Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal) Each 2260.42 1415.7000 1050.00 2323.00 Most recent diastolic blood pressure greater than or equal to 90 mm Hg (HTN, CKD, CAD) (DM) 1.0000 each 0.01 0.0100 0.01 0.01 Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method Each 344.25 215.6000 103.39 1050.00 Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method Each 707.20 442.9200 103.39 2323.00 Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial Each 661.18 414.0900 103.39 2323.00 Unlisted procedure, nose Each 3270.60 2048.3800 195.43 3270.60 Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium) Each 500.25 313.3100 195.43 1050.00 Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without removal of antrochoanal polyps Each 3923.50 2457.2900 1575.00 5026.08 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) Each 641.70 401.9000 151.82 1300.00 Nasal/sinus endoscopy, diagnostic; with maxillary sinusoscopy (via inferior meatus or canine fossa puncture) Each 3923.50 2457.2900 325.00 3183.00 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure) Each 5911.50 3702.3700 1300.00 5000.00 Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage Each 6442.65 4035.0300 1300.00 5000.00 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed Each 2131.11 1334.7200 1491.78 5754.11 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior) Each 3456.89 2165.0500 1871.00 5754.11 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior) Each 3357.15 2102.5800 2035.00 5754.11 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; Each 2153.50 1348.7400 1507.45 3061.49 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy Each 2157.63 1351.3200 1510.34 5754.11 Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus Each 3008.14 1884.0000 2035.00 5754.11 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus Each 2677.17 1676.7100 1575.00 5754.11 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performed Each 2167.65 1357.6000 1517.36 5754.11 Nasal/sinus endoscopy, surgical, with sphenoidotomy; Each 2153.50 1348.7400 1507.45 5754.11 Intubation, endotracheal, emergency procedure Each 585.95 366.9800 154.00 1050.00 Tracheotomy tube change prior to establishment of fistula tract Each 530.40 332.1900 195.43 1050.00 Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn Each 2650.95 1660.2900 1300.00 2650.95 Laryngoscopy, direct, operative, with biopsy; Each 5261.17 3295.0700 1300.00 5000.00 Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope Each 6744.78 4224.2500 1575.00 5000.00 Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope Each 6471.15 4052.8800 1871.00 5000.00 Laryngoscopy, flexible; diagnostic Each 471.10 295.0500 151.82 1300.00 Laryngoscopy, flexible or rigid telescopic, with stroboscopy Each 1079.50 676.0900 325.00 1300.00 Tracheobronchoscopy through established tracheostomy incision Each 1176.15 736.6200 417.78 2323.00 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) Each 3051.93 1911.4200 1300.00 3051.92 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings Each 3223.77 2019.0500 1300.00 3223.77 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage Each 3112.95 1949.6400 1300.00 3112.95 Catheter aspiration (separate procedure); nasotracheal Each 555.35 347.8200 173.52 2323.00 Surgical closure tracheostomy or fistula; with plastic repair Each 6318.40 3957.2100 1300.00 5000.00 Biopsy, pleura, percutaneous needle Each 1631.25 1021.6500 1050.00 2323.00 Core needle biopsy, lung or mediastinum, percutaneous, including imaging guidance, when performed Each 1682.65 1053.8400 1050.00 1682.65 Insertion of indwelling tunneled pleural catheter with cuff 1.0000 each 1307.00 818.5700 914.90 3145.88 Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure) Each 702.00 439.6600 491.40 1389.56 Removal of indwelling tunneled pleural catheter with cuff Each 105.70 66.2000 73.99 1050.00 Thoracentesis, needle or catheter, aspiration of the pleural space; without imaging guidance Each 734.00 459.7000 500.22 1050.00 Thoracentesis, needle or catheter, aspiration of the pleural space; with imaging guidance Each 1627.00 1018.9900 500.22 1627.00 Pleural drainage, percutaneous, with insertion of indwelling catheter; without imaging guidance Each 5410.80 3388.7800 1300.00 5000.00 Falls risk assessment documented (GER) 1.0000 each 0.01 0.0100 0.01 0.01 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular Each 1.30 0.8100 0.91 10277.52 Exploration for postoperative hemorrhage, thrombosis or infection; neck Each 6615.37 4143.2100 1050.00 5000.00 Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture) Each 635.00 397.7000 154.00 1050.00 Collection of venous blood by venipuncture 1.0000 Each 22.90 14.3400 3.00 17.18 Transfusion, blood or blood components 1.0000 Each 352.80 220.9600 246.96 1050.00 Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older 1.0000 each 721.49 451.8700 533.90 2827.92 Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older Each 4216.15 2640.5700 1300.00 4216.15 Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older Each 4339.68 2717.9400 1575.00 4339.68 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; age 5 years or older 1.0000 each 1061.35 664.7200 742.94 1389.56 Removal of tunneled central venous catheter, without subcutaneous port or pump Each 1296.68 812.1100 500.22 2323.00 Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion Each 1095.40 686.0500 810.60 2323.00 Collection of blood specimen from a completely implantable venous access device 1.0000 Each 228.80 143.3000 103.39 1050.00 Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified 1.0000 Each 182.00 113.9900 103.39 1050.00 Declotting by thrombolytic agent of implanted vascular access device or catheter Each 355.70 222.7700 154.00 1050.00 Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report Each 776.00 486.0100 154.00 1300.00 Arterial puncture, withdrawal of blood for diagnosis Each 312.00 195.4100 103.39 1050.00 Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous 1.0000 each 105.30 65.9500 73.71 1050.00 Placement of needle for intraosseous infusion Each 640.08 400.8800 249.56 1050.00 Thrombolysis, cerebral, by intravenous infusion Each 670.19 419.7400 287.00 1050.00 Ligation or biopsy, temporal artery Each 958.40 600.2500 670.88 1390.41 Diagnostic bone marrow; aspiration(s) Each 511.70 320.4800 358.19 1390.41 Diagnostic bone marrow; biopsy(ies) Each 511.70 320.4800 358.19 1390.41 Diagnostic bone marrow; biopsy(ies) and aspiration(s) Each 2145.80 1343.9100 1050.00 2342.07 Drainage of lymph node abscess or lymphadenitis; simple Each 2525.10 1581.4700 1050.00 2525.10 Biopsy or excision of lymph node(s); open, superficial Each 5881.74 3683.7300 1300.00 5000.00 Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal, axillary) Each 1485.00 930.0600 1050.00 2323.00 Biopsy or excision of lymph node(s); open, deep cervical node(s) Each 5746.53 3599.0500 1300.00 5000.00 Biopsy or excision of lymph node(s); open, deep axillary node(s) Each 5905.21 3698.4300 1300.00 5000.00 Biopsy or excision of lymph node(s); open, inguinofemoral node(s) Each 5250.05 3288.1100 1300.00 5000.00 Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple Each 4698.88 2942.9100 2258.00 5000.77 Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy Each 3903.59 2444.8200 2732.51 8802.63 Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure) 1.0000 each 1892.21 1185.0900 1050.00 1892.21 Patient screened for tobacco use and received tobacco cessation intervention (counseling, pharmacotherapy, or both), if identified as a tobacco user (PV, CAD) 1.0000 each 0.01 0.0100 0.01 0.01 Biopsy of lip Each 815.35 510.6500 195.43 1050.00 Excision of lip; V-excision with primary direct linear closure Each 4545.85 2847.0700 1300.00 4545.85 Incision of labial frenum (frenotomy) Each 223.60 140.0400 156.52 1050.00 Biopsy, vestibule of mouth Each 925.60 579.7000 325.00 1050.00 Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair Each 3239.60 2028.9600 325.00 3106.00 Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair Each 3536.00 2214.6000 325.00 3106.00 Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy) Each 2452.30 1535.8800 1050.00 2452.30 Incision of lingual frenum (frenotomy) Each 1482.00 928.1800 1050.00 2323.00 Biopsy of tongue; anterior two-thirds Each 1590.15 995.9100 325.00 1590.15 Biopsy of tongue; posterior one-third Each 5647.25 3536.8700 325.00 4178.96 Biopsy of floor of mouth Each 1725.35 1080.5900 325.00 1725.35 Excision of lesion of tongue without closure Each 4277.50 2679.0000 1050.00 4277.50 Excision of lesion of tongue with closure; anterior two-thirds Each 3622.30 2268.6500 1300.00 3622.30 Excision of lingual frenum (frenectomy) Each 6367.00 3987.6500 325.00 4711.58 Excision, lesion of floor of mouth Each 6809.40 4264.7300 1050.00 5038.96 Drainage of abscess, cyst, hematoma from dentoalveolar structures Each 660.40 413.6100 103.39 2323.00 Excision of lesion or tumor (except listed above), dentoalveolar structures; without repair Each 4096.55 2565.6700 325.00 3106.00 Alveoloplasty, each quadrant (specify) Each 3344.35 2094.5600 325.00 3106.00 Unlisted procedure, dentoalveolar structures Each 5784.61 3622.9000 195.43 5000.00 Biopsy of palate, uvula Each 2222.50 1391.9500 325.00 2222.50 Excision, lesion of palate, uvula; without closure Each 2174.65 1361.9800 325.00 2704.13 Uvulectomy, excision of uvula Each 3523.14 2206.5400 1300.00 3523.14 Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral Each 3829.30 2398.2900 325.00 3106.00 Sialolithotomy; parotid, extraoral or complicated intraoral Each 6498.75 4070.1700 1300.00 5000.00 Biopsy of salivary gland; needle Each 1617.10 1012.7900 325.00 1617.10 Biopsy of salivary gland; incisional Each 3421.60 2142.9500 1249.38 3421.60 Excision of parotid tumor or parotid gland; lateral lobe, with dissection and preservation of facial nerve Each 6861.08 4297.0900 2698.00 5077.20 Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve Each 8899.49 5573.7500 2698.00 7216.00 Injection procedure for sialography Each 49.25 30.8500 34.48 1050.00 Dilation salivary duct Each 3517.30 2202.8800 325.00 3106.00 Unlisted procedure, salivary glands or ducts Each 4799.50 3005.9300 195.43 4799.50 Biopsy; oropharynx Each 7151.59 4479.0400 1050.00 5292.17 Biopsy; nasopharynx, visible lesion, simple Each 2051.46 1284.8300 1050.00 2704.13 Excision or destruction of lesion of pharynx, any method Each 6923.58 4336.2400 1300.00 5123.45 Tonsillectomy and adenoidectomy; younger than age 12 Each 5495.72 3441.9700 1575.00 5026.08 Tonsillectomy and adenoidectomy; age 12 or over Each 6537.98 4094.7300 2035.00 5000.00 Tonsillectomy, primary or secondary; younger than age 12 Each 6695.30 4193.2700 1871.00 5026.08 Tonsillectomy, primary or secondary; age 12 or over Each 6855.90 4293.8500 1871.00 5073.37 Adenoidectomy, primary; younger than age 12 Each 5495.95 3442.1100 1871.00 5000.00 Adenoidectomy, primary; age 12 or over Each 1678.24 1051.0800 1174.77 2704.13 Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); simple Each 789.35 494.3700 417.78 2323.00 Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy); with secondary surgical intervention Each 4835.35 3028.3800 1300.00 4835.35 Unlisted procedure, pharynx, adenoids, or tonsils Each 3388.78 2122.3900 195.43 3388.78 Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Each 408.40 255.7800 302.22 2323.00 Esophagoscopy, flexible, transoral; with biopsy, single or multiple Each 5319.32 3331.4900 1050.00 5000.00 Esophagoscopy, flexible, transoral; with band ligation of esophageal varices Each 402.85 252.3000 298.11 2323.00 Esophagoscopy, flexible, transoral; with removal of foreign body(s) Each 291.40 182.5000 215.64 2323.00 Esophagoscopy, flexible, transoral; with endoscopic ultrasound examination Each 6868.58 4301.7900 1300.00 5082.75 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Each 3564.25 2232.2900 747.71 3564.25 Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance Each 4909.20 3074.6300 747.71 4909.20 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination limited to the esophagus, stomach or duodenum, and adjacent structures Each 4909.86 3075.0500 1300.00 4909.86 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple Each 4567.60 2860.6900 747.71 4567.60 Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or catheter Each 282.90 177.1800 198.03 1605.86 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided intramural or transmural fine needle aspiration/biopsy(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) Each 5407.85 3386.9400 1300.00 5000.00 Esophagogastroduodenoscopy, flexible, transoral; with band ligation of esophageal/gastric varices Each 531.50 332.8800 372.05 1605.86 Esophagogastroduodenoscopy, flexible, transoral; with dilation of gastric/duodenal stricture(s) (eg, balloon, bougie) Each 4540.20 2843.5300 1300.00 4540.20 Esophagogastroduodenoscopy, flexible, transoral; with directed placement of percutaneous gastrostomy tube Each 4734.30 2965.0900 1300.00 4734.30 Esophagogastroduodenoscopy, flexible, transoral; with removal of foreign body(s) Each 5004.18 3134.1100 747.71 5000.00 Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire Each 4038.00 2529.0000 747.71 4038.00 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) Each 4540.20 2843.5300 1300.00 4540.20 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps Each 5000.79 3131.9900 1300.00 5000.00 Esophagogastroduodenoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique Each 5205.50 3260.2000 1300.00 5000.00 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound-guided transmural injection of diagnostic or therapeutic substance(s) (eg, anesthetic, neurolytic agent) or fiducial marker(s) (includes endoscopic ultrasound examination of the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis) Each 4739.70 2968.4700 1500.80 4739.70 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection Each 8536.19 5346.2200 1500.80 6316.78 Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any method Each 4494.00 2814.5900 1300.00 4494.00 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic ultrasound examination, including the esophagus, stomach, and either the duodenum or a surgically altered stomach where the jejunum is examined distal to the anastomosis Each 6052.95 3790.9600 1500.80 5000.00 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Each 8599.40 5385.8000 1300.00 6363.56 Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple Each 2172.47 1360.6200 1300.00 3044.47 Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy Each 2550.48 1597.3600 1300.00 3044.47 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s) Each 810.44 507.5800 567.31 3044.47 Endoscopic retrograde cholangiopancreatography (ERCP); with destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy) Each 3753.10 2350.5700 1300.00 4969.23 Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) Each 4319.20 2705.1100 1575.00 4969.23 Endoscopic cannulation of papilla with direct visualization of pancreatic/common bile duct(s) (List separately in addition to code(s) for primary procedure) 1.0000 each 3753.10 2350.5700 1300.00 3753.10 Endoscopic retrograde cholangiopancreatography (ERCP); with placement of endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent Each 4785.40 2997.1000 1575.00 4969.23 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of foreign body(s) or stent(s) from biliary/pancreatic duct(s) Each 8811.90 5518.8900 1575.00 6520.81 Endoscopic retrograde cholangiopancreatography (ERCP); with removal and exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and guide wire passage, when performed, including sphincterotomy, when performed, each stent exchanged Each 6098.73 3819.6300 1575.00 5000.00 Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including sphincterotomy, when performed, each duct Each 2577.68 1614.4000 1575.00 3044.47 Dilation of esophagus, by unguided sound or bougie, single or multiple passes Each 285.00 178.5000 210.90 2323.00 Gastrotomy; with exploration or foreign body removal Each 460.10 288.1600 322.07 1050.00 Unlisted laparoscopy procedure, stomach Each 13228.61 8285.0800 1575.00 9789.17 Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report) 1.0000 each 660.40 413.6100 154.00 1300.00 Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (eg, for gastrointestinal hemorrhage), including lavage if performed 1.0000 each 581.35 364.1000 154.00 1050.00 Repositioning of a naso- or oro-gastric feeding tube, through the duodenum for enteric nutrition Each 635.00 397.7000 245.80 1050.00 Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract Each 331.55 207.6500 232.08 1050.00 Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis Each 5763.18 3609.4800 2035.00 5763.18 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Each 387.90 242.9400 271.53 1605.86 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with biopsy, single or multiple Each 309.30 193.7100 216.51 1605.86 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma coagulator) Each 467.20 292.6100 327.04 1605.86 Ileoscopy, through stoma; with biopsy, single or multiple Each 146.60 91.8200 108.48 2323.00 Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Each 584.75 366.2300 432.72 2323.00 Colonoscopy through stoma; with biopsy, single or multiple Each 2996.03 1876.4200 957.69 2996.03 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps Each 3648.00 2284.7500 957.69 3648.00 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique Each 6004.00 3760.3100 957.69 5000.00 Laparoscopy, surgical, appendectomy Each 7859.36 4922.3200 1575.00 7000.00 Biopsy of anorectal wall, anal approach (eg, congenital megacolon) Each 2269.75 1421.5400 1050.00 2414.58 Proctosigmoidoscopy, rigid; with biopsy, single or multiple Each 5274.80 3303.6100 957.69 5000.00 Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Each 2920.90 1829.3600 732.98 2920.90 Sigmoidoscopy, flexible; with biopsy, single or multiple Each 3947.10 2472.0700 732.98 3947.10 Sigmoidoscopy, flexible; with endoscopic ultrasound examination Each 4525.56 2834.3600 732.98 4525.56 Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or transmural fine needle aspiration/biopsy(s) Each 4838.85 3030.5700 957.69 4838.85 Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) Each 2757.65 1727.1200 957.69 2757.65 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Each 5185.50 3247.6800 732.98 5000.00 Colonoscopy, flexible; with removal of foreign body(s) Each 5271.40 3301.4800 957.69 5000.00 Colonoscopy, flexible; with biopsy, single or multiple Each 5279.10 3306.3000 957.69 5000.00 Colonoscopy, flexible; with directed submucosal injection(s), any substance Each 5562.20 3483.6100 957.69 5000.00 Colonoscopy, flexible; with control of bleeding, any method Each 5185.50 3247.6800 957.69 5000.00 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps Each 6413.85 4016.9900 957.69 5000.00 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique Each 6372.32 3990.9800 957.69 5000.00 Colonoscopy, flexible; with transendoscopic balloon dilation Each 3142.70 1968.2700 957.69 3142.70 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) Each 5889.48 3688.5800 957.69 5000.00 Colonoscopy, flexible; with endoscopic mucosal resection Each 7421.78 4648.2600 1300.00 5492.11 Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and cecum, and adjacent structures Each 3820.85 2393.0000 957.69 3820.85 Colonoscopy, flexible; with band ligation(s) (eg, hemorrhoids) Each 5666.30 3548.8000 957.69 5000.00 Anorectal exam, surgical, requiring anesthesia (general, spinal, or epidural), diagnostic Each 4941.68 3094.9700 1300.00 4941.68 Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure) Each 958.40 600.2500 670.88 1575.00 Incision and drainage, perianal abscess, superficial Each 1103.50 691.1200 732.98 2323.00 Sphincterotomy, anal, division of sphincter (separate procedure) Each 4358.15 2729.5100 1575.00 4358.15 Incision of thrombosed hemorrhoid, external Each 302.00 189.1400 211.40 1050.00 Hemorrhoidectomy, internal, by rubber band ligation(s) Each 1141.55 714.9500 325.00 1141.55 Hemorrhoidectomy, internal and external, single column/group; Each 5157.53 3230.1600 1575.00 5000.00 Hemorrhoidectomy, internal and external, 2 or more columns/groups; Each 5535.74 3467.0300 1575.00 5000.00 Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous Each 4856.96 3041.9200 1575.00 4856.96 Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric Each 4577.78 2867.0600 1575.00 4577.78 Excision of thrombosed hemorrhoid, external Each 663.00 415.2400 325.00 1050.00 Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Each 2914.10 1825.1000 103.39 2914.10 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision Each 5312.05 3326.9400 1050.00 5000.00 Biopsy of liver, needle; percutaneous Each 1627.80 1019.4900 1050.00 2323.00 Biopsy of liver, wedge Each 3867.90 2422.4600 1050.00 3867.90 Unlisted laparoscopic procedure, liver Each 6079.40 3807.5300 2035.00 5000.77 Injection procedure for cholangiography, percutaneous, complete diagnostic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation; existing access Each 489.85 306.7900 154.00 3145.88 Removal of calculi/debris from biliary duct(s) and/or gallbladder, percutaneous, including destruction of calculi by any method (eg, mechanical, electrohydraulic, lithotripsy) when performed, imaging guidance (eg, fluoroscopy), and all associated radiological supervision and interpretation (List separately in addition to code for primary procedure) 1.0000 each 882.95 552.9900 618.06 1050.00 Laparoscopy, surgical; cholecystectomy Each 12711.65 7961.3100 2035.00 9406.62 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance Each 635.00 397.7000 444.50 1300.00 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance Each 2081.70 1303.7700 747.71 2081.70 Biopsy, abdominal or retroperitoneal mass, percutaneous needle Each 1627.70 1019.4300 1050.00 2323.00 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) Each 8889.95 5567.7800 1575.00 7000.00 Laparoscopy, surgical; with biopsy (single or multiple) Each 8058.15 5046.8200 1871.00 7000.00 Unlisted laparoscopy procedure, abdomen, peritoneum and omentum Each 10608.00 6643.7900 1050.00 7849.92 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous Each 135.00 84.5500 94.50 1390.41 Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous Each 153.47 96.1200 107.43 1390.41 Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, contrast injection when performed, and radiological supervision and interpretation, percutaneous Each 2074.00 1298.9500 1300.00 3145.88 Exchange of previously placed abscess or cyst drainage catheter under radiological guidance (separate procedure) Each 142.70 89.3700 99.89 1605.86 Repair initial inguinal hernia, age 5 years or older; reducible Each 5924.25 3710.3600 1871.00 5000.00 Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated Each 6614.45 4142.6300 1871.00 5000.00 Repair recurrent inguinal hernia, any age; reducible Each 4390.80 2749.9600 1871.00 4390.80 Repair lumbar hernia Each 4398.60 2754.8400 1300.00 5000.77 Repair recurrent incisional or ventral hernia; incarcerated or strangulated Each 6807.08 4263.2700 2035.00 6807.08 Repair spigelian hernia Each 4513.80 2826.9900 1575.00 4513.80 Laparoscopy, surgical; repair initial inguinal hernia Each 11032.65 6909.7500 1871.00 8164.16 Laparoscopy, surgical; repair recurrent inguinal hernia Each 5737.30 3593.2700 2698.00 5737.30 Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible Each 5731.05 3589.3600 1871.00 5731.05 Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated Each 11057.90 6925.5600 1871.00 8182.85 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated Each 11430.85 7159.1400 1871.00 8802.63 Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated Each 5784.73 3622.9700 1871.00 8802.63 Unlisted laparoscopy procedure, hernioplasty, herniorrhaphy, herniotomy Each 3915.57 2452.3200 2035.00 5000.77 Unlisted procedure, abdomen, peritoneum and omentum Each 724.00 453.4400 506.80 1050.00 Renal biopsy; percutaneous, by trocar or needle Each 1627.70 1019.4300 1050.00 2323.00 Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous Each 1492.70 934.8800 574.43 2323.00 Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation Each 2797.10 1751.8200 1300.00 2797.10 Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation Each 2308.80 1446.0000 1050.00 2308.80 Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed; including new access into the renal collecting system Each 1627.70 1019.4300 1139.39 3040.07 Lithotripsy, extracorporeal shock wave Each 13912.50 8713.4000 2841.18 10295.25 Bladder irrigation, simple, lavage and/or instillation Each 449.30 281.4000 154.00 1050.00 Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine) Each 71.80 44.9700 50.26 1050.00 Insertion of temporary indwelling bladder catheter; simple (eg, Foley) Each 280.80 175.8700 103.39 1050.00 Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon) Each 466.95 292.4500 128.88 1050.00 Change of cystostomy tube; simple Each 249.60 156.3200 174.72 1050.00 Change of cystostomy tube; complicated Each 391.05 244.9100 289.38 2323.00 Bladder instillation of anticarcinogenic agent (including retention time) Each 644.80 403.8400 154.00 644.80 Complex uroflowmetry (eg, calibrated electronic equipment) Each 139.35 87.2700 97.54 1050.00 Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure) 1.0000 each 494.00 309.3900 345.80 1050.00 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging 1.0000 Each 91.50 57.3100 51.41 1050.00 Cystorrhaphy, suture of bladder wound, injury or rupture; simple Each 5673.90 3553.5600 1300.00 5000.00 Cystourethroscopy (separate procedure) Each 1218.90 763.4000 530.83 2323.00 Cystourethroscopy with irrigation and evacuation of multiple obstructing clots Each 5372.65 3364.8900 1300.00 5000.00 Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; Each 6407.65 4013.1100 1300.00 5000.00 Cystourethroscopy, with biopsy(s) Each 7356.00 4607.0600 1300.00 5443.44 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands Each 1927.27 1207.0500 1300.00 3040.07 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy Each 3901.05 2443.2300 1300.00 3901.05 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm) Each 4045.60 2533.7600 1300.00 4045.60 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm) Each 5535.43 3466.8400 1575.00 5000.00 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; LARGE bladder tumor(s) Each 6566.73 4112.7400 1575.00 5000.00 Cystourethroscopy with direct vision internal urethrotomy Each 4082.00 2556.5600 1575.00 4082.00 Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female Each 2672.80 1673.9700 1300.00 2672.80 Cystourethroscopy, with injection(s) for chemodenervation of the bladder Each 2182.95 1367.1800 1300.00 2182.95 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple Each 2669.70 1672.0300 1300.00 2669.70 Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm) Each 11016.85 6899.8500 1300.00 8152.47 Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureteral calculus Each 2027.94 1270.1000 1300.00 3040.07 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type) Each 6246.35 3912.0900 1300.00 5000.00 Cystourethroscopy with ureteroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, electrocautery, and incision) Each 3417.90 2140.6300 1575.00 3417.90 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic Each 6826.35 4275.3400 1575.00 5051.50 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included) Each 6376.65 3993.7000 1871.00 5000.00 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) Each 6214.20 3891.9500 1871.00 6214.20 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion Each 2202.48 1379.4200 1541.74 4361.86 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type) Each 11275.60 7061.9100 1871.00 8819.00 Transurethral resection of bladder neck (separate procedure) Each 4981.10 3119.6600 1575.00 4981.10 Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included) Each 8016.20 5020.5500 1871.00 5931.99 Transurethral resection; residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included) Each 7138.25 4470.6900 1300.00 5282.30 Dilation of urethral stricture by passage of filiform and follower, male; initial Each 2951.50 1848.5200 325.00 2194.00 Transurethral destruction of prostate tissue; by radiofrequency thermotherapy Each 7404.80 4637.6300 1300.00 7216.00 Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy Each 2714.10 1699.8400 1300.00 2714.10 Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical Each 398.30 249.4600 278.81 1050.00 Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery Each 305.80 191.5200 165.83 1050.00 Circumcision, using clamp or other device with regional dorsal penile or ring block Each 1628.00 1019.6200 1050.00 2323.00 Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age Each 5998.91 3757.1200 1300.00 5000.00 Irrigation of corpora cavernosa for priapism Each 635.00 397.7000 245.80 2323.00 Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine, phentolamine) Each 507.00 317.5300 154.00 1050.00 Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach Each 8151.87 5105.5200 1575.00 6032.38 Fixation of contralateral testis (separate procedure) Each 2660.38 1666.1900 1575.00 3040.07 Excision of local lesion of epididymis Each 5270.90 3301.1600 1575.00 5000.00 Excision of spermatocele, with or without epididymectomy Each 6535.95 4093.4700 1655.93 5000.00 Excision of hydrocele; unilateral Each 2660.38 1666.1900 1575.00 3145.88 Biopsy, prostate; needle or punch, single or multiple, any approach Each 2470.00 1546.9600 1300.00 2470.00 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple Each 1931.30 1209.5700 1050.00 1931.30 Incision and drainage of vulva or perineal abscess Each 639.00 400.2100 259.96 1300.00 Incision and drainage of Bartholin's gland abscess Each 264.15 165.4400 157.30 1050.00 Marsupialization of Bartholin's gland cyst Each 3874.60 2426.6600 1300.00 3874.60 Lysis of labial adhesions Each 3900.00 2442.5700 1050.00 3900.00 Destruction of lesion(s), vulva; simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Each 3138.70 1965.7700 325.00 3106.00 Destruction of lesion(s), vulva; extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Each 3326.95 2083.6700 1575.00 3326.95 Biopsy of vulva or perineum (separate procedure); 1 lesion Each 687.45 430.5500 481.22 1050.00 Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure) 1.0000 each 576.15 360.8400 325.00 1050.00 Vulvectomy simple; partial Each 6718.55 4207.8300 2035.00 5000.00 Destruction of vaginal lesion(s); simple (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) Each 2605.20 1631.6400 1050.00 2605.20 Biopsy of vaginal mucosa; simple (separate procedure) Each 1003.60 628.5500 325.00 1050.00 Biopsy of vaginal mucosa; extensive, requiring suture (including cysts) Each 5791.75 3627.3700 1300.00 5000.00 Irrigation of vagina and/or application of medicament for treatment of bacterial, parasitic, or fungoid disease Each 179.90 112.6700 51.41 1050.00 Fitting and insertion of pessary or other intravaginal support device Each 307.85 192.8100 154.00 1050.00 Diaphragm or cervical cap fitting with instructions Each 109.20 68.3900 76.44 1050.00 Combined anteroposterior colporrhaphy, including cystourethroscopy, when performed; Each 3360.00 2104.3700 2035.00 4357.55 Removal or revision of sling for stress incontinence (eg, fascia or synthetic) Each 5879.10 3682.0800 2035.00 5000.00 Pelvic examination under anesthesia (other than local) Each 2772.73 1736.5600 1300.00 2772.73 Colposcopy of the entire vagina, with cervix if present; Each 6743.00 4223.1400 154.00 4989.82 Colposcopy of the cervix including upper/adjacent vagina; Each 388.95 243.6000 154.00 1300.00 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix and endocervical curettage Each 738.40 462.4600 259.96 1300.00 Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix Each 442.00 276.8200 259.96 1050.00 Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage Each 410.80 257.2800 154.00 1050.00 Colposcopy of the cervix including upper/adjacent vagina; with loop electrode biopsy(s) of the cervix Each 3625.30 2270.5300 325.00 3106.00 Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix Each 4019.35 2517.3200 325.00 3106.00 Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) Each 1174.15 735.3700 325.00 1174.15 Endocervical curettage (not done as part of a dilation and curettage) Each 1051.45 658.5200 584.99 1051.45 Cautery of cervix; cryocautery, initial or repeat Each 465.90 291.7900 259.96 1050.00 Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser Each 4681.78 2932.2000 1300.00 4681.78 Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; loop electrode excision Each 3481.60 2180.5300 1300.00 3481.60 Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure) Each 248.55 155.6700 157.30 1050.00 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) Each 7004.30 4386.7900 1300.00 5183.18 Vaginal hysterectomy, for uterus 250 g or less; Each 3360.00 2104.3700 2035.00 4357.55 Insertion of intrauterine device (IUD) 1.0000 each 247.50 155.0100 154.00 1050.00 Removal of intrauterine device (IUD) Each 346.30 216.8900 242.41 1050.00 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography Each 169.50 106.1600 118.65 1050.00 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C Each 6419.50 4020.5300 1575.00 5000.00 Hysteroscopy, surgical; with removal of leiomyomata Each 8275.80 5183.1300 1575.00 6124.09 Hysteroscopy, surgical; with removal of impacted foreign body Each 6630.75 4152.8400 1575.00 5000.00 Hysteroscopy, surgical; with endometrial ablation (eg, endometrial resection, electrosurgical ablation, thermoablation) Each 7552.22 4729.9600 2035.00 5588.64 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) Each 10734.13 6722.7900 2258.00 8802.63 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) Each 6310.25 3952.1100 2258.00 8802.63 Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) Each 9761.20 6113.4400 2035.00 7223.29 Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method Each 6452.33 4041.0900 2035.00 6452.33 Unlisted laparoscopy procedure, oviduct, ovary Each 7617.85 4771.0600 1575.00 5637.21 Fetal non-stress test Each 137.30 85.9900 96.11 1050.00 Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy Each 7955.50 4982.5300 1871.00 7000.00 Curettage, postpartum Each 4932.40 3089.1600 1575.00 4932.40 Cerclage of cervix, during pregnancy; vaginal Each 3427.00 2146.3300 1050.00 3427.00 External cephalic version, with or without tocolysis 1.0000 each 8.25 5.1700 5.78 2592.28 Antepartum care only; 4-6 visits 1.0000 each 110.25 69.0500 77.18 1050.00 Antepartum care only; 7 or more visits 1.0000 each 125.85 78.8200 88.10 1050.00 Postpartum care only (separate procedure) Each 456.55 285.9400 319.58 1050.00 Treatment of incomplete abortion, any trimester, completed surgically Each 4339.30 2717.7000 2035.00 4339.30 Treatment of missed abortion, completed surgically; first trimester Each 4842.99 3033.1600 2035.00 4842.99 Unlisted procedure, maternity care and delivery Each 65.50 41.0200 45.85 1300.00 Partial thyroid lobectomy, unilateral; with or without isthmusectomy Each 13212.60 8275.0500 1871.00 9777.32 Total thyroid lobectomy, unilateral; with or without isthmusectomy Each 7388.55 4627.4500 1300.00 7000.00 Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid Each 10062.60 6302.2100 2035.00 7446.32 Stereotactic computer-assisted (navigational) procedure; cranial, extradural (List separately in addition to code for primary procedure) 1.0000 each 2093.35 1311.0600 154.00 2093.35 Stereotactic computer-assisted (navigational) procedure; spinal (List separately in addition to code for primary procedure) 1.0000 each 2966.96 1858.2000 154.00 2966.96 Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes Each 1777.98 1113.5500 325.00 1777.98 Spinal puncture, lumbar, diagnostic; Each 636.75 398.8000 471.20 2323.00 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); Each 2603.80 1630.7600 586.08 2603.80 Injection, epidural, of blood or clot patch Each 903.00 565.5500 586.08 2323.00 Injection procedure for discography, each level; lumbar Each 424.00 265.5500 154.00 1050.00 Injection procedure for discography, each level; cervical or thoracic Each 292.00 182.8800 154.00 1050.00 Myelography via lumbar injection, including radiological supervision and interpretation; cervical Each 1492.70 934.8800 154.00 1492.70 Myelography via lumbar injection, including radiological supervision and interpretation; lumbosacral Each 1492.80 934.9400 154.00 1492.80 Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) Each 1909.70 1196.0500 586.08 1909.70 Spinal puncture, lumbar, diagnostic; with fluoroscopic or CT guidance Each 2703.25 1693.0500 586.08 2703.25 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); with fluoroscopic or CT guidance Each 2596.00 1625.8700 586.08 2596.00 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); without reprogramming or refill 1.0000 each 311.00 194.7800 217.70 1300.00 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming 1.0000 each 334.00 209.1800 233.80 1300.00 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill 1.0000 each 440.00 275.5700 251.64 1050.00 Electronic analysis of programmable, implanted pump for intrathecal or epidural drug infusion (includes evaluation of reservoir status, alarm status, drug prescription status); with reprogramming and refill (requiring skill of a physician or other qualified health care professional) 1.0000 each 450.00 281.8400 251.64 1300.00 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, cervical Each 7270.07 4553.2500 1575.00 7545.00 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar Each 7715.65 4832.3100 2035.00 7715.65 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure) 1.0000 each 2160.80 1353.3100 1512.56 2160.80 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; cervical Each 1752.28 1097.4500 1296.69 7545.00 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar Each 9113.50 5707.7900 2035.00 9113.50 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional cervical interspace (List separately in addition to code for primary procedure) 1.0000 each 1752.28 1097.4500 1050.00 1752.28 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace (List separately in addition to code for primary procedure) 1.0000 each 1606.60 1006.2100 1050.00 1606.60 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical Each 1926.15 1206.3500 1425.35 7545.00 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; thoracic Each 2809.63 1759.6700 2035.00 7545.00 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar Each 1926.68 1206.6800 1425.74 7545.00 Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) 1.0000 each 1671.57 1046.9000 1170.10 2035.00 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; thoracic Each 2230.10 1396.7100 1650.27 7545.00 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc) Each 8434.96 5282.8200 2258.00 8434.96 Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single segment; each additional segment, thoracic or lumbar (List separately in addition to code for primary procedure) 1.0000 each 1738.06 1088.5500 1050.00 1738.06 Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed Each 5638.45 3531.3600 1050.00 11103.73 Revision or removal of implanted spinal neurostimulator pulse generator or receiver Each 5638.45 3531.3600 1050.00 5000.00 Repair of dural/cerebrospinal fluid leak, not requiring laminectomy Each 4403.78 2758.0800 1050.00 4403.78 Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular) Each 481.00 301.2500 154.00 1050.00 Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve Each 530.40 332.1900 154.00 1050.00 Injection(s), anesthetic agent(s) and/or steroid; brachial plexus Each 695.14 435.3700 325.00 2323.00 Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement) Each 985.00 616.9100 325.00 1050.00 Injection(s), anesthetic agent(s) and/or steroid; axillary nerve Each 654.00 409.6000 325.00 2323.00 Injection(s), anesthetic agent(s) and/or steroid; suprascapular nerve Each 663.00 415.2400 154.00 1050.00 Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level Each 642.00 402.0800 475.08 2323.00 Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, each additional level (List separately in addition to code for primary procedure) Each 1132.00 708.9700 759.59 2323.00 Injection(s), anesthetic agent(s) and/or steroid; ilioinguinal, iliohypogastric nerves Each 656.00 410.8500 459.20 1050.00 Injection(s), anesthetic agent(s) and/or steroid; pudendal nerve Each 1075.00 673.2700 759.59 2323.00 Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve Each 1068.00 668.8900 154.00 1068.00 Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement) Each 986.00 617.5300 154.00 1050.00 Injection(s), anesthetic agent(s) and/or steroid; femoral nerve Each 641.00 401.4600 154.00 1050.00 Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion by catheter (including catheter placement) Each 972.00 608.7600 154.00 1050.00 Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) Each 990.00 620.0400 154.00 1050.00 Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch Each 984.90 616.8400 154.00 1050.00 Injection(s), anesthetic agent(s) and/or steroid; plantar common digital nerve(s) (eg, Morton's neuroma) Each 308.00 192.9000 154.00 1050.00 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, single level Each 2348.20 1470.6800 759.59 2348.20 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), cervical or thoracic, each additional level (List separately in addition to code for primary procedure) 1.0000 each 1555.48 974.1900 1050.00 2323.00 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, single level Each 2348.10 1470.6200 759.59 2348.10 Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, each additional level (List separately in addition to code for primary procedure) 1.0000 each 1493.05 935.1000 1050.00 2323.00 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) unilateral; by injection(s) (includes imaging guidance, when performed) Each 5787.48 3624.7000 1300.00 5000.00 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by injections (includes imaging guidance, when performed) Each 5764.33 3610.2000 1300.00 5000.00 Transversus abdominis plane (TAP) block (abdominal plane block, rectus sheath block) bilateral; by continuous infusions (includes imaging guidance, when performed) Each 5732.50 3590.2600 1300.00 5000.00 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level Each 3520.70 2205.0100 154.00 3520.70 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure) 1.0000 each 2241.85 1404.0700 154.00 2241.85 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure) 1.0000 each 886.57 555.2600 154.00 1050.00 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level Each 3531.25 2211.6200 154.00 3531.25 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure) 1.0000 each 1526.85 956.2700 154.00 1526.85 Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure) 1.0000 each 1077.70 674.9600 154.00 1077.70 Injection, anesthetic agent; sphenopalatine ganglion Each 457.00 286.2200 154.00 1050.00 Injection, anesthetic agent; stellate ganglion (cervical sympathetic) Each 1067.00 668.2600 759.59 2323.00 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, unilateral (eg, for blepharospasm, hemifacial spasm) Each 561.00 351.3500 241.21 1050.00 Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine) Each 627.10 392.7500 241.21 1050.00 Chemodenervation of muscle(s); neck muscle(s), excluding muscles of the larynx, unilateral (eg, for cervical dystonia, spasmodic torticollis) Each 697.00 436.5300 241.21 1050.00 Destruction by neurolytic agent, intercostal nerve Each 1684.00 1054.6900 759.59 2323.00 Destruction by neurolytic agent; plantar common digital nerve Each 856.45 536.3900 241.21 1050.00 Destruction by neurolytic agent; other peripheral nerve or branch Each 1116.00 698.9500 325.00 1116.00 Chemodenervation of one extremity; 5 or more muscles Each 673.00 421.5000 154.00 1050.00 Neuroplasty and/or transposition; ulnar nerve at elbow Each 6308.86 3951.2400 1300.00 5000.00 Neuroplasty and/or transposition; median nerve at carpal tunnel Each 4805.38 3009.6100 1300.00 4805.38 Decompression; plantar digital nerve Each 4350.95 2725.0000 1050.00 4350.95 Transection or avulsion of other spinal nerve, extradural Each 3392.14 2124.5000 1300.00 3392.14 Excision of neuroma; major peripheral nerve, except sciatic Each 4988.31 3124.1800 1575.00 4988.31 Unlisted procedure, nervous system Each 1650.57 1033.7500 241.21 1650.57 Removal of foreign body, external eye; conjunctival superficial Each 388.95 243.6000 103.39 1050.00 Removal of foreign body, external eye; corneal, without slit lamp Each 674.65 422.5300 249.56 1050.00 Removal of foreign body, external eye; corneal, with slit lamp Each 167.00 104.5900 103.39 1050.00 Excision or transposition of pterygium; with graft Each 1886.83 1181.7200 1320.78 2035.00 Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); anterior synechiae, except goniosynechiae Each 6983.80 4373.9500 1871.00 5168.01 Severing adhesions of anterior segment of eye, incisional technique (with or without injection of air or liquid) (separate procedure); posterior synechiae Each 3336.45 2089.6200 1871.00 3336.45 Removal of implanted material, anterior segment of eye Each 8323.65 5213.1000 1920.23 7216.00 Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure) Each 6988.75 4377.0500 1871.00 5171.68 Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsification), with aspiration Each 6916.00 4331.4900 1920.23 6916.00 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation Each 6834.15 4280.2300 1920.23 6716.00 Intravitreal injection of a pharmacologic agent (separate procedure) Each 562.00 351.9800 287.00 1050.00 Injection of medication or other substance into Tenon's capsule Each 481.00 301.2500 241.31 1050.00 Excision of chalazion; single Each 290.00 181.6300 203.00 1050.00 Excision of chalazion; multiple, same lid Each 379.00 237.3700 265.30 1050.00 Correction of trichiasis; epilation, by forceps only Each 150.00 93.9400 103.39 1050.00 Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure Each 442.00 276.8200 309.40 1300.00 Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; Each 1584.00 992.0600 1108.80 1978.74 Snip incision of lacrimal punctum Each 266.00 166.6000 186.20 1050.00 Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery Each 404.00 253.0300 241.31 1050.00 Closure of the lacrimal punctum; by plug, each Each 488.00 305.6300 241.31 1050.00 Dilation of lacrimal punctum, with or without irrigation Each 292.00 182.8800 204.40 1050.00 Probing of lacrimal canaliculi, with or without irrigation Each 312.00 195.4100 218.40 1050.00 Drainage external ear, abscess or hematoma; simple Each 383.80 240.3700 268.66 1050.00 Excision external ear; partial, simple repair Each 4369.90 2736.8700 1050.00 4369.90 Excision soft tissue lesion, external auditory canal Each 5557.40 3480.6000 1300.00 5000.00 Removal foreign body from external auditory canal; without general anesthesia Each 391.05 244.9100 103.39 1050.00 Removal foreign body from external auditory canal; with general anesthesia Each 5677.00 3555.5100 1050.00 5000.00 Removal impacted cerumen using irrigation/lavage, unilateral Each 121.00 75.7800 51.41 1050.00 Removal impacted cerumen requiring instrumentation, unilateral Each 194.50 121.8200 51.41 1050.00 Debridement, mastoidectomy cavity, simple (eg, routine cleaning) Each 365.05 228.6300 154.00 1050.00 Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than routine cleaning) Each 789.35 494.3700 417.78 1300.00 Reconstruction of external auditory canal (meatoplasty) (eg, for stenosis due to injury, infection) (separate procedure) Each 5772.76 3615.4800 1575.00 5026.08 Ventilating tube removal requiring general anesthesia Each 5677.85 3556.0400 1050.00 5000.00 Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia Each 949.50 594.6700 417.78 1575.00 Tympanostomy (requiring insertion of ventilating tube), general anesthesia Each 5201.65 3257.7900 1249.38 5000.00 Mastoidectomy; complete Each 3808.38 2385.1900 2665.86 5026.08 Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch Each 5685.25 3560.6700 1077.00 5000.00 Myringoplasty (surgery confined to drumhead and donor area) Each 7935.60 4970.0700 1300.00 5872.34 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction Each 6435.30 4030.4300 2035.00 5026.08 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction Each 3721.40 2330.7100 2604.98 5026.08 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction Each 7296.00 4569.4800 2698.00 7216.00 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction Each 8195.27 5132.7000 2698.00 7216.00 Labyrinthotomy, with perfusion of vestibuloactive drug(s), transcanal Each 1513.20 947.7200 1059.24 2035.00 Radiologic examination, eye, for detection of foreign body 1.0000 each 306.80 192.1500 74.72 245.44 Radiologic examination, mandible; partial, less than 4 views 1.0000 each 344.25 215.6000 74.72 275.40 Radiologic examination, mandible; complete, minimum of 4 views 1.0000 each 604.25 378.4400 100.64 483.40 Radiologic examination, mastoids; complete, minimum of 3 views per side 1.0000 each 491.90 308.0800 100.64 393.52 Radiologic examination, internal auditory meati, complete 1.0000 each 191.40 119.8700 92.25 477.20 Radiologic examination, facial bones; less than 3 views 1.0000 each 416.00 260.5400 74.72 332.80 Radiologic examination, facial bones; complete, minimum of 3 views 1.0000 each 660.40 413.6100 100.64 528.32 Radiologic examination, nasal bones, complete, minimum of 3 views 1.0000 each 487.80 305.5100 74.72 390.24 Radiologic examination; orbits, complete, minimum of 4 views 1.0000 each 666.65 417.5200 100.64 533.32 Radiologic examination, sinuses, paranasal, less than 3 views 1.0000 each 433.70 271.6300 74.72 346.96 Radiologic examination, sinuses, paranasal, complete, minimum of 3 views 1.0000 each 579.30 362.8200 74.72 463.44 Radiologic examination, sella turcica 1.0000 each 400.40 250.7700 74.72 320.32 X-ray of skull, fewer than 4 views 1.0000 each 297.45 186.2900 100.64 237.96 Radiologic examination, skull; complete, minimum of 4 views 1.0000 each 834.10 522.4000 100.64 667.28 Radiologic examination, teeth; partial examination, less than full mouth 1.0000 each 182.35 114.2100 87.89 227.42 Radiologic examination, teeth; complete, full mouth 1.0000 each 204.80 128.2700 98.71 227.42 Radiologic examination, temporomandibular joint, open and closed mouth; bilateral 1.0000 each 660.40 413.6100 74.72 528.32 Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) Each 4276.50 2678.3700 212.54 3421.20 Cephalogram, orthodontic 1.0000 each 82.40 51.6100 39.72 79.95 Orthopantogram (eg, panoramic x-ray) 1.0000 each 108.00 67.6400 52.06 86.40 Radiologic examination; neck, soft tissue 1.0000 each 443.05 277.4800 74.72 354.44 Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique 1.0000 each 488.80 306.1400 74.72 391.04 Radiologic examination, salivary gland for calculus 1.0000 each 391.05 244.9100 74.72 312.84 Sialography, radiological supervision and interpretation 1.0000 each 912.10 571.2500 212.54 729.68 Computed tomography, head or brain; without contrast material Each 1753.45 1098.1900 100.64 1402.76 Computed tomography, head or brain; with contrast material(s) Each 2639.50 1653.1200 164.90 2111.60 Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections Each 2891.20 1810.7600 164.90 2312.96 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material Each 2081.05 1303.3600 100.64 1664.84 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Each 2315.05 1449.9200 164.90 1852.04 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections Each 2874.55 1800.3300 164.90 2299.64 Computed tomography, maxillofacial area; without contrast material Each 1913.60 1198.4900 100.64 1530.88 Computed tomography, maxillofacial area; with contrast material(s) Each 2191.30 1372.4100 164.90 1753.04 Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections Each 2874.55 1800.3300 164.90 2299.64 Computed tomography, soft tissue neck; without contrast material Each 2351.45 1472.7100 100.64 1881.16 Computed tomography, soft tissue neck; with contrast material(s) Each 2291.10 1434.9200 164.90 1832.88 Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections Each 2874.55 1800.3300 164.90 2299.64 Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing Each 2515.80 1575.6500 164.90 2012.64 Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing Each 2285.90 1431.6600 164.90 1828.72 Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) Each 3496.50 2189.8600 212.54 2797.20 Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and further sequences Each 4398.15 2754.5600 339.98 3518.52 Magnetic resonance angiography, head; without contrast material(s) Each 3829.30 2398.2900 212.54 3063.44 Magnetic resonance angiography, head; with contrast material(s) Each 3027.45 1896.0900 339.98 2421.96 Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences Each 3943.70 2469.9400 339.98 3154.96 Magnetic resonance angiography, neck; without contrast material(s) Each 3329.05 2084.9800 212.54 2663.24 Magnetic resonance angiography, neck; with contrast material(s) Each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences Each 4336.80 2716.1400 339.98 3469.44 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material Each 3229.20 2022.4500 212.54 2583.36 Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) Each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and further sequences Each 4206.80 2634.7200 339.98 3365.44 Radiologic examination, chest; single view 1.0000 each 353.60 221.4600 74.72 282.88 Radiologic examination, chest; 2 views 1.0000 each 477.35 298.9600 74.72 381.88 Radiologic examination, chest; 3 views 1.0000 each 529.35 331.5300 74.72 423.48 Radiologic examination, chest; 4 or more views 1.0000 each 555.35 347.8200 100.64 444.28 Radiologic examination, ribs, unilateral; 2 views 1.0000 each 556.40 348.4700 74.72 445.12 Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views 1.0000 each 503.35 315.2500 100.64 402.68 Radiologic examination, ribs, bilateral; 3 views 1.0000 each 653.10 409.0400 100.64 522.48 Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views 1.0000 each 798.70 500.2300 100.64 638.96 Radiologic examination; sternum, minimum of 2 views 1.0000 each 527.30 330.2500 74.72 421.84 Radiologic examination; sternoclavicular joint or joints, minimum of 3 views 1.0000 each 582.40 364.7600 74.72 465.92 Computed tomography, thorax, diagnostic; without contrast material Each 1776.30 1112.5000 100.64 1421.04 Computed tomography, thorax, diagnostic; with contrast material(s) Each 2151.80 1347.6700 164.90 1721.44 Computed tomography, thorax, diagnostic; without contrast material, followed by contrast material(s) and further sections Each 2754.95 1725.4300 164.90 2203.96 Computed tomography, thorax, low dose for lung cancer screening, without contrast material(s) Each 469.05 293.7700 74.72 375.24 Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing Each 2015.50 1262.3100 164.90 1612.40 Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s) Each 3329.05 2084.9800 212.54 2663.24 Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast material(s) Each 3329.05 2084.9800 660.51 2663.24 Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast material(s), followed by contrast material(s) and further sequences Each 4770.50 2987.7600 339.98 3816.40 Radiologic examination, spine, single view, specify level 1.0000 each 289.10 181.0600 74.72 231.28 Radiologic examination, spine, cervical; 2 or 3 views 1.0000 each 402.50 252.0900 74.72 322.00 Radiologic examination, spine, cervical; 4 or 5 views 1.0000 each 635.45 397.9800 100.64 508.36 Radiologic examination, spine, cervical; 6 or more views 1.0000 each 968.25 606.4100 100.64 774.60 Radiologic examination, spine; thoracic, 2 views 1.0000 each 388.95 243.6000 100.64 311.16 Radiologic examination, spine; thoracic, 3 views 1.0000 each 574.10 359.5600 100.64 459.28 Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); one view 1.0000 each 793.50 496.9700 74.72 634.80 Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed (eg, scoliosis evaluation); 2 or 3 views 1.0000 each 704.10 440.9800 100.64 563.28 Radiologic examination, spine, lumbosacral; 2 or 3 views 1.0000 each 598.00 374.5300 100.64 478.40 Radiologic examination, spine, lumbosacral; minimum of 4 views 1.0000 each 873.60 547.1400 100.64 698.88 Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views 1.0000 each 1036.90 649.4100 100.64 829.52 Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views 1.0000 each 1036.90 649.4100 100.64 829.52 Computed tomography, cervical spine; without contrast material Each 2138.25 1339.1900 100.64 1710.60 Computed tomography, cervical spine; with contrast material Each 1752.40 1097.5300 339.98 1401.92 Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections Each 2397.20 1501.3700 164.90 1917.76 Computed tomography, thoracic spine; without contrast material Each 2403.45 1505.2800 100.64 1922.76 Computed tomography, thoracic spine; with contrast material Each 1468.50 919.7200 164.90 1174.80 Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections Each 1916.70 1200.4300 164.90 1533.36 Computed tomography, lumbar spine; without contrast material Each 2298.40 1439.4900 100.64 1838.72 Computed tomography, lumbar spine; with contrast material Each 2256.80 1413.4300 339.98 1805.44 Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Each 3446.55 2158.5700 164.90 2757.24 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material Each 3229.20 2022.4500 212.54 2583.36 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s) Each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material Each 3661.85 2293.4200 212.54 2929.48 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s) Each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material Each 3229.20 2022.4500 212.54 2583.36 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s) Each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; cervical Each 4398.15 2754.5600 339.98 3518.52 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; thoracic Each 4206.80 2634.7200 339.98 3365.44 Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and further sequences; lumbar Each 4206.80 2634.7200 339.98 3365.44 Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s) Each 3329.05 2084.9800 1295.00 2663.24 Radiologic examination, pelvis; 1 or 2 views 1.0000 each 411.85 257.9400 100.64 329.48 Radiologic examination, pelvis; complete, minimum of 3 views 1.0000 each 601.10 376.4700 100.64 480.88 Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing Each 2285.90 1431.6600 164.90 1828.72 Computed tomography, pelvis; without contrast material Each 2393.05 1498.7700 100.64 1914.44 Computed tomography, pelvis; with contrast material(s) Each 2312.95 1448.6000 164.90 1850.36 Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections Each 2514.70 1574.9600 164.90 2011.76 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) Each 3829.30 2398.2900 212.54 3063.44 Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s) Each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences Each 4987.85 3123.8900 339.98 3990.28 Radiologic examination, sacroiliac joints; 3 or more views 1.0000 each 513.80 321.7900 100.64 411.04 Radiologic examination, sacrum and coccyx, minimum of 2 views 1.0000 each 513.80 321.7900 74.72 411.04 Myelography, cervical, radiological supervision and interpretation 1.0000 each 1908.40 1195.2300 660.51 1526.72 Myelography, thoracic, radiological supervision and interpretation 1.0000 each 836.15 523.6800 403.02 706.75 Myelography, lumbosacral, radiological supervision and interpretation 1.0000 each 1391.50 871.5000 660.51 1113.20 Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), radiological supervision and interpretation 1.0000 each 3815.80 2389.8400 660.51 3052.64 Radiologic examination; clavicle, complete 1.0000 each 407.70 255.3400 74.72 326.16 Radiologic examination; scapula, complete 1.0000 each 547.05 342.6200 100.64 437.64 Radiologic examination, shoulder; 1 view 1.0000 each 339.05 212.3500 74.72 271.24 Radiologic examination, shoulder; complete, minimum of 2 views 1.0000 each 482.55 302.2200 74.72 386.04 Radiologic examination, shoulder, arthrography, radiological supervision and interpretation 1.0000 each 934.95 585.5600 339.98 747.96 Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction 1.0000 each 601.10 376.4700 74.72 480.88 Radiologic examination; humerus, minimum of 2 views 1.0000 each 388.95 243.6000 74.72 311.16 Radiologic examination, elbow; 2 views 1.0000 each 408.70 255.9700 74.72 326.96 Radiologic examination, elbow; complete, minimum of 3 views 1.0000 each 408.70 255.9700 74.72 326.96 Radiologic examination, elbow, arthrography, radiological supervision and interpretation 1.0000 each 1094.10 685.2300 339.98 875.28 Radiologic examination; forearm, 2 views 1.0000 each 388.95 243.6000 74.72 311.16 Radiologic examination; upper extremity, infant, minimum of 2 views 1.0000 each 232.95 145.9000 100.64 186.36 Radiologic examination, wrist; 2 views 1.0000 each 370.25 231.8900 74.72 296.20 Radiologic examination, wrist; complete, minimum of 3 views 1.0000 each 370.25 231.8900 74.72 296.20 Radiologic examination, wrist, arthrography, radiological supervision and interpretation 1.0000 each 932.90 584.2800 339.98 746.32 Radiologic examination, hand; 2 views 1.0000 each 388.95 243.6000 100.64 311.16 Radiologic examination, hand; minimum of 3 views 1.0000 each 408.70 255.9700 74.72 326.96 Radiologic examination, finger(s), minimum of 2 views 1.0000 each 238.15 149.1500 74.72 190.52 Computed tomography, upper extremity; without contrast material Each 2323.35 1455.1100 100.64 1858.68 Computed tomography, upper extremity; with contrast material(s) Each 1839.80 1152.2700 339.98 1471.84 Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections Each 2285.90 1431.6600 164.90 1828.72 Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing Each 2285.90 1431.6600 164.90 1828.72 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) Each 3329.05 2084.9800 212.54 2663.24 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast material(s) and further sequences Each 4336.80 2716.1400 339.98 3469.44 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) Each 3229.20 2022.4500 212.54 2583.36 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Each 3329.05 2084.9800 660.51 2663.24 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) and further sequences Each 4336.80 2716.1400 339.98 3469.44 Magnetic resonance angiography, upper extremity, with or without contrast material(s) Each 3329.05 2084.9800 1295.00 2663.24 Radiologic examination, hip, unilateral, with pelvis when performed; 1 view 1.0000 each 425.35 266.4000 74.72 340.28 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views 1.0000 each 584.50 366.0700 74.72 467.60 Radiologic examination, hips, bilateral, with pelvis when performed; 2 views 1.0000 each 766.50 480.0600 100.64 613.20 Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views 1.0000 each 81.90 51.2900 39.48 107.69 Radiologic examination, hip, arthrography, radiological supervision and interpretation 1.0000 each 836.15 523.6800 339.98 668.92 Radiologic examination, femur; minimum 2 views 1.0000 each 430.55 269.6500 74.72 344.44 Radiologic examination, knee; 1 or 2 views 1.0000 each 370.25 231.8900 74.72 296.20 Radiologic examination, knee; 3 views 1.0000 each 417.05 261.2000 74.72 333.64 Radiologic examination, knee; complete, 4 or more views 1.0000 each 471.10 295.0500 100.64 376.88 Radiologic examination, knee; both knees, standing, anteroposterior 1.0000 each 425.35 266.4000 74.72 340.28 Radiologic examination, knee, arthrography, radiological supervision and interpretation 1.0000 each 1111.80 696.3200 339.98 889.44 Radiologic examination; tibia and fibula, 2 views 1.0000 each 370.25 231.8900 74.72 296.20 Radiologic examination; lower extremity, infant, minimum of 2 views 1.0000 each 833.05 521.7400 74.72 666.44 Radiologic examination, ankle; 2 views 1.0000 each 370.25 231.8900 74.72 296.20 Radiologic examination, ankle; complete, minimum of 3 views 1.0000 each 450.30 282.0200 74.72 360.24 Radiologic examination, ankle, arthrography, radiological supervision and interpretation 1.0000 each 1014.00 635.0700 339.98 811.20 Radiologic examination, foot; 2 views 1.0000 each 618.80 387.5500 74.72 495.04 Radiologic examination, foot; complete, minimum of 3 views 1.0000 each 408.70 255.9700 74.72 326.96 Radiologic examination; calcaneus, minimum of 2 views 1.0000 each 814.30 510.0000 74.72 651.44 Radiologic examination; toe(s), minimum of 2 views 1.0000 each 226.70 141.9800 74.72 181.36 Computed tomography, lower extremity; without contrast material Each 2048.80 1283.1600 100.64 1639.04 Computed tomography, lower extremity; with contrast material(s) Each 2191.30 1372.4100 164.90 1753.04 Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections Each 2285.90 1431.6600 164.90 1828.72 Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing Each 2285.90 1431.6600 164.90 1828.72 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) Each 3661.85 2293.4200 212.54 2929.48 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast material(s) and further sequences Each 4770.50 2987.7600 339.98 3816.40 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material Each 3376.90 2114.9500 212.54 2701.52 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) Each 3329.05 2084.9800 660.51 2663.24 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) and further sequences Each 4336.80 2716.1400 339.98 3469.44 Radiologic examination, abdomen; 1 view 1.0000 each 411.85 257.9400 74.72 329.48 Radiologic examination, abdomen; 2 views 1.0000 each 437.85 274.2300 100.64 350.28 Radiologic examination, abdomen; 3 or more views 1.0000 each 470.10 294.4200 100.64 376.08 Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest 1.0000 each 173.55 108.6900 83.65 138.84 Computed tomography, abdomen; without contrast material Each 2175.70 1362.6400 100.64 1740.56 Computed tomography, abdomen; with contrast material(s) Each 2545.90 1594.5000 164.90 2036.72 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections Each 2891.20 1810.7600 164.90 2312.96 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing Each 4231.80 2650.3800 339.98 3385.44 Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing Each 2629.10 1646.6100 164.90 2103.28 Computed tomography, abdomen and pelvis; without contrast material Each 4028.95 2523.3300 212.54 3223.16 Computed tomography, abdomen and pelvis; with contrast material(s) Each 4283.80 2682.9400 339.98 3427.04 Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions Each 4655.05 2915.4600 339.98 3724.04 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) Each 3329.05 2084.9800 212.54 2663.24 Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s) Each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further sequences Each 4398.15 2754.5600 339.98 3518.52 Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study 1.0000 each 702.00 439.6600 164.90 561.60 Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study 1.0000 each 875.70 548.4500 164.90 700.56 Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study 1.0000 each 963.05 603.1600 164.90 770.44 Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study, including glucagon, when administered 1.0000 each 1035.85 648.7500 164.90 828.68 Radiologic small intestine follow-through study, including multiple serial images (List separately in addition to code for primary procedure for upper GI radiologic examination) 1.0000 each 285.75 178.9700 137.73 228.60 Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; single-contrast (eg, barium) study 1.0000 each 861.10 539.3100 164.90 688.88 Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; double-contrast (eg, high-density barium and air via enteroclysis tube) study, including glucagon, when administered 1.0000 each 777.20 486.7600 164.90 621.76 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Each 2285.90 1431.6600 100.64 1828.72 Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study 1.0000 each 911.05 570.5900 164.90 728.84 Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high density barium and air) study, including glucagon, when administered 1.0000 each 1170.00 732.7700 164.90 936.00 Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium ileus) 1.0000 each 643.80 403.2100 164.90 515.04 Cholecystography, oral contrast 1.0000 each 457.60 286.5900 164.90 366.08 Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation 1.0000 each 626.10 392.1300 301.78 500.88 Cholangiography and/or pancreatography; additional set intraoperative, radiological supervision and interpretation (List separately in addition to code for primary procedure) 1.0000 each 366.10 229.2900 176.46 292.88 Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation 1.0000 each 846.55 530.1900 408.04 677.24 Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and interpretation 1.0000 each 1786.70 1119.0100 861.19 1429.36 Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple fluoroscopies and images, radiological supervision and interpretation 1.0000 each 575.10 360.1900 277.20 460.08 Percutaneous transhepatic dilation of biliary duct stricture with or without placement of stent, radiological supervision and interpretation 1.0000 each 1893.85 1186.1200 1060.56 1515.08 Urography (pyelography), intravenous, with or without KUB, with or without tomography 1.0000 each 1047.30 655.9200 164.90 837.84 Urography, infusion, drip technique and/or bolus technique; 1.0000 each 404.10 253.0900 164.90 323.28 Urography, infusion, drip technique and/or bolus technique; with nephrotomography 1.0000 each 570.50 357.3000 164.90 456.40 Urography, retrograde, with or without KUB 1.0000 Each 887.10 555.5900 339.98 709.68 Urography, antegrade, radiological supervision and interpretation 1.0000 Each 1006.70 630.5000 339.98 805.36 Cystography, minimum of 3 views, radiological supervision and interpretation 1.0000 each 599.05 375.1900 335.47 479.24 Vasography, vesiculography, or epididymography, radiological supervision and interpretation 1.0000 each 194.00 121.5000 93.51 227.42 Urethrocystography, retrograde, radiological supervision and interpretation 1.0000 each 633.35 396.6700 212.54 506.68 Urethrocystography, voiding, radiological supervision and interpretation 1.0000 each 926.65 580.3600 212.54 741.32 Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and interpretation 1.0000 each 436.55 273.4100 210.42 477.20 Dilation of ureter(s) or urethra, radiological supervision and interpretation 1.0000 each 626.10 392.1300 301.78 1771.85 Pelvimetry, with or without placental localization 1.0000 each 316.40 198.1600 74.72 253.12 Hysterosalpingography, radiological supervision and interpretation 1.0000 each 769.60 482.0000 212.54 615.68 Cardiac magnetic resonance imaging for morphology and function without contrast material; Each 3329.05 2084.9800 212.54 2663.24 Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; Each 4336.80 2716.1400 339.98 3469.44 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium Each 825.80 517.2000 74.72 660.64 Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) Each 1872.00 1172.4300 164.90 1497.60 Aortography, abdominal, by serialography, radiological supervision and interpretation Each 1346.90 843.5600 649.21 2827.92 Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological supervision and interpretation Each 1583.60 991.8100 763.30 2827.92 Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing Each 2285.90 1431.6600 164.90 1828.72 Angiography, extremity, unilateral, radiological supervision and interpretation Each 1107.70 693.7500 533.91 2827.92 Angiography, extremity, bilateral, radiological supervision and interpretation Each 1096.35 686.6400 528.44 2827.92 Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation Each 1337.75 837.8300 644.80 4714.12 Venography, extremity, unilateral, radiological supervision and interpretation Each 1047.30 655.9200 504.80 1389.56 Venography, extremity, bilateral, radiological supervision and interpretation Each 1301.05 814.8500 627.11 1389.56 Venography, caval, superior, with serialography, radiological supervision and interpretation Each 1490.30 933.3700 718.32 1389.56 Venography, renal, bilateral, selective, radiological supervision and interpretation Each 2967.10 1858.2900 1430.14 2827.92 Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological supervision and interpretation 1.0000 Each 757.10 474.1700 423.98 605.68 Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen collection), with placement of catheter, radiological supervision and interpretation 1.0000 each 2618.70 1640.0900 1466.47 2094.96 Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time 1.0000 each 191.35 119.8400 107.16 227.42 Radiologic examination from nose to rectum for foreign body, single view, child 1.0000 each 295.35 184.9800 74.72 236.28 Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation 1.0000 each 695.80 435.7800 335.38 556.64 Radiological examination, surgical specimen 1.0000 Each 317.20 198.6600 152.89 477.20 Radiologic examination, single plane body section (eg, tomography), other than with urography 1.0000 each 382.15 239.3400 100.64 305.72 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation 1.0000 Each 370.25 231.8900 144.03 296.20 Unlisted computed tomography procedure (eg, diagnostic, interventional) 1.0000 each 1205.05 754.7200 74.72 964.04 Unlisted diagnostic radiographic procedure 1.0000 each 1085.20 679.6600 74.72 868.16 Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abnormalities), including A-mode encephalography as secondary component where indicated 1.0000 each 377.50 236.4300 100.64 302.00 Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral (determination of corneal thickness) Each 40.00 25.0500 19.28 32.00 Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens power calculation Each 205.00 128.3900 98.81 164.00 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation 1.0000 each 850.70 532.7900 100.64 680.56 Ultrasound, chest (includes mediastinum), real time with image documentation Each 506.50 317.2200 100.64 405.20 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 1.0000 each 723.85 453.3500 100.64 579.08 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited 1.0000 each 629.20 394.0700 74.72 503.36 Ultrasound, abdominal, real time with image documentation; complete Each 927.70 581.0200 100.64 742.16 Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) Each 822.65 515.2300 100.64 658.12 Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) 1.0000 each 409.80 256.6600 100.64 327.84 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete Each 890.25 557.5600 100.64 712.20 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited Each 848.65 531.5100 100.64 678.92 Ultrasound, spinal canal and contents 1.0000 each 459.70 287.9100 100.64 367.76 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation 1.0000 each 590.70 369.9600 100.64 472.56 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) 1.0000 each 536.65 336.1000 258.67 429.32 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation 1.0000 each 408.70 255.9700 100.64 326.96 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) 1.0000 each 326.55 204.5200 157.40 261.24 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; single or first gestation 1.0000 each 642.70 402.5200 212.54 514.16 Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic examination, transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) 1.0000 each 355.70 222.7700 171.45 284.56 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation 1.0000 each 239.20 149.8100 100.64 191.36 Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses 1.0000 each 269.35 168.6900 100.64 215.48 Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus 1.0000 each 368.15 230.5700 100.64 294.52 Ultrasound, pregnant uterus, real time with image documentation, transvaginal 1.0000 each 329.70 206.4900 100.64 263.76 Fetal biophysical profile; with non-stress testing 1.0000 each 932.90 584.2800 100.64 746.32 Fetal biophysical profile; without non-stress testing 1.0000 each 854.90 535.4200 100.64 683.92 Doppler velocimetry, fetal; umbilical artery 1.0000 each 292.55 183.2200 100.64 234.04 Doppler velocimetry, fetal; middle cerebral artery 1.0000 each 292.55 183.2200 100.64 234.04 Ultrasound, transvaginal 1.0000 each 830.95 520.4200 100.64 664.76 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete Each 984.90 616.8400 100.64 787.92 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) Each 582.40 364.7600 100.64 465.92 Ultrasound, scrotum and contents Each 472.15 295.7100 100.64 377.72 Ultrasound, transrectal; 1.0000 each 445.10 278.7700 100.64 356.08 Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) 1.0000 each 239.25 149.8400 100.64 191.40 Ultrasound, complete joint (ie, joint space and peri-articular soft tissue structures) real-time with image documentation 1.0000 each 696.80 436.4100 100.64 557.44 Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft tissue structure[s], or soft tissue mass[es]), real-time with image documentation 1.0000 each 459.70 287.9100 100.64 367.76 Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care professional manipulation) 1.0000 each 324.50 203.2300 74.72 259.60 Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health care professional manipulation) 1.0000 each 221.50 138.7300 74.72 177.20 Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure) 1.0000 Each 598.00 374.5300 288.24 478.40 Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation 1.0000 Each 561.60 351.7300 270.69 449.28 Ultrasonic guidance for amniocentesis, imaging supervision and interpretation 1.0000 each 648.95 406.4400 312.79 519.16 Ultrasonic guidance for interstitial radioelement application 1.0000 each 327.60 205.1800 157.90 262.08 Ultrasonic guidance, intraoperative 1.0000 each 315.75 197.7500 152.19 252.60 Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure) 1.0000 each 210.10 131.5900 117.66 168.08 Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) (List separately in addition to code for primary procedure) 1.0000 each 219.45 137.4400 122.89 175.56 Fluoroscopic guidance and localization of needle or catheter tip for spine or paraspinous diagnostic or therapeutic injection procedures (epidural or subarachnoid) (List separately in addition to code for primary procedure) 1.0000 each 191.35 119.8400 107.16 153.08 Computed tomography guidance for stereotactic localization 1.0000 each 2618.70 1640.0900 1018.67 2094.96 Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), radiological supervision and interpretation 1.0000 each 2618.70 1640.0900 1018.67 2094.96 Computed tomography guidance for placement of radiation therapy fields 1.0000 Each 308.20 193.0300 119.89 246.56 Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization device) radiological supervision and interpretation 1.0000 each 1336.40 836.9900 519.86 1069.12 Magnetic resonance imaging, breast, without contrast material; unilateral Each 3329.05 2084.9800 212.54 2663.24 Magnetic resonance imaging, breast, without contrast material; bilateral Each 3329.05 2084.9800 212.54 2663.24 Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral Each 387.90 242.9400 150.89 310.32 Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral Each 4336.80 2716.1400 1687.02 3469.44 Mammary ductogram or galactogram, single duct, radiological supervision and interpretation 1.0000 each 483.60 302.8800 212.54 386.88 Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure) 1.0000 each 94.65 59.2800 45.62 75.72 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral 1.0000 each 523.10 327.6200 126.21 418.48 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral 1.0000 each 653.10 409.0400 159.76 522.48 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed 1.0000 each 523.10 327.6200 129.13 418.48 Manual application of stress performed by physician or other qualified health care professional for joint radiography, including contralateral joint if indicated 1.0000 each 297.45 186.2900 74.72 237.96 Bone age studies 1.0000 each 327.60 205.1800 100.64 262.08 Bone length studies (orthoroentgenogram, scanogram) 1.0000 each 500.25 313.3100 100.64 400.20 Radiologic examination, osseous survey; complete (axial and appendicular skeleton) 1.0000 each 1304.15 816.7900 100.64 1043.32 Radiologic examination, osseous survey, infant 1.0000 each 426.40 267.0500 100.64 341.12 Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) 1.0000 each 718.65 450.0900 100.64 574.92 Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA) 1.0000 each 113.35 70.9900 54.63 90.68 Therapeutic radiology treatment planning; simple 1.0000 each 91.50 57.3100 51.24 73.20 Therapeutic radiology treatment planning; intermediate 1.0000 each 137.30 85.9900 76.89 109.84 Therapeutic radiology treatment planning; complex 1.0000 each 202.80 127.0100 113.57 162.24 Therapeutic radiology simulation-aided field setting; simple 1.0000 Session(s) 690.55 432.4900 117.17 552.44 Therapeutic radiology simulation-aided field setting; intermediate 1.0000 Session(s) 1097.20 687.1800 312.79 877.76 Therapeutic radiology simulation-aided field setting; complex 1.0000 Each 1265.70 792.7100 312.79 1012.56 Respiratory motion management simulation (List separately in addition to code for primary procedure) 1.0000 Session(s) 1060.80 664.3800 594.05 848.64 3-dimensional radiotherapy plan, including dose-volume histograms 1.0000 Each 3842.80 2406.7500 1165.70 3074.24 Unlisted procedure, therapeutic radiology clinical treatment planning 1.0000 Session(s) 339.50 212.6300 117.17 271.60 Basic radiation dosimetry calculation, central axis depth dose calculation, TDF, NSD, gap calculation, off axis factor, tissue inhomogeneity factors, calculation of non-ionizing radiation surface and depth dose, as required during course of treatment, only when prescribed by the treating physician 1.0000 Each 351.50 220.1400 117.17 281.20 Intensity modulated radiotherapy plan, including dose-volume histograms for target and critical structure partial tolerance specifications 1.0000 each 4483.45 2807.9800 1165.70 3586.76 Teletherapy isodose plan; simple (1 or 2 unmodified ports directed to a single area of interest), includes basic dosimetry calculation(s) 1.0000 each 351.50 220.1400 196.84 334.69 Teletherapy isodose plan; complex (multiple treatment areas, tangential ports, the use of wedges, blocking, rotational beam, or special beam considerations), includes basic dosimetry calculation(s) 1.0000 each 395.20 247.5100 221.31 334.69 Brachytherapy isodose plan; simple (calculation[s] made from 1 to 4 sources, or remote afterloading brachytherapy, 1 channel), includes basic dosimetry calculation(s) 1.0000 each 481.50 301.5600 269.64 385.20 Brachytherapy isodose plan; intermediate (calculation[s] made from 5 to 10 sources, or remote afterloading brachytherapy, 2-12 channels), includes basic dosimetry calculation(s) 1.0000 each 1147.10 718.4300 312.79 917.68 Special teletherapy port plan, particles, hemibody, total body 1.0000 each 1167.90 731.4600 312.79 934.32 Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by the treating physician 1.0000 Each 351.50 220.1400 117.17 281.20 Treatment devices, design and construction; simple (simple block, simple bolus) 1.0000 each 666.65 417.5200 117.17 533.32 Treatment devices, design and construction; intermediate (multiple blocks, stents, bite blocks, special bolus) 1.0000 each 666.65 417.5200 117.17 533.32 Treatment devices, design and construction; complex (irregular blocks, special shields, compensators, wedges, molds or casts) 1.0000 Each 666.65 417.5200 312.79 533.32 Continuing medical physics consultation, including assessment of treatment parameters, quality assurance of dose delivery, and review of patient treatment documentation in support of the radiation oncologist, reported per week of therapy 1.0000 Week 210.10 131.5900 117.17 168.08 Multi-leaf collimator (MLC) device(s) for intensity modulated radiation therapy (IMRT), design and construction per IMRT plan 1.0000 each 973.45 609.6700 312.79 778.76 Special medical radiation physics consultation 1.0000 each 210.10 131.5900 117.17 168.08 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple 1.0000 each 1571.45 984.2000 501.08 1257.16 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex 1.0000 each 1571.45 984.2000 501.08 1257.16 Guidance for localization of target volume for delivery of radiation treatment, includes intrafraction tracking, when performed 1.0000 each 101.90 63.8200 57.06 81.52 Unlisted procedure, medical radiation physics, dosimetry and treatment devices, and special services 1.0000 each 351.50 220.1400 117.17 281.20 Radiation treatment delivery, => 1 MeV; simple 1.0000 each 309.90 194.0900 111.33 247.92 Radiation treatment delivery, => 1 MeV; intermediate 1.0000 each 309.90 194.0900 173.54 247.92 Radiation treatment delivery, => 1 MeV; complex 1.0000 Session(s) 598.00 374.5300 223.21 478.40 Therapeutic radiology port image(s) 1.0000 Each 130.00 81.4200 72.80 104.00 Radiation treatment management, 5 treatments 5.0000 Session(s) 226.70 141.9800 126.95 181.36 Special treatment procedure (eg, total body irradiation, hemibody radiation, per oral or endocavitary irradiation) 1.0000 each 1571.45 984.2000 501.08 1257.16 Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source, when performed 1.0000 each 3667.00 2296.6400 654.31 2933.60 Supervision, handling, loading of radiation source 1.0000 each 2092.00 1310.2200 1171.52 1673.60 Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) 1.0000 each 844.10 528.6600 348.29 675.28 Thyroid imaging (including vascular flow, when performed); 1.0000 Each 811.20 508.0500 348.29 648.96 Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) 1.0000 each 1759.70 1102.1000 348.29 1407.76 Parathyroid planar imaging (including subtraction, when performed); 1.0000 each 1303.10 816.1300 348.29 1042.48 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT) 1.0000 Each 957.25 599.5300 348.29 765.80 Bone marrow imaging; limited area 1.0000 each 957.00 599.3700 348.29 765.60 Lymphatics and lymph nodes imaging 1.0000 each 1402.95 878.6700 451.99 1122.36 Liver and spleen imaging; static only 1.0000 each 1574.55 986.1400 348.29 1259.64 Hepatobiliary system imaging, including gallbladder when present; 1.0000 each 2358.70 1477.2500 348.29 1886.96 Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed 1.0000 each 1986.40 1244.0800 451.99 1589.12 Salivary gland imaging; 1.0000 each 606.10 379.6000 339.42 484.88 Gastric emptying imaging study (eg, solid, liquid, or both); 1.0000 each 2358.70 1477.2500 348.29 1886.96 Acute gastrointestinal blood loss imaging 1.0000 each 1616.15 1012.1900 348.29 1292.92 Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) 1.0000 each 1857.45 1163.3200 348.29 1485.96 Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt) 1.0000 each 659.35 412.9500 348.29 527.48 Bone and/or joint imaging; limited area 1.0000 each 1101.35 689.7800 348.29 881.08 Bone and/or joint imaging; multiple areas 1.0000 each 364.30 228.1600 204.01 372.67 Bone and/or joint imaging; whole body Each 1881.35 1178.2900 348.29 1505.08 Bone and/or joint imaging; 3 phase study 1.0000 each 1994.70 1249.2800 348.29 1595.76 Non-cardiac vascular flow imaging (ie, angiography, venography) Each 654.45 409.8800 348.29 523.56 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) Each 2844.40 1781.4500 1206.11 2275.52 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection Each 4220.30 2643.1700 1206.11 3376.24 Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) Each 960.00 601.2500 537.60 1290.54 Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection Each 1731.00 1084.1300 969.36 1384.80 Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study; 1.0000 each 3976.95 2490.7600 1206.11 3181.56 Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing Each 2330.65 1459.6900 348.29 1864.52 Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or pharmacologic), wall motion study plus ejection fraction, with or without quantification Each 747.30 468.0300 418.49 597.84 Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic) 1.0000 each 3976.95 2490.7600 1367.18 3181.56 Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic) 1.0000 each 4174.55 2614.5200 1367.18 3339.64 Pulmonary perfusion imaging (eg, particulate) 1.0000 each 1100.30 689.1200 348.29 880.24 Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging 1.0000 each 1402.95 878.6700 451.99 1122.36 Quantitative differential pulmonary perfusion, including imaging when performed 1.0000 each 991.10 620.7300 348.29 792.88 Brain imaging, less than 4 static views; with vascular flow 1.0000 each 1040.00 651.3500 348.29 832.00 Brain imaging, minimum 4 static views; 1.0000 each 1359.00 851.1400 451.99 1087.20 Brain imaging, minimum 4 static views; with vascular flow 1.0000 each 1147.00 718.3700 451.99 917.60 Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography 1.0000 each 551.20 345.2200 308.67 483.63 Cerebrospinal fluid leakage detection and localization 1.0000 each 551.20 345.2200 308.67 1290.54 Radiopharmaceutical dacryocystography 1.0000 each 606.10 379.6000 339.42 484.88 Kidney imaging morphology; 1.0000 each 714.65 447.5900 348.29 571.72 Kidney imaging morphology; with vascular flow 1.0000 each 514.25 322.0700 287.98 411.40 Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention 1.0000 each 2330.65 1459.6900 451.99 1864.52 Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic) 1.0000 each 1623.45 1016.7700 451.99 1298.76 Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic) 1.0000 each 2026.95 1269.4800 451.99 1621.56 Testicular imaging with vascular flow 1.0000 each 797.00 499.1600 348.29 637.60 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, single area (eg, head, neck, chest, pelvis), single day imaging 1.0000 each 957.00 599.3700 348.29 765.60 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, 2 or more areas (eg, abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or more days 1.0000 each 2450.75 1534.9000 348.29 1960.60 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, single day imaging Each 2016.00 1262.6200 1128.96 1612.80 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single area (eg, head, neck, chest, pelvis), single day imaging Each 2169.45 1358.7300 1206.11 1735.56 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; limited area (eg, chest, head/neck) 1.0000 each 3976.95 2490.7600 1367.18 3181.56 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh 1.0000 Session(s) 4908.80 3074.3800 1367.18 3927.04 Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body 1.0000 each 5567.10 3486.6700 1367.18 4453.68 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over 2 or more days 1.0000 each 3206.30 2008.1100 1206.11 2565.04 Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) 1.0000 Each 314.10 196.7200 8.46 232.43 General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Thyroid stimulating hormone (TSH) (84443) 1.0000 each 328.70 205.8600 91.38 243.24 Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295) 1.0000 Each 404.55 253.3700 7.01 299.37 Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase, alkaline (84075) Potassium (84132) Protein, total (84155) Sodium (84295) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) Urea nitrogen (BUN) (84520) 1.0000 Each 455.50 285.2800 10.56 337.07 Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and appropriate manual differential WBC count (85007 or 85009) Hepatitis B surface antigen (HBsAg) (87340) Antibody, rubella (86762) Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) (86592) Antibody screen, RBC, each serum technique (86850) Blood typing, ABO (86900) AND Blood typing, Rh (D) (86901) 1.0000 each 559.50 350.4100 47.81 414.03 Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) 1.0000 Each 319.30 199.9800 13.39 236.28 Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) 1.0000 each 196.55 123.1000 8.68 145.45 Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803) 1.0000 each 180.95 113.3300 47.63 133.90 Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate amino (AST) (SGOT) (84450) 1.0000 Each 212.15 132.8700 8.17 156.99 Amikacin 1.0000 each 187.20 117.2400 15.08 138.53 Carbamazepine; total 1.0000 each 148.70 93.1300 14.57 110.04 Cyclosporine 1.0000 each 208.00 130.2700 18.05 153.92 Digoxin; total 1.0000 each 124.80 78.1600 13.28 92.35 Valproic acid (dipropylacetic acid); total 1.0000 Each 128.95 80.7600 13.54 95.42 Ethosuximide 1.0000 each 228.80 143.3000 16.34 169.31 Gentamicin 1.0000 Each 128.95 80.7600 16.38 95.42 Lamotrigine 1.0000 each 260.00 162.8400 13.25 192.40 Lidocaine 1.0000 each 124.80 78.1600 14.69 92.35 Lithium 1.0000 each 83.20 52.1100 6.61 61.57 Oxcarbazepine 1.0000 each 24.95 15.6300 6.94 18.46 Phenobarbital 1.0000 each 64.50 40.4000 15.30 47.73 Phenytoin; total 1.0000 Each 141.45 88.5900 13.25 104.67 Phenytoin; free 1.0000 each 53.05 33.2300 13.76 39.26 Primidone 1.0000 each 93.60 58.6200 16.59 69.26 Procainamide; 1.0000 each 90.75 56.8400 25.23 75.00 Procainamide; with metabolites (eg, n-acetyl procainamide) 1.0000 each 187.20 117.2400 16.75 138.53 Quinidine 1.0000 each 292.25 183.0400 14.60 216.26 Sirolimus 1.0000 each 301.60 188.8900 13.73 223.18 Tacrolimus 1.0000 Each 324.50 203.2300 13.73 240.13 Theophylline 1.0000 each 72.50 45.4100 14.14 53.65 Tobramycin 1.0000 each 228.80 143.3000 16.13 169.31 Topiramate 1.0000 each 238.15 149.1500 11.92 176.23 Vancomycin 1.0000 Each 127.90 80.1000 13.54 94.65 Quantitation of therapeutic drug, not elsewhere specified 1.0000 Each 235.05 147.2100 18.64 173.94 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service 1.0000 each 582.40 364.7600 12.60 430.98 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; read by instrument assisted direct optical observation (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when performed, per date of service 1.0000 each 582.40 364.7600 17.14 430.98 Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; by instrument chemistry analyzers (eg, utilizing immunoassay [eg, EIA, ELISA, EMIT, FPIA, IA, KIMS, RIA]), chromatography (eg, GC, HPLC), and mass spectrometry either with or without chromatography, (eg, DART, DESI, GC-MS, GC-MS/MS, LC-MS, LC-MS/MS, LDTD, MALDI, TOF) includes sample validation when performed, per date of service 1.0000 each 168.50 105.5300 46.84 124.69 Alcohols 1.0000 each 2902.95 1818.1200 807.02 2148.18 Alkaloids, not otherwise specified 1.0000 each 145.60 91.1900 40.48 107.74 Amphetamines; 5 or more 1.0000 each 167.45 104.8700 46.55 123.91 Antidepressants, tricyclic and other cyclicals; 1 or 2 1.0000 each 228.80 143.3000 63.61 169.31 Antipsychotics, not otherwise specified; 1-3 1.0000 each 167.45 104.8700 46.55 123.91 Barbiturates 1.0000 each 249.60 156.3200 69.39 184.70 Benzodiazepines; 1-12 1.0000 each 228.80 143.3000 63.61 169.31 Buprenorphine 1.0000 each 109.36 68.4900 30.40 80.93 Cannabinoids, natural 1.0000 each 80.10 50.1700 22.27 59.27 Cocaine 1.0000 each 66.85 41.8700 18.58 49.47 Methadone 1.0000 each 138.30 86.6200 38.45 102.34 Skeletal muscle relaxants; 1 or 2 1.0000 each 59.30 37.1400 16.49 43.88 Clinical pathology consultation; limited, without review of patient's history and medical records 1.0000 each 468.00 293.1100 45.96 346.32 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy 1.0000 each 110.25 69.0500 4.02 81.58 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy 1.0000 Each 111.30 69.7100 3.17 82.36 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy 1.0000 Each 89.45 56.0200 3.48 66.19 Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy 1.0000 Each 100.90 63.1900 2.25 74.67 Urinalysis; microscopic only 1.0000 Each 31.20 19.5400 3.05 23.09 Urine pregnancy test, by visual color comparison methods 1.0000 each 177.85 111.3900 8.61 131.61 Volume measurement for timed collection, each 1.0000 Each 15.60 9.7700 3.64 11.54 BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major breakpoint, qualitative or quantitative 1.0000 each 579.30 362.8200 161.05 428.68 BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; minor breakpoint, qualitative or quantitative 1.0000 each 579.30 362.8200 144.84 428.68 CFTR (cystic fibrosis transmembrane conductance regulator) (eg, cystic fibrosis) gene analysis; common variants (eg, ACMG/ACOG guidelines) 1.0000 each 1447.70 906.6900 402.46 1071.30 CYP2D6 (cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *4, *5, *6, *9, *10, *17, *19, *29, *35, *41, *1XN, *2XN, *4XN) 1.0000 each 921.45 577.1000 256.16 681.87 CYP2C9 (cytochrome P450, family 2, subfamily C, polypeptide 9) (eg, drug metabolism), gene analysis, common variants (eg, *2, *3, *5, *6) 1.0000 each 1100.30 689.1200 174.81 814.22 F2 (prothrombin, coagulation factor II) (eg, hereditary hypercoagulability) gene analysis, 20210G>A variant 1.0000 each 244.40 153.0700 65.69 180.86 F5 (coagulation factor V) (eg, hereditary hypercoagulability) gene analysis, Leiden variant 1.0000 each 201.80 126.3900 56.10 149.33 FMR1 (fragile X mental retardation 1) (eg, fragile X mental retardation) gene analysis; evaluation to detect abnormal (eg, expanded) alleles 1.0000 each 785.20 491.7700 57.04 581.05 HFE (hemochromatosis) (eg, hereditary hemochromatosis) gene analysis, common variants (eg, C282Y, H63D) 1.0000 each 730.10 457.2600 65.36 540.27 JAK2 (Janus kinase 2) (eg, myeloproliferative disorder) gene analysis, p.Val617Phe (V617F) variant 1.0000 each 265.20 166.0900 73.73 196.25 MTHFR (5,10-methylenetetrahydrofolate reductase) (eg, hereditary hypercoagulability) gene analysis, common variants (eg, 677T, 1298C) 1.0000 each 304.70 190.8300 65.34 225.48 MECP2 (methyl CpG binding protein 2) (eg, Rett syndrome) gene analysis; full sequence analysis 1.0000 each 2715.45 1700.6900 527.87 2009.43 UGT1A1 (UDP glucuronosyltransferase 1 family, polypeptide A1) (eg, drug metabolism, hereditary unconjugated hyperbilirubinemia [Gilbert syndrome]) gene analysis, common variants (eg, *28, *36, *37) 1.0000 each 1934.40 1211.5100 234.00 1431.46 HLA Class II typing, low resolution (eg, antigen equivalents); one locus (eg, HLA-DRB1, -DRB3/4/5, -DQB1, -DQA1, -DPB1, or -DPA1), each 1.0000 each 254.80 159.5800 70.83 188.55 MOLECULAR PATHOLOGY PROCEDURE LEVEL 2 1.0000 each 1555.85 974.4300 137.00 1151.33 Fetal chromosomal aneuploidy (eg, trisomy 21, monosomy X) genomic sequence analysis panel, circulating cell-free fetal DNA in maternal blood, must include analysis of chromosomes 13, 18, and 21 1.0000 each 1103.45 691.0900 306.76 948.81 Fetal aneuploidy (trisomy 21, 18, and 13) DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy 1.0000 each 2067.50 1294.8800 574.76 1529.95 Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); qualitative 1.0000 each 38.50 24.1100 4.52 28.49 Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); quantitative 1.0000 each 124.80 78.1600 8.17 92.35 Adrenocorticotropic hormone (ACTH) 1.0000 each 456.55 285.9400 38.62 337.85 Albumin; serum, plasma or whole blood 1.0000 each 78.00 48.8500 4.95 57.72 Albumin; other source, quantitative, each specimen 1.0000 Each 75.90 47.5400 7.78 56.17 Albumin; urine (eg, microalbumin), quantitative 1.0000 each 56.15 35.1700 5.78 41.55 Alcohol (ethanol); breath 1.0000 each 114.40 71.6500 30.00 84.66 Aldolase 1.0000 each 130.00 81.4200 9.71 96.20 Aldosterone 1.0000 Each 414.95 259.8800 40.75 307.06 Alpha-1-antitrypsin; total 1.0000 each 173.70 108.7900 13.44 128.54 Alpha-1-antitrypsin; phenotype 1.0000 each 197.60 123.7600 14.46 146.22 Alpha-fetoprotein (AFP); serum 1.0000 each 216.30 135.4700 16.77 160.06 Aluminum 1.0000 each 187.20 117.2400 25.48 138.53 Amino acids; multiple, qualitative, each specimen 1.0000 Each 228.80 143.3000 13.87 169.31 Amino acids; single, quantitative, each specimen 1.0000 Each 416.00 260.5400 22.98 307.84 Amino acids, 6 or more amino acids, quantitative, each specimen 1.0000 Each 724.90 454.0000 16.87 536.43 Ammonia 1.0000 Each 178.90 112.0500 14.57 132.39 Amylase 1.0000 Each 107.10 67.0800 6.48 79.25 Androstenedione 1.0000 each 310.95 194.7500 29.28 230.10 Angiotensin I - converting enzyme (ACE) 1.0000 each 195.50 122.4400 14.60 144.67 Arsenic 1.0000 each 55.10 34.5100 15.32 40.77 Ascorbic acid (Vitamin C), blood 1.0000 each 146.65 91.8500 9.89 108.52 Beta-2 microglobulin 1.0000 each 146.65 91.8500 16.18 108.52 Bile acids; total 1.0000 each 78.00 48.8500 17.12 57.72 Bile acids; cholylglycine 1.0000 each 124.80 78.1600 26.58 92.35 Bilirubin; total 1.0000 Each 80.10 50.1700 5.02 59.27 Bilirubin; direct 1.0000 Each 83.20 52.1100 5.02 61.57 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection) 1.0000 Each 91.50 57.3100 4.38 67.71 Blood, occult, by peroxidase activity (eg, guaiac), qualitative; other sources 1.0000 each 43.70 27.3700 5.32 32.34 Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening 1.0000 each 32.25 20.2000 4.23 23.86 Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations 1.0000 each 45.80 28.6800 12.73 33.89 Cadmium 1.0000 each 66.55 41.6800 18.50 49.25 Vitamin D; 25 hydroxy, includes fraction(s), if performed 1.0000 Each 266.25 166.7500 29.60 197.02 Calcitonin 1.0000 each 310.95 194.7500 26.79 230.10 Calcium; total 1.0000 Each 87.35 54.7100 5.16 64.64 Calcium; ionized 1.0000 Each 228.80 143.3000 13.68 169.31 Calcium; urine quantitative, timed specimen 1.0000 each 83.20 52.1100 6.03 61.57 Calculus; quantitative analysis, chemical 1.0000 each 61.25 38.3600 12.87 45.32 Calculus; infrared spectroscopy 1.0000 each 130.00 81.4200 12.90 96.20 Calculus; X-ray diffraction 1.0000 each 218.90 137.1000 12.52 161.99 Carbon dioxide (bicarbonate) 1.0000 Each 95.70 59.9400 4.88 70.82 Carboxyhemoglobin; quantitative 1.0000 Each 184.10 115.3000 12.32 136.23 Carcinoembryonic antigen (CEA) 1.0000 each 208.00 130.2700 18.96 153.92 Carotene 1.0000 each 146.65 91.8500 9.22 108.52 Catecholamines; total urine 1.0000 each 118.75 74.3700 27.30 87.88 Catecholamines; fractionated 1.0000 each 208.00 130.2700 25.25 153.92 Cathepsin-D 1.0000 each 262.10 164.1500 18.06 193.95 Ceruloplasmin 1.0000 each 130.00 81.4200 10.74 96.20 Chemiluminescent assay 1.0000 each 331.80 207.8100 14.12 245.53 Chloride; blood 1.0000 Each 98.80 61.8800 4.60 73.11 Chloride; urine 1.0000 each 98.80 61.8800 5.75 73.11 Chloride; other source 1.0000 each 98.80 61.8800 5.00 73.11 Cholesterol, serum or whole blood, total 1.0000 each 98.80 61.8800 4.35 73.11 Cholinesterase; serum 1.0000 each 124.80 78.1600 7.87 92.35 Cholinesterase; RBC 1.0000 each 167.45 104.8700 9.81 123.91 Citrate 1.0000 each 346.30 216.8900 27.80 256.26 Collagen cross links, any method 1.0000 each 310.95 194.7500 18.68 230.10 Copper 1.0000 each 173.70 108.7900 12.41 128.54 Cortisol; free 1.0000 Each 292.25 183.0400 16.71 216.26 Cortisol; total 1.0000 Each 195.50 122.4400 16.30 144.67 Column chromatography, includes mass spectrometry, if performed (eg, HPLC, LC, LC/MS, LC/MS-MS, GC, GC/MS-MS, GC/MS, HPLC/MS), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen 1.0000 each 789.35 494.3700 24.09 584.12 Creatine kinase (CK), (CPK); total 1.0000 Each 107.10 67.0800 6.51 79.25 Creatine kinase (CK), (CPK); MB fraction only 1.0000 Each 94.65 59.2800 11.55 70.04 Creatinine; blood 1.0000 Each 90.50 56.6800 5.12 66.97 Creatinine; other source 1.0000 Each 87.35 54.7100 5.18 64.64 Cryofibrinogen 1.0000 each 146.65 91.8500 14.14 108.52 Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit) 1.0000 each 255.85 160.2400 6.47 189.33 Cyanocobalamin (Vitamin B-12); 1.0000 Each 130.00 81.4200 15.08 96.20 Cyanocobalamin (Vitamin B-12); unsaturated binding capacity 1.0000 each 228.80 143.3000 14.32 169.31 Cystatin C 1.0000 each 122.70 76.8500 18.52 90.80 Cystine and homocystine, urine, qualitative 1.0000 each 167.45 104.8700 9.55 123.91 Dehydroepiandrosterone (DHEA) 1.0000 each 292.25 183.0400 25.27 216.26 Dehydroepiandrosterone-sulfate (DHEA-S) 1.0000 each 301.60 188.8900 22.23 223.18 Dibucaine number 1.0000 each 93.60 58.6200 12.25 69.26 Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed 1.0000 each 346.30 216.8900 38.50 256.26 Erythropoietin 1.0000 each 270.40 169.3500 18.79 200.10 Estradiol; total 1.0000 each 411.85 257.9400 27.94 304.77 Estrogens; fractionated 1.0000 each 93.60 58.6200 26.02 69.26 Estriol 1.0000 each 109.20 68.3900 24.18 80.81 Estrone 1.0000 each 280.80 175.8700 24.95 207.79 Ethylene glycol 1.0000 each 1474.25 923.3200 14.90 1090.94 Fat or lipids, feces; qualitative 1.0000 each 53.05 33.2300 5.10 39.26 Fat or lipids, feces; quantitative 1.0000 each 270.40 169.3500 16.80 200.10 Ferritin 1.0000 each 146.65 91.8500 13.63 108.52 Folic acid; serum 1.0000 Each 113.35 70.9900 14.70 83.88 Folic acid; RBC 1.0000 each 99.85 62.5400 17.65 73.89 Galactose 1.0000 each 98.40 61.6300 11.20 72.82 Galactose-1-phosphate uridyl transferase; quantitative 1.0000 each 61.35 38.4200 17.06 45.40 Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each 1.0000 Each 72.80 45.5900 9.30 53.87 Gammaglobulin (immunoglobulin); IgE 1.0000 each 195.50 122.4400 16.46 144.67 Gammaglobulin (immunoglobulin); immunoglobulin subclasses (eg, IgG1, 2, 3, or 4), each 1.0000 Each 45.80 28.6800 8.02 33.89 Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); 1.0000 Each 168.50 105.5300 26.07 124.69 Gastrin 1.0000 each 195.50 122.4400 17.63 144.67 Glucose, body fluid, other than blood 1.0000 each 95.70 59.9400 3.93 70.82 Glucose; quantitative, blood (except reagent strip) 1.0000 Each 99.85 62.5400 3.93 73.89 Glucose; blood, reagent strip 1.0000 Each 64.50 40.4000 5.04 47.73 Glucose; post glucose dose (includes glucose) 1.0000 Each 102.95 64.4800 4.75 76.18 Glucose; tolerance test (GTT), 3 specimens (includes glucose) 1.0000 each 277.70 173.9200 12.87 205.50 Glucose; tolerance test, each additional beyond 3 specimens (List separately in addition to code for primary procedure) 1.0000 Each 31.20 19.5400 3.92 23.09 Glucose-6-phosphate dehydrogenase (G6PD); quantitative 1.0000 each 130.00 81.4200 9.70 96.20 Glutamyltransferase, gamma (GGT) 1.0000 each 111.30 69.7100 7.20 82.36 Glycated protein 1.0000 each 195.50 122.4400 16.76 144.67 Gonadotropin; follicle stimulating hormone (FSH) 1.0000 each 195.50 122.4400 18.58 144.67 Gonadotropin; luteinizing hormone (LH) 1.0000 each 195.50 122.4400 18.52 144.67 Growth hormone, human (HGH) (somatotropin) 1.0000 each 208.00 130.2700 16.67 153.92 Haptoglobin; quantitative 1.0000 Each 195.50 122.4400 12.58 144.67 Helicobacter pylori; breath test analysis for urease activity, non-radioactive isotope (eg, C-13) 1.0000 each 194.50 121.8200 54.07 143.93 Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F) 1.0000 each 75.70 47.4100 12.87 56.02 Hemoglobin fractionation and quantitation; chromatography (eg, A2, S, C, and/or F) 1.0000 each 87.35 54.7100 18.06 64.64 Hemoglobin; glycosylated (A1C) 1.0000 Each 72.80 45.5900 9.71 53.87 Hemoglobin; methemoglobin, quantitative 1.0000 each 12.50 7.8300 3.48 10.25 Hemosiderin, qualitative 1.0000 each 105.05 65.7900 4.75 77.74 Histamine 1.0000 each 374.40 234.4900 29.53 277.06 Homocysteine 1.0000 each 111.30 69.7100 17.92 82.36 Homovanillic acid (HVA) 1.0000 each 249.60 156.3200 22.41 184.70 Hydroxycorticosteroids, 17- (17-OHCS) 1.0000 each 187.20 117.2400 17.90 138.53 Hydroxyindolacetic acid, 5-(HIAA) 1.0000 each 195.50 122.4400 12.90 144.67 Hydroxyprogesterone, 17-d 1.0000 each 310.95 194.7500 27.17 230.10 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method 1.0000 Each 63.45 39.7400 11.53 46.95 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, RIA) 1.0000 Each 616.70 386.2400 18.40 456.36 Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified 1.0000 Each 275.60 172.6100 17.27 203.94 Insulin; total 1.0000 each 151.85 95.1000 11.43 112.37 Insulin; free 1.0000 each 40.55 25.4000 11.27 30.01 Iron 1.0000 Each 127.90 80.1000 6.47 94.65 Iron binding capacity 1.0000 each 65.50 41.0200 8.74 48.47 Ketogenic steroids, fractionation 1.0000 each 83.10 52.0500 15.47 61.49 Ketosteroids, 17- (17-KS); total 1.0000 each 116.50 72.9600 12.80 86.21 Ketosteroids, 17- (17-KS); fractionation 1.0000 each 477.35 298.9600 28.50 353.24 Lactate (lactic acid) 1.0000 Each 270.40 169.3500 11.57 200.10 Lactate dehydrogenase (LD), (LDH); 1.0000 Each 72.80 45.5900 6.04 53.87 Lactate dehydrogenase (LD), (LDH); isoenzymes, separation and quantitation 1.0000 each 93.60 58.6200 12.79 69.26 Lactose, urine, qualitative 1.0000 each 11.05 6.9200 3.07 12.04 Lead 1.0000 each 109.20 68.3900 12.11 80.81 Fetal lung maturity assessment; lecithin sphingomyelin (L/S) ratio 1.0000 each 522.10 326.9900 21.99 386.35 Fetal lung maturity assessment; fluorescence polarization 1.0000 each 100.00 62.6300 18.91 74.00 Lipase 1.0000 Each 99.85 62.5400 6.89 73.89 Lipoprotein (a) 1.0000 each 187.20 117.2400 14.32 138.53 Lipoprotein, blood; electrophoretic separation and quantitation 1.0000 each 251.70 157.6400 11.26 186.26 Lipoprotein, blood; high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (eg, electrophoresis, ultracentrifugation) 1.0000 each 328.65 205.8300 33.86 243.20 Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) 1.0000 each 98.80 61.8800 8.19 73.11 Lipoprotein, direct measurement; VLDL cholesterol 1.0000 each 79.05 49.5100 12.75 58.50 Lipoprotein, direct measurement; LDL cholesterol 1.0000 each 117.50 73.5900 10.50 86.95 Magnesium 1.0000 Each 75.90 47.5400 6.70 56.17 Mass spectrometry and tandem mass spectrometry (eg, MS, MS/MS, MALDI, MS-TOF, QTOF), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen 1.0000 Each 64.50 40.4000 17.93 47.73 Mercury, quantitative 1.0000 each 52.00 32.5700 14.46 38.48 Metanephrines 1.0000 each 292.25 183.0400 16.94 216.26 Myelin basic protein, cerebrospinal fluid 1.0000 each 270.40 169.3500 17.20 200.10 Myoglobin 1.0000 Each 172.65 108.1300 12.92 127.76 Natriuretic peptide 1.0000 Each 192.40 120.5000 39.26 142.38 Nephelometry, each analyte not elsewhere specified 1.0000 Each 39.50 24.7400 10.98 29.23 Nucleotidase 5'- 1.0000 each 244.40 153.0700 11.15 180.86 Oligoclonal immune (oligoclonal bands) 1.0000 Each 70.70 44.2800 19.65 52.32 Organic acids; total, quantitative, each specimen 1.0000 Each 257.90 161.5200 23.60 190.85 Organic acids; qualitative, each specimen 1.0000 Each 395.20 247.5100 16.45 292.45 Organic acid, single, quantitative 1.0000 each 113.35 70.9900 21.21 83.88 Osmolality; blood 1.0000 Each 105.05 65.7900 6.61 77.74 Osmolality; urine 1.0000 Each 105.05 65.7900 6.82 77.74 Oxalate 1.0000 each 167.45 104.8700 14.45 123.91 Parathormone (parathyroid hormone) 1.0000 Each 133.10 83.3600 37.00 98.49 pH; body fluid, not otherwise specified 1.0000 each 83.20 52.1100 3.58 61.57 Phencyclidine (PCP) 1.0000 each 249.60 156.3200 69.39 184.70 Calprotectin, fecal 1.0000 each 319.30 199.9800 19.63 236.28 Phosphatase, acid; total 1.0000 each 105.25 65.9200 7.64 77.88 Phosphatase, acid; prostatic 1.0000 each 146.65 91.8500 9.66 108.52 Phosphatase, alkaline; 1.0000 Each 115.45 72.3100 5.18 85.43 Phosphatase, alkaline; isoenzymes 1.0000 each 187.20 117.2400 14.78 138.53 Phosphatidylglycerol 1.0000 each 261.05 163.5000 16.52 193.18 Phosphorus inorganic (phosphate); 1.0000 Each 80.10 50.1700 4.74 59.27 Phosphorus inorganic (phosphate); urine 1.0000 each 80.10 50.1700 5.78 59.27 Porphobilinogen, urine; quantitative 1.0000 each 115.45 72.3100 8.44 85.43 Porphyrins, urine; qualitative 1.0000 each 230.90 144.6100 13.36 170.87 Porphyrins, urine; quantitation and fractionation 1.0000 each 115.45 72.3100 14.71 85.43 Potassium; serum, plasma or whole blood 1.0000 Each 98.80 61.8800 4.76 73.11 Potassium; urine 1.0000 Each 98.80 61.8800 4.73 73.11 Prealbumin 1.0000 each 117.50 73.5900 14.59 86.95 Pregnanediol 1.0000 each 88.70 55.5500 21.27 65.64 Progesterone 1.0000 each 195.50 122.4400 20.86 144.67 Prolactin 1.0000 each 260.00 162.8400 19.38 192.40 Prostate specific antigen (PSA); total 1.0000 Each 158.10 99.0200 18.39 116.99 Prostate specific antigen (PSA); free 1.0000 each 186.15 116.5900 18.39 137.75 Protein, total, except by refractometry; serum, plasma or whole blood 1.0000 Each 42.65 26.7100 3.67 31.56 Protein, total, except by refractometry; urine 1.0000 Each 90.50 56.6800 3.67 66.97 Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid) 1.0000 each 87.35 54.7100 4.00 64.64 Protein, total, by refractometry, any source 1.0000 each 20.80 13.0300 5.61 15.39 Protein; electrophoretic fractionation and quantitation, serum 1.0000 Each 38.50 24.1100 10.70 28.49 Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF) 1.0000 Each 37.50 23.4900 10.42 27.75 Protein; Western Blot, with interpretation and report, blood or other body fluid, immunological probe for band identification, each 1.0000 Each 789.35 494.3700 29.21 584.12 Protoporphyrin, RBC; quantitative 1.0000 each 208.00 130.2700 14.35 153.92 Proinsulin 1.0000 each 436.80 273.5700 26.69 323.23 Pyridoxal phosphate (Vitamin B-6) 1.0000 each 292.25 183.0400 28.10 216.26 Pyruvate 1.0000 each 249.60 156.3200 14.48 184.70 Pyruvate kinase 1.0000 each 167.45 104.8700 9.44 123.91 Receptor assay; estrogen 1.0000 each 1174.15 735.3700 87.88 868.87 Receptor assay; progesterone 1.0000 each 249.75 156.4200 64.88 184.82 Receptor assay; non-endocrine (specify receptor) 1.0000 each 456.55 285.9400 36.57 337.85 Renin 1.0000 each 249.60 156.3200 21.99 184.70 Riboflavin (Vitamin B-2) 1.0000 each 246.50 154.3800 20.24 182.41 Selenium 1.0000 each 83.20 52.1100 23.13 61.57 Serotonin 1.0000 each 581.35 364.1000 30.98 430.20 Sex hormone binding globulin (SHBG) 1.0000 each 62.40 39.0800 17.35 46.18 Sodium; serum, plasma or whole blood 1.0000 Each 101.90 63.8200 4.81 75.41 Sodium; urine 1.0000 Each 98.80 61.8800 5.06 73.11 Sodium; other source 1.0000 each 98.80 61.8800 4.86 73.11 Somatomedin 1.0000 each 331.80 207.8100 21.26 245.53 Spectrophotometry, analyte not elsewhere specified 1.0000 each 146.65 91.8500 8.10 108.52 Sugars (mono-, di-, and oligosaccharides); single qualitative, each specimen 1.0000 Each 67.60 42.3400 5.50 50.02 Testosterone; free 1.0000 each 88.40 55.3600 24.58 65.42 Testosterone; total 1.0000 Each 315.10 197.3500 25.81 233.17 Thiamine (Vitamin B-1) 1.0000 each 238.15 149.1500 21.23 176.23 Thiocyanate 1.0000 each 249.60 156.3200 11.63 184.70 Thyroglobulin 1.0000 each 156.00 97.7000 16.06 115.44 Thyroxine; total 1.0000 each 148.70 93.1300 6.87 110.04 Thyroxine; free 1.0000 Each 178.90 112.0500 9.02 132.39 Thyroid stimulating hormone (TSH) 1.0000 Each 172.65 108.1300 16.80 127.76 Tocopherol alpha (Vitamin E) 1.0000 each 187.20 117.2400 14.18 138.53 Transferase; aspartate amino (AST) (SGOT) 1.0000 each 115.45 72.3100 5.18 85.43 Transferase; alanine amino (ALT) (SGPT) 1.0000 each 111.30 69.7100 5.30 82.36 Transferrin 1.0000 each 173.70 108.7900 12.76 128.54 Triglycerides 1.0000 each 166.40 104.2200 5.74 123.14 Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR) 1.0000 each 87.35 54.7100 6.47 64.64 Triiodothyronine T3; total (TT-3) 1.0000 each 109.20 68.3900 14.18 80.81 Triiodothyronine T3; free 1.0000 each 151.85 95.1000 16.94 112.37 Troponin, quantitative 1.0000 Each 118.55 74.2500 12.47 87.73 Trypsin; feces, qualitative 1.0000 each 49.00 30.6900 7.30 36.26 Urea nitrogen; quantitative 1.0000 Each 60.30 37.7700 3.95 44.62 Urea nitrogen, urine 1.0000 Each 83.20 52.1100 5.56 61.57 Uric acid; blood 1.0000 Each 94.65 59.2800 4.52 70.04 Uric acid; other source 1.0000 each 91.50 57.3100 5.08 67.71 Urobilinogen, urine; semiquantitative 1.0000 each 20.80 13.0300 5.78 15.39 Vanillylmandelic acid (VMA), urine 1.0000 each 187.20 117.2400 15.50 138.53 Vasoactive intestinal peptide (VIP) 1.0000 each 414.95 259.8800 35.33 307.06 Vasopressin (antidiuretic hormone, ADH) 1.0000 each 156.00 97.7000 33.94 115.44 Vitamin A 1.0000 each 238.15 149.1500 11.61 176.23 Xylose absorption test, blood and/or urine 1.0000 each 228.80 143.3000 12.91 169.31 Zinc 1.0000 each 195.50 122.4400 11.39 144.67 C-peptide 1.0000 each 280.80 175.8700 20.81 207.79 Gonadotropin, chorionic (hCG); quantitative 1.0000 Each 205.90 128.9600 15.05 152.37 Gonadotropin, chorionic (hCG); qualitative 1.0000 Each 177.85 111.3900 7.52 131.61 Unlisted chemistry procedure 1.0000 Each 700.95 439.0000 194.86 518.70 Bleeding time 1.0000 each 48.90 30.6300 4.82 36.19 Blood count; blood smear, microscopic examination with manual differential WBC count 1.0000 Each 46.80 29.3100 3.80 34.63 Blood count; blood smear, microscopic examination without manual differential WBC count 1.0000 each 58.25 36.4800 3.43 43.10 Blood count; hematocrit (Hct) 1.0000 Each 43.70 27.3700 2.37 32.34 Blood count; hemoglobin (Hgb) 1.0000 Each 43.70 27.3700 2.37 32.34 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count 1.0000 Each 152.90 95.7600 7.77 113.15 Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) 1.0000 Each 121.70 76.2200 6.47 90.06 Blood count; red blood cell (RBC), automated 1.0000 Each 43.70 27.3700 3.02 32.34 Blood count; reticulocyte, manual 1.0000 each 25.35 15.8800 4.31 18.76 Blood count; reticulocyte, automated 1.0000 each 57.20 35.8200 3.99 42.33 Blood count; leukocyte (WBC), automated 1.0000 Each 53.05 33.2300 2.54 39.26 Blood count; platelet, automated 1.0000 Each 64.50 40.4000 4.48 47.73 Bone marrow, smear interpretation 1.0000 Each 213.20 133.5300 59.27 648.41 Clot retraction 1.0000 each 31.20 19.5400 8.67 23.09 Clotting; factor II, prothrombin, specific 1.0000 each 331.80 207.8100 12.98 245.53 Clotting; factor V (AcG or proaccelerin), labile factor 1.0000 each 331.80 207.8100 17.65 245.53 Clotting; factor VII (proconvertin, stable factor) 1.0000 each 331.80 207.8100 17.90 245.53 Clotting; factor VIII (AHG), 1-stage 1.0000 each 106.10 66.4500 17.90 78.51 Clotting; factor VIII, VW factor, ristocetin cofactor 1.0000 each 106.10 66.4500 22.94 78.51 Clotting; factor VIII, VW factor antigen 1.0000 each 106.10 66.4500 22.94 78.51 Clotting; factor VIII, von Willebrand factor, multimetric analysis 1.0000 each 106.10 66.4500 22.94 78.51 Clotting; factor IX (PTC or Christmas) 1.0000 each 331.80 207.8100 19.04 245.53 Clotting; factor X (Stuart-Prower) 1.0000 each 331.80 207.8100 17.90 245.53 Clotting; factor XI (PTA) 1.0000 each 331.80 207.8100 17.90 245.53 Clotting; factor XII (Hageman) 1.0000 each 331.80 207.8100 19.35 245.53 Clotting; factor XIII (fibrin stabilizing) 1.0000 each 178.10 111.5400 16.34 131.79 Clotting; factor XIII (fibrin stabilizing), screen solubility 1.0000 each 143.50 89.8700 9.11 106.19 Clotting inhibitors or anticoagulants; antithrombin III, activity 1.0000 each 395.20 247.5100 11.85 292.45 Clotting inhibitors or anticoagulants; antithrombin III, antigen assay 1.0000 each 324.50 203.2300 10.81 240.13 Clotting inhibitors or anticoagulants; protein C, antigen 1.0000 each 292.25 183.0400 12.01 216.26 Clotting inhibitors or anticoagulants; protein C, activity 1.0000 each 249.60 156.3200 13.84 184.70 Clotting inhibitors or anticoagulants; protein S, total 1.0000 each 301.60 188.8900 11.61 223.18 Clotting inhibitors or anticoagulants; protein S, free 1.0000 Each 310.95 194.7500 15.32 230.10 Activated Protein C (APC) resistance assay 1.0000 each 101.90 63.8200 15.32 75.41 Coagulation time; Lee and White 1.0000 each 38.45 24.0800 4.69 28.45 Fibrin(ogen) degradation (split) products (FDP) (FSP); agglutination slide, semiquantitative 1.0000 each 126.90 79.4800 6.89 93.91 Fibrin degradation products, D-dimer; quantitative 1.0000 Each 178.90 112.0500 10.18 132.39 Fibrinogen; activity 1.0000 Each 130.00 81.4200 9.72 96.20 Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay 1.0000 each 374.40 234.4900 6.53 277.06 Hemolysin, acid 1.0000 each 167.45 104.8700 8.87 123.91 Heparin assay 1.0000 each 544.95 341.3000 13.09 403.26 Leukocyte alkaline phosphatase with count 1.0000 each 167.45 104.8700 8.60 123.91 Muramidase 1.0000 each 228.80 143.3000 18.75 169.31 Platelet, aggregation (in vitro), each agent 1.0000 Each 125.85 78.8200 24.91 93.13 Phospholipid neutralization; platelet 1.0000 each 190.30 119.1800 17.98 140.82 Prothrombin time; 1.0000 Each 60.30 37.7700 4.29 44.62 Russell viper venom time (includes venom); diluted 1.0000 each 40.55 25.4000 9.58 30.01 Reptilase test 1.0000 each 353.60 221.4600 9.85 261.66 Sedimentation rate, erythrocyte; non-automated 1.0000 each 41.95 26.2700 4.27 31.04 Sedimentation rate, erythrocyte; automated 1.0000 each 75.90 47.5400 2.70 56.17 Sickling of RBC, reduction 1.0000 each 111.30 69.7100 5.51 82.36 Thrombin time; plasma 1.0000 each 105.05 65.7900 5.77 77.74 Thromboplastin time, partial (PTT); plasma or whole blood 1.0000 Each 65.50 41.0200 6.01 48.47 Thromboplastin time, partial (PTT); substitution, plasma fractions, each 1.0000 Each 130.00 81.4200 6.47 96.20 Viscosity 1.0000 each 187.20 117.2400 11.67 138.53 Agglutinins, febrile (eg, Brucella, Francisella, Murine typhus, Q fever, Rocky Mountain spotted fever, scrub typhus), each antigen 1.0000 Each 82.15 51.4500 6.98 60.79 Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each 1.0000 Each 23.90 14.9700 5.22 17.69 Allergen specific IgE; qualitative, multiallergen screen (eg, disk, sponge, card) 1.0000 each 22.90 14.3400 6.37 16.95 Allergen specific IgE; quantitative or semiquantitative, recombinant or purified component, each 1.0000 each 65.55 41.0500 17.93 48.51 Antibody identification; leukocyte antibodies 1.0000 Each 318.25 199.3200 15.05 235.50 Antibody identification; platelet antibodies 1.0000 Each 331.80 207.8100 18.37 245.53 Antibody identification; platelet associated immunoglobulin assay 1.0000 each 414.95 259.8800 12.46 307.06 Antinuclear antibodies (ANA); 1.0000 each 151.85 95.1000 12.09 112.37 Antinuclear antibodies (ANA); titer 1.0000 each 87.35 54.7100 11.16 64.64 Antistreptolysin 0; titer 1.0000 each 109.20 68.3900 7.30 80.81 C-reactive protein; 1.0000 each 52.00 32.5700 5.18 38.48 C-reactive protein; high sensitivity (hsCRP) 1.0000 each 99.85 62.5400 12.95 73.89 Beta 2 Glycoprotein I antibody, each 1.0000 Each 86.30 54.0500 23.99 63.86 Cardiolipin (phospholipid) antibody, each Ig class 1.0000 Each 73.85 46.2500 20.53 54.65 Cold agglutinin; screen 1.0000 each 107.10 67.0800 8.07 79.25 Cold agglutinin; titer 1.0000 each 146.65 91.8500 8.06 108.52 Complement; antigen, each component 1.0000 Each 195.50 122.4400 12.00 144.67 Complement; functional activity, each component 1.0000 Each 167.45 104.8700 12.00 123.91 Complement; total hemolytic (CH50) 1.0000 each 260.00 162.8400 20.32 192.40 Complement fixation tests, each antigen 1.0000 Each 29.60 18.5400 8.23 21.90 Cyclic citrullinated peptide (CCP), antibody 1.0000 each 97.80 61.2500 12.95 72.37 Deoxyribonuclease, antibody 1.0000 each 249.60 156.3200 13.25 184.70 Deoxyribonucleic acid (DNA) antibody; native or double stranded 1.0000 each 151.85 95.1000 13.74 112.37 Deoxyribonucleic acid (DNA) antibody; single stranded 1.0000 each 231.90 145.2400 12.11 171.61 Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm, RNP, Sc170, J01), each antibody 1.0000 Each 130.00 81.4200 17.93 96.20 Fluorescent noninfectious agent antibody; screen, each antibody 1.0000 Each 107.10 67.0800 12.05 79.25 Fluorescent noninfectious agent antibody; titer, each antibody 1.0000 Each 34.30 21.4800 9.54 25.38 Hemagglutination inhibition test (HAI) 1.0000 each 95.40 59.7500 8.19 70.60 Immunoassay for tumor antigen, qualitative or semiquantitative (eg, bladder tumor antigen) 1.0000 each 78.00 48.8500 21.68 57.72 Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29) 1.0000 Each 87.35 54.7100 20.81 64.64 Immunoassay for tumor antigen, quantitative; CA 19-9 1.0000 each 228.80 143.3000 20.81 169.31 Immunoassay for tumor antigen, quantitative; CA 125 1.0000 each 86.30 54.0500 20.81 63.86 Heterophile antibodies; screening 1.0000 each 121.70 76.2200 5.18 90.06 Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each 1.0000 Each 390.00 244.2600 20.81 288.60 Immunoassay for infectious agent antibody, quantitative, not otherwise specified 1.0000 Each 124.80 78.1600 14.99 92.35 Immunoelectrophoresis; serum 1.0000 each 138.30 86.6200 29.92 102.34 Immunodiffusion; not elsewhere specified 1.0000 each 214.25 134.1800 14.05 158.54 Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each antigen or antibody 1.0000 Each 34.30 21.4800 9.54 25.38 Immune complex assay 1.0000 each 246.50 154.3800 24.37 182.41 Immunofixation electrophoresis; serum 1.0000 Each 64.50 40.4000 17.93 47.73 Immunofixation electrophoresis; other fluids with concentration (eg, urine, CSF) 1.0000 Each 249.60 156.3200 29.35 184.70 Inhibin A 1.0000 each 121.70 76.2200 15.59 90.06 Insulin antibodies 1.0000 each 145.60 91.1900 21.41 107.74 Intrinsic factor antibodies 1.0000 each 228.80 143.3000 15.08 169.31 Islet cell antibody 1.0000 each 98.80 61.8800 23.57 73.11 Natural killer (NK) cells, total count 1.0000 each 413.90 259.2300 37.73 306.29 T cells; total count 1.0000 Each 139.35 87.2700 37.73 103.12 T cells; absolute CD4 and CD8 count, including ratio 1.0000 Each 139.35 87.2700 38.74 103.12 T cells; absolute CD4 count 1.0000 each 156.00 97.7000 26.78 115.44 Microsomal antibodies (eg, thyroid or liver-kidney), each 1.0000 Each 130.00 81.4200 14.55 96.20 Particle agglutination; screen, each antibody 1.0000 Each 152.90 95.7600 11.54 113.15 Rheumatoid factor; qualitative 1.0000 each 90.50 56.6800 6.14 66.97 Rheumatoid factor; quantitative 1.0000 each 47.85 29.9700 5.67 35.41 Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon 1.0000 each 178.90 112.0500 49.73 132.39 Skin test; tuberculosis, intradermal 1.0000 each 29.10 18.2300 8.09 24.38 Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) 1.0000 Each 75.90 47.5400 4.27 56.17 Antibody; adenovirus 1.0000 each 208.00 130.2700 12.87 153.92 Antibody; Aspergillus 1.0000 Each 47.85 29.9700 13.30 35.41 Antibody; bacterium, not elsewhere specified 1.0000 each 420.15 263.1400 12.88 310.91 Antibody; Bartonella 1.0000 Each 53.05 33.2300 10.18 39.26 Antibody; Bordetella 1.0000 each 187.20 117.2400 13.19 138.53 Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot) 1.0000 Each 130.00 81.4200 15.49 96.20 Antibody; Borrelia burgdorferi (Lyme disease) 1.0000 each 260.00 162.8400 17.03 192.40 Antibody; Brucella 1.0000 Each 187.20 117.2400 8.93 138.53 Antibody; Candida 1.0000 each 270.40 169.3500 12.01 200.10 Antibody; Chlamydia 1.0000 Each 34.30 21.4800 9.54 25.38 Antibody; Chlamydia, IgM 1.0000 each 36.40 22.8000 10.12 26.94 Antibody; Cryptococcus 1.0000 each 249.60 156.3200 14.41 184.70 Antibody; cytomegalovirus (CMV) 1.0000 Each 187.20 117.2400 14.39 138.53 Antibody; cytomegalovirus (CMV), IgM 1.0000 each 83.20 52.1100 16.85 61.57 Antibody; Diphtheria 1.0000 each 249.60 156.3200 15.21 184.70 Antibody; enterovirus (eg, coxsackie, echo, polio) 1.0000 Each 124.80 78.1600 13.03 92.35 Antibody; Epstein-Barr (EB) virus, early antigen (EA) 1.0000 each 109.20 68.3900 13.12 80.81 Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA) 1.0000 each 109.20 68.3900 15.29 80.81 Antibody; Epstein-Barr (EB) virus, viral capsid (VCA) 1.0000 Each 109.20 68.3900 18.14 80.81 Antibody; Ehrlichia 1.0000 Each 92.55 57.9600 10.18 68.49 Antibody; fungus, not elsewhere specified 1.0000 each 52.00 32.5700 12.25 38.48 Antibody; Giardia lamblia 1.0000 each 226.70 141.9800 14.72 167.76 Antibody; Helicobacter pylori 1.0000 each 238.15 149.1500 16.85 176.23 Antibody; helminth, not elsewhere specified 1.0000 each 208.00 130.2700 13.01 153.92 Antibody; Haemophilus influenza 1.0000 each 208.00 130.2700 15.84 153.92 Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot) 1.0000 each 466.95 292.4500 19.35 345.54 Antibody; hepatitis, delta agent 1.0000 each 105.05 65.7900 17.16 77.74 Antibody; herpes simplex, non-specific type test 1.0000 each 195.50 122.4400 14.39 144.67 Antibody; herpes simplex, type 1 1.0000 Each 95.70 59.9400 13.19 70.82 Antibody; herpes simplex, type 2 1.0000 Each 95.70 59.9400 19.35 70.82 Antibody; HIV-1 1.0000 each 488.80 306.1400 8.89 361.71 Antibody; HIV-2 1.0000 each 111.30 69.7100 13.52 82.36 Antibody; HIV-1 and HIV-2, single result 1.0000 Each 43.70 27.3700 12.15 32.34 Hepatitis B core antibody (HBcAb); total 1.0000 Each 195.50 122.4400 12.05 144.67 Hepatitis B core antibody (HBcAb); IgM antibody 1.0000 each 43.70 27.3700 11.77 32.34 Hepatitis B surface antibody (HBsAb) 1.0000 Each 138.30 86.6200 10.74 102.34 Hepatitis Be antibody (HBeAb) 1.0000 each 38.50 24.1100 10.70 28.49 Hepatitis A antibody (HAAb) 1.0000 each 57.20 35.8200 12.39 42.33 Hepatitis A antibody (HAAb), IgM antibody 1.0000 each 41.60 26.0500 11.26 30.78 Antibody; influenza virus 1.0000 each 56.15 35.1700 13.55 41.55 Antibody; Legionella 1.0000 each 187.20 117.2400 15.30 138.53 Antibody; mumps 1.0000 each 195.50 122.4400 13.05 144.67 Antibody; mycoplasma 1.0000 Each 167.45 104.8700 13.24 123.91 Antibody; Nocardia 1.0000 each 47.85 29.9700 13.30 35.41 Antibody; parvovirus 1.0000 Each 151.85 95.1000 15.03 112.37 Antibody; respiratory syncytial virus 1.0000 each 56.60 35.4500 15.73 41.88 Antibody; Rickettsia 1.0000 Each 63.45 39.7400 17.64 46.95 Antibody; rubella 1.0000 each 110.25 69.0500 14.39 81.58 Antibody; rubeola 1.0000 Each 195.50 122.4400 12.88 144.67 Antibody; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) 1.0000 each 106.40 66.6400 29.58 78.74 Antibody; tetanus 1.0000 each 249.60 156.3200 14.80 184.70 Antibody; Toxoplasma 1.0000 each 187.20 117.2400 14.39 138.53 Antibody; Toxoplasma, IgM 1.0000 each 52.00 32.5700 14.41 38.48 Antibody; Treponema pallidum 1.0000 Each 151.85 95.1000 13.24 112.37 Antibody; varicella-zoster 1.0000 Each 195.50 122.4400 12.88 144.67 Antibody; virus, not elsewhere specified 1.0000 each 136.25 85.3300 12.88 100.82 Thyroglobulin antibody 1.0000 Each 130.00 81.4200 15.91 96.20 Hepatitis C antibody; 1.0000 Each 216.30 135.4700 14.27 160.06 Hepatitis C antibody; confirmatory test (eg, immunoblot) 1.0000 each 414.95 259.8800 15.49 307.06 HLA typing; A, B, or C (eg, A10, B7, B27), single antigen 1.0000 Each 260.00 162.8400 25.81 192.40 HLA typing; A, B, or C, multiple antigens 1.0000 each 517.90 324.3600 58.00 383.25 Antibody screen, RBC, each serum technique 1.0000 Each 101.90 63.8200 12.21 75.41 Antibody elution (RBC), each elution 1.0000 Each 135.20 84.6800 37.59 147.40 Antibody identification, RBC antibodies, each panel for each serum technique 1.0000 Each 117.50 73.5900 32.66 287.83 Antihuman globulin test (Coombs test); direct, each antiserum 1.0000 Each 98.80 61.8800 6.74 73.11 Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell 1.0000 Each 51.45 32.2200 7.15 147.40 Antihuman globulin test (Coombs test); indirect, each antibody titer 1.0000 Each 113.35 70.9900 6.48 147.40 Autologous blood or component, collection processing and storage; predeposited 1.0000 each 180.95 113.3300 50.30 147.40 Blood typing, serologic; ABO 1.0000 Each 46.80 29.3100 3.74 110.63 Blood typing, serologic; Rh (D) 1.0000 Each 72.80 45.5900 3.74 53.87 Blood typing, serologic; antigen testing of donor blood using reagent serum, each antigen test 1.0000 Each 135.20 84.6800 7.94 287.83 Blood typing, serologic; RBC antigens, other than ABO or Rh (D), each 1.0000 Each 60.30 37.7700 4.79 287.83 Blood typing, serologic; Rh phenotyping, complete 1.0000 each 132.10 82.7300 9.69 97.75 Compatibility test each unit; immediate spin technique 1.0000 Unit(s) 128.95 80.7600 35.85 147.40 Compatibility test each unit; incubation technique 1.0000 Unit(s) 70.70 44.2800 19.65 147.40 Compatibility test each unit; antiglobulin technique 1.0000 Unit(s) 70.70 44.2800 19.65 147.40 Fresh frozen plasma, thawing, each unit 1.0000 Unit(s) 117.50 73.5900 32.66 147.40 Hemolysins and agglutinins; auto, screen, each 1.0000 Each 381.70 239.0600 8.77 282.46 Hemolysins and agglutinins; incubated 1.0000 each 23.90 14.9700 6.64 17.69 Irradiation of blood product, each unit 1.0000 Unit(s) 44.10 27.6200 12.26 33.44 Pooling of platelets or other blood products 1.0000 each 35.10 21.9800 9.76 147.40 Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with chemical agents or drugs, each 1.0000 Each 105.05 65.7900 29.20 77.74 Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; incubation with enzymes, each 1.0000 Each 24.95 15.6300 6.94 287.83 Pretreatment of RBCs for use in RBC antibody detection, identification, and/or compatibility testing; by density gradient separation 1.0000 each 746.70 467.6600 137.76 552.56 Pretreatment of serum for use in RBC antibody identification; incubation with drugs, each 1.0000 Each 673.90 422.0600 187.34 498.69 Pretreatment of serum for use in RBC antibody identification; by dilution 1.0000 each 61.35 38.4200 17.06 45.40 Pretreatment of serum for use in RBC antibody identification; incubation with inhibitors, each 1.0000 Each 115.45 72.3100 32.10 147.40 Pretreatment of serum for use in RBC antibody identification; by differential red cell absorption using patient RBCs or RBCs of known phenotype, each absorption 1.0000 Each 144.55 90.5300 31.25 106.97 Splitting of blood or blood products, each unit 1.0000 Unit(s) 50.30 31.5000 13.98 147.40 Concentration (any type), for infectious agents 1.0000 Each 31.20 19.5400 6.68 23.09 Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) 1.0000 Each 189.30 118.5600 10.32 140.08 Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species 1.0000 Each 183.05 114.6400 9.44 135.46 Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate 1.0000 Each 27.05 16.9400 7.52 20.02 Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates 1.0000 Each 171.60 107.4700 8.62 126.98 Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates 1.0000 Each 127.90 80.1000 9.47 94.65 Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate 1.0000 Each 95.70 59.9400 8.08 70.82 Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate 1.0000 Each 43.70 27.3700 8.08 32.34 Culture, presumptive, pathogenic organisms, screening only; 1.0000 Each 230.90 144.6100 6.63 170.87 Culture, bacterial; quantitative colony count, urine 1.0000 Each 188.25 117.9000 8.07 139.30 Culture, bacterial; with isolation and presumptive identification of each isolate, urine 1.0000 Each 52.00 32.5700 8.09 38.48 Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; skin, hair, or nail 1.0000 Each 355.70 222.7700 7.71 263.22 Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood) 1.0000 Each 167.45 104.8700 8.41 123.91 Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood 1.0000 Each 167.45 104.8700 20.46 123.91 Culture, fungi, definitive identification, each organism; yeast 1.0000 Each 13.03 8.1600 3.62 12.90 Culture, mycoplasma, any source 1.0000 each 187.20 117.2400 15.39 138.53 Culture, chlamydia, any source 1.0000 each 230.90 144.6100 19.60 170.87 Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates 1.0000 Each 100.90 63.1900 10.80 74.67 Culture, typing; immunofluorescent method, each antiserum 1.0000 Each 24.95 15.6300 5.57 18.46 Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum 1.0000 Each 14.55 9.1100 4.04 10.77 Macroscopic examination; arthropod 1.0000 each 115.45 72.3100 4.27 85.43 Macroscopic examination; parasite 1.0000 each 64.50 40.4000 4.31 47.73 Pinworm exam (eg, cellophane tape prep) 1.0000 each 52.00 32.5700 4.27 38.48 Homogenization, tissue, for culture 1.0000 each 38.50 24.1100 5.88 28.49 Ova and parasites, direct smears, concentration and identification 1.0000 each 42.65 26.7100 8.90 31.56 Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer agents) 1.0000 Each 54.10 33.8800 7.48 40.03 Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate 1.0000 Each 54.10 33.8800 8.65 40.03 Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types 1.0000 Each 64.50 40.4000 4.27 47.73 Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types 1.0000 Each 124.80 78.1600 5.39 92.35 Smear, primary source with interpretation; special stain for inclusion bodies or parasites (eg, malaria, coccidia, microsporidia, trypanosomes, herpes viruses) 1.0000 Each 69.70 43.6500 5.99 51.58 Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites 1.0000 each 52.00 32.5700 14.46 38.48 Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps) 1.0000 each 58.25 36.4800 5.82 43.10 Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies) 1.0000 each 83.20 52.1100 4.27 61.57 Toxin or antitoxin assay, tissue culture (eg, Clostridium difficile toxin) 1.0000 each 159.10 99.6400 19.74 117.73 Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect 1.0000 Each 92.55 57.9600 25.73 68.49 Virus isolation; tissue culture, additional studies or definitive identification (eg, hemabsorption, neutralization, immunofluorescence stain), each isolate 1.0000 Each 65.50 41.0200 18.21 48.47 Virus isolation; centrifuge enhanced (shell vial) technique, includes identification with immunofluorescence stain, each virus 1.0000 Each 220.50 138.1000 19.56 163.17 Infectious agent antigen detection by immunofluorescent technique; adenovirus 1.0000 each 21.85 13.6800 6.07 18.04 Infectious agent antigen detection by immunofluorescent technique; Chlamydia trachomatis 1.0000 each 115.45 72.3100 11.98 85.43 Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 2 1.0000 each 63.45 39.7400 11.98 46.95 Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 1 1.0000 each 156.00 97.7000 11.98 115.44 Infectious agent antigen detection by immunofluorescent technique; influenza B virus 1.0000 Each 72.80 45.5900 12.25 53.87 Infectious agent antigen detection by immunofluorescent technique; influenza A virus 1.0000 Each 72.80 45.5900 16.07 53.87 Infectious agent antigen detection by immunofluorescent technique; Legionella pneumophila 1.0000 each 310.95 194.7500 15.60 230.10 Infectious agent antigen detection by immunofluorescent technique; Parainfluenza virus, each type 1.0000 Each 21.85 13.6800 6.07 20.54 Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus 1.0000 Each 21.85 13.6800 6.07 16.78 Infectious agent antigen detection by immunofluorescent technique; Varicella zoster virus 1.0000 each 289.10 181.0600 13.42 213.93 Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism 1.0000 Each 225.70 141.3600 16.10 167.02 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Clostridium difficile toxin(s) 1.0000 Each 158.10 99.0200 11.98 116.99 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Cryptococcus neoformans 1.0000 each 101.90 63.8200 13.42 75.41 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; cryptosporidium 1.0000 each 137.30 85.9900 13.82 101.60 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; giardia 1.0000 each 137.30 85.9900 11.98 101.60 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Helicobacter pylori, stool 1.0000 each 41.60 26.0500 11.56 30.78 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) 1.0000 Each 130.00 81.4200 10.33 96.20 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis B surface antigen (HBsAg) neutralization 1.0000 each 117.50 73.5900 10.33 86.95 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; hepatitis Be antigen (HBeAg) 1.0000 each 38.50 24.1100 10.70 28.49 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies, single result 1.0000 Each 69.70 43.6500 19.38 51.58 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; HIV-1 1.0000 each 124.80 78.1600 24.06 92.35 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; respiratory syncytial virus 1.0000 each 167.45 104.8700 13.91 123.91 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; rotavirus 1.0000 each 124.80 78.1600 11.98 92.35 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Shiga-like toxin 1.0000 each 34.30 21.4800 9.54 25.38 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; Streptococcus, group A 1.0000 each 139.35 87.2700 16.81 103.12 Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; not otherwise specified, each organism 1.0000 Each 59.30 37.1400 11.98 43.88 Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi, amplified probe technique 1.0000 each 789.35 494.3700 35.09 584.12 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique 1.0000 each 146.65 91.8500 22.75 108.52 Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique 1.0000 Each 125.85 78.8200 34.99 93.13 Infectious agent detection by nucleic acid (DNA or RNA); Clostridium difficile, toxin gene(s), amplified probe technique 1.0000 each 170.30 106.6600 37.27 126.02 Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, amplified probe technique 1.0000 each 261.05 163.5000 35.09 193.18 Infectious agent detection by nucleic acid (DNA or RNA); influenza virus, for multiple types or sub-types, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, first 2 types or sub-types 1.0000 Each 249.60 156.3200 69.39 184.70 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, quantification 1.0000 each 414.95 259.8800 42.84 307.06 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified probe technique, includes reverse transcription when performed 1.0000 each 517.90 324.3600 35.09 383.25 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed 1.0000 each 647.90 405.7800 42.84 479.45 Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique 1.0000 each 179.90 112.6700 35.09 133.13 Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification, includes reverse transcription when performed 1.0000 each 475.30 297.6800 85.10 351.72 Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria tuberculosis, amplified probe technique 1.0000 each 124.80 78.1600 34.69 92.35 Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique 1.0000 each 124.80 78.1600 26.88 92.35 Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique 1.0000 each 125.85 78.8200 34.99 93.13 Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), low-risk types (eg, 6, 11, 42, 43, 44) 1.0000 each 101.90 63.8200 28.33 75.41 Infectious agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types (eg, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68) 1.0000 each 100.90 63.1900 28.05 74.67 Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets 1.0000 each 217.25 136.0600 60.40 178.29 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique 1.0000 each 190.00 119.0000 52.82 140.60 Infectious agent detection by nucleic acid (DNA or RNA); Trichomonas vaginalis, amplified probe technique 1.0000 each 128.95 80.7600 35.09 95.42 Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism 1.0000 Each 114.40 71.6500 31.80 84.66 Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; direct probe(s) technique 1.0000 each 204.90 128.3300 43.67 151.63 Infectious agent detection by nucleic acid (DNA or RNA), multiple organisms; amplified probe(s) technique 1.0000 each 310.95 194.7500 70.20 230.10 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Influenza 1.0000 Each 118.55 74.2500 16.55 87.73 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; respiratory syncytial virus 1.0000 each 34.30 21.4800 9.54 25.38 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; Streptococcus, group A 1.0000 each 48.90 30.6300 13.59 36.19 Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; not otherwise specified 1.0000 each 67.60 42.3400 16.07 50.02 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus 1.0000 each 743.60 465.7200 206.72 550.26 Unlisted microbiology procedure 1.0000 each 65.55 41.0500 18.22 48.51 Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation 1.0000 each 69.30 43.4000 19.27 51.28 Cytopathology, selective cellular enhancement technique with interpretation (eg, liquid based slide preparation method), except cervical or vaginal 1.0000 Each 351.50 220.1400 45.96 260.11 Sex chromatin identification; Barr bodies 1.0000 each 31.10 19.4800 8.65 23.01 Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; manual screening under physician supervision 1.0000 each 136.25 85.3300 20.26 100.82 Cytopathology, smears, any other source; screening and interpretation 1.0000 each 182.00 113.9900 22.78 134.68 Cytopathology, smears, any other source; preparation, screening and interpretation 1.0000 each 148.70 93.1300 22.78 110.04 Cytopathology, slides, cervical or vaginal (the Bethesda System); manual screening under physician supervision 1.0000 each 55.10 34.5100 15.15 40.77 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site 1.0000 Each 340.10 213.0000 94.55 251.67 Cytopathology, evaluation of fine needle aspirate; interpretation and report 1.0000 Each 351.50 220.1400 45.96 260.11 Flow cytometry, cell cycle or DNA analysis 1.0000 each 216.30 135.4700 45.96 160.06 Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker 1.0000 Each 34.30 21.4800 9.54 287.83 Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additional marker (List separately in addition to code for first marker) 1.0000 Each 34.30 21.4800 9.54 25.38 Flow cytometry, interpretation; 2 to 8 markers 1.0000 each 98.80 61.8800 27.47 73.11 Flow cytometry, interpretation; 9 to 15 markers 1.0000 each 113.98 71.3900 31.69 84.35 Flow cytometry, interpretation; 16 or more markers 1.0000 Each 151.95 95.1700 42.24 112.44 Tissue culture for non-neoplastic disorders; lymphocyte 1.0000 Each 384.80 241.0000 106.97 284.75 Tissue culture for non-neoplastic disorders; skin or other solid tissue biopsy 1.0000 Each 522.10 326.9900 140.73 386.35 Tissue culture for neoplastic disorders; bone marrow, blood cells 1.0000 Each 858.00 537.3700 143.75 634.92 Chromosome analysis; count 5 cells, 1 karyotype, with banding 1.0000 Each 621.90 389.5000 172.89 460.21 Chromosome analysis; count 15-20 cells, 2 karyotypes, with banding 1.0000 Each 442.00 276.8200 122.88 327.08 Chromosome analysis; analyze 20-25 cells 1.0000 each 821.60 514.5700 144.61 607.98 Molecular cytogenetics; DNA probe, each (eg, FISH) 1.0000 Each 345.30 216.2600 21.42 255.52 Molecular cytogenetics; chromosomal in situ hybridization, analyze 10-30 cells (eg, for microdeletions) 1.0000 each 345.30 216.2600 34.81 255.52 Chromosome analysis; additional karyotypes, each study 1.0000 Each 442.00 276.8200 33.47 327.08 Chromosome analysis; additional high resolution study 1.0000 each 468.00 293.1100 34.43 346.32 Cytogenetics and molecular cytogenetics, interpretation and report 1.0000 Each 621.90 389.5000 172.89 460.21 Unlisted cytogenetic study 1.0000 each 621.90 389.5000 45.96 460.21 Level I - Surgical pathology, gross examination only 1.0000 Each 79.05 49.5100 21.98 58.50 Level III - Surgical pathology, gross and microscopic examination Abortion, induced Abscess Aneurysm - arterial/ventricular Anus, tag Appendix, other than incidental Artery, atheromatous plaque Bartholin's gland cyst Bone fragment(s), other than pathologic fracture Bursa/synovial cyst Carpal tunnel tissue Cartilage, shavings Cholesteatoma Colon, colostomy stoma Conjunctiva - biopsy/pterygium Cornea Diverticulum - esophagus/small intestine Dupuytren's contracture tissue Femoral head, other than fracture Fissure/fistula Foreskin, other than newborn Gallbladder Ganglion cyst Hematoma Hemorrhoids Hydatid of Morgagni Intervertebral disc Joint, loose body Meniscus Mucocele, salivary Neuroma - Morton's/traumatic Pilonidal cyst/sinus Polyps, inflammatory - nasal/sinusoidal Skin - cyst/tag/debridement Soft tissue, debridement Soft tissue, lipoma Spermatocele Tendon/tendon sheath Testicular appendage Thrombus or embolus Tonsil and/or adenoids Varicocele Vas deferens, other than sterilization Vein, varicosity 1.0000 Each 244.40 153.0700 45.96 180.86 Level IV - Surgical pathology, gross and microscopic examination Abortion - spontaneous/missed Artery, biopsy Bone marrow, biopsy Bone exostosis Brain/meninges, other than for tumor resection Breast, biopsy, not requiring microscopic evaluation of surgical margins Breast, reduction mammoplasty Bronchus, biopsy Cell block, any source Cervix, biopsy Colon, biopsy Duodenum, biopsy Endocervix, curettings/biopsy Endometrium, curettings/biopsy Esophagus, biopsy Extremity, amputation, traumatic Fallopian tube, biopsy Fallopian tube, ectopic pregnancy Femoral head, fracture Fingers/toes, amputation, non-traumatic Gingiva/oral mucosa, biopsy Heart valve Joint, resection Kidney, biopsy Larynx, biopsy Leiomyoma(s), uterine myomectomy - without uterus Lip, biopsy/wedge resection Lung, transbronchial biopsy Lymph node, biopsy Muscle, biopsy Nasal mucosa, biopsy Nasopharynx/oropharynx, biopsy Nerve, biopsy Odontogenic/dental cyst Omentum, biopsy Ovary with or without tube, non-neoplastic Ovary, biopsy/wedge resection Parathyroid gland Peritoneum, biopsy Pituitary tumor Placenta, other than third trimester Pleura/pericardium - biopsy/tissue Polyp, cervical/endometrial Polyp, colorectal Polyp, stomach/small intestine Prostate, needle biopsy Prostate, TUR Salivary gland, biopsy Sinus, paranasal biopsy Skin, other than cyst/tag/debridement/plastic repair Small intestine, biopsy Soft tissue, other than tumor/mass/lipoma/debridement Spleen Stomach, biopsy Synovium Testis, other than tumor/biopsy/castration Thyroglossal duct/brachial cleft cyst Tongue, biopsy Tonsil, biopsy Trachea, biopsy Ureter, biopsy Urethra, biopsy Urinary bladder, biopsy Uterus, with or without tubes and ovaries, for prolapse Vagina, biopsy Vulva/labia, biopsy 1.0000 Each 408.70 255.9700 45.96 302.44 Level V - Surgical pathology, gross and microscopic examination Adrenal, resection Bone - biopsy/curettings Bone fragment(s), pathologic fracture Brain, biopsy Brain/meninges, tumor resection Breast, excision of lesion, requiring microscopic evaluation of surgical margins Breast, mastectomy - partial/simple Cervix, conization Colon, segmental resection, other than for tumor Extremity, amputation, non-traumatic Eye, enucleation Kidney, partial/total nephrectomy Larynx, partial/total resection Liver, biopsy - needle/wedge Liver, partial resection Lung, wedge biopsy Lymph nodes, regional resection Mediastinum, mass Myocardium, biopsy Odontogenic tumor Ovary with or without tube, neoplastic Pancreas, biopsy Placenta, third trimester Prostate, except radical resection Salivary gland Sentinel lymph node Small intestine, resection, other than for tumor Soft tissue mass (except lipoma) - biopsy/simple excision Stomach - subtotal/total resection, other than for tumor Testis, biopsy Thymus, tumor Thyroid, total/lobe Ureter, resection Urinary bladder, TUR Uterus, with or without tubes and ovaries, other than neoplastic/prolapse 1.0000 Each 486.70 304.8200 135.30 360.16 Level VI - Surgical pathology, gross and microscopic examination Bone resection Breast, mastectomy - with regional lymph nodes Colon, segmental resection for tumor Colon, total resection Esophagus, partial/total resection Extremity, disarticulation Fetus, with dissection Larynx, partial/total resection - with regional lymph nodes Lung - total/lobe/segment resection Pancreas, total/subtotal resection Prostate, radical resection Small intestine, resection for tumor Soft tissue tumor, extensive resection Stomach - subtotal/total resection for tumor Testis, tumor Tongue/tonsil -resection for tumor Urinary bladder, partial/total resection Uterus, with or without tubes and ovaries, neoplastic Vulva, total/subtotal resection 1.0000 Each 510.65 319.8200 141.96 648.41 Decalcification procedure (List separately in addition to code for surgical pathology examination) 1.0000 Each 91.50 57.3100 25.44 67.71 Special stain including interpretation and report; Group I for microorganisms (eg, acid fast, methenamine silver) 1.0000 Each 152.90 95.7600 42.51 113.15 Special stain including interpretation and report; Group II, all other (eg, iron, trichrome), except stain for microorganisms, stains for enzyme constituents, or immunocytochemistry and immunohistochemistry 1.0000 Each 106.10 66.4500 29.50 78.51 Pathology consultation during surgery; first tissue block, with frozen section(s), single specimen 1.0000 Each 354.65 222.1200 98.59 262.44 Pathology consultation during surgery; each additional tissue block with frozen section(s) (List separately in addition to code for primary procedure) 1.0000 Each 147.70 92.5000 41.06 109.30 Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), initial site 1.0000 Each 182.00 113.9900 50.60 648.41 Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), each additional site (List separately in addition to code for primary procedure) 1.0000 Each 182.00 113.9900 50.60 134.68 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure) 1.0000 each 297.45 186.2900 82.69 220.11 Immunohistochemistry or immunocytochemistry, per specimen; initial single antibody stain procedure 1.0000 Each 327.60 205.1800 91.07 242.42 Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure 1.0000 each 297.45 186.2900 82.69 287.83 Immunofluorescence, per specimen; initial single antibody stain procedure 1.0000 Each 555.35 347.8200 154.39 410.96 Electron microscopy, diagnostic 1.0000 Each 1530.90 958.8000 425.59 1132.87 Morphometric analysis, tumor immunohistochemistry (eg, Her-2/neu, estrogen receptor/progesterone receptor), quantitative or semiquantitative, per specimen, each single antibody stain procedure; using computer-assisted technology 1.0000 Each 507.50 317.8500 141.08 375.55 In situ hybridization (eg, FISH), per specimen; each additional single probe stain procedure (List separately in addition to code for primary procedure) 1.0000 each 150.80 94.4500 41.92 111.59 In situ hybridization (eg, FISH), per specimen; initial single probe stain procedure 1.0000 Each 199.70 125.0700 55.52 147.78 Bilirubin, total, transcutaneous 1.0000 each 55.10 34.5100 5.02 40.77 Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count 1.0000 Each 49.90 31.2500 5.60 36.93 Leukocyte assessment, fecal, qualitative or semiquantitative 1.0000 each 49.90 31.2500 4.27 36.93 Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine) 1.0000 each 66.55 41.6800 7.33 49.25 Meat fibers, feces 1.0000 each 16.45 10.3000 4.57 12.17 Nasal smear for eosinophils 1.0000 each 36.40 22.8000 5.79 26.94 Semen analysis; volume, count, motility, and differential 1.0000 each 185.10 115.9300 12.31 136.97 Semen analysis; sperm presence and motility of sperm, if performed 1.0000 each 107.10 67.0800 12.05 79.25 Hepatitis B immune globulin (HBIg), human, for intramuscular use 1.0000 ML 357.80 224.0900 116.20 268.35 Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use 150.0000 IU 11688.00 7320.1900 267.30 8766.00 Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each 50.0000 mg 0.01 0.0100 0.01 1494.26 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered 1.0000 Each 46.80 29.3100 32.76 37.44 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure) 1.0000 Each 32.25 20.2000 22.58 25.80 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 1.0000 each 69.70 43.6500 48.79 61.24 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) 1.0000 Each 35.35 22.1400 24.74 28.28 Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid) 1.0000 each 37.45 23.4500 26.22 61.24 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule, for intramuscular use 1.0000 each 683.15 427.8600 444.05 512.36 Hepatitis A vaccine (HepA), adult dosage, for intramuscular use 1.0000 ML 266.20 166.7200 173.03 199.65 Hepatitis A vaccine (HepA), pediatric/adolescent dosage-2 dose schedule, for intramuscular use 1.0000 each 151.60 94.9500 98.54 113.70 Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use 1.0000 each 394.10 246.8200 256.16 295.58 Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, 3 dose schedule, for intramuscular use 1.0000 each 17.85 11.1800 11.60 13.39 Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, 4 dose schedule, for intramuscular use 1.0000 each 19.80 12.4000 12.87 14.85 Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent (4vHPV), 3 dose schedule, for intramuscular use 1.0000 each 17.85 11.1800 11.60 13.39 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use 1.0000 each 1017.08 637.0000 661.10 762.81 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use 0.2500 ML 46.00 28.8100 29.90 34.50 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use 0.5000 ML 53.23 33.3400 34.60 39.92 Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use 0.2500 ML 17.85 11.1800 11.60 13.39 Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use 0.5000 ml 103.00 64.5100 66.95 77.25 Influenza virus vaccine, trivalent, live (LAIV3), for intranasal use 0.2000 ML 96.00 60.1200 62.40 72.00 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use 0.5000 ml 168.50 105.5300 109.52 126.38 Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use 0.5000 ML 246.05 154.1000 159.93 184.54 Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use 0.5000 ML 774.55 485.1000 503.46 580.91 Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use 1.0000 each 110.25 69.0500 71.66 82.69 Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use 1.0000 each 168.50 105.5300 109.52 126.38 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use 0.5000 ml 17.85 11.1800 11.60 13.39 Rabies vaccine, for intramuscular use 1.0000 ML 1283.50 803.8600 312.47 962.62 Rotavirus vaccine, pentavalent (RV5), 3 dose schedule, live, for oral use 1.0000 each 17.85 11.1800 11.60 13.39 Rotavirus vaccine, human, attenuated (RV1), 2 dose schedule, live, for oral use 1.0000 each 17.85 11.1800 11.60 13.39 Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use 1.0000 each 17.85 11.1800 11.60 13.39 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL, for intramuscular use 0.2500 ml 67.45 42.2400 43.84 50.59 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use 0.5000 ml 67.45 42.2400 43.84 50.59 Typhoid vaccine, live, oral 1.0000 each 19.80 12.4000 12.87 14.85 Diphtheria, tetanus toxoids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use 1.0000 each 17.85 11.1800 11.60 13.39 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP-IPV/Hib), for intramuscular use 1.0000 each 17.85 11.1800 11.60 13.39 Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use 1.0000 each 17.85 11.1800 11.60 13.39 Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use 1.0000 each 93.60 58.6200 60.84 70.20 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use 1.0000 each 381.20 238.7500 247.78 285.90 Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use 1.0000 each 17.85 11.1800 11.60 13.39 Poliovirus vaccine, inactivated (IPV), for subcutaneous or intramuscular use 1.0000 each 1341.60 840.2400 872.04 1006.20 Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use 0.5000 ML 106.90 66.9500 69.48 80.18 Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use 0.5000 ML 155.45 97.3600 101.04 116.59 Varicella virus vaccine (VAR), live, for subcutaneous use 1.0000 each 17.85 11.1800 11.60 13.39 Yellow fever vaccine, live, for subcutaneous use 0.5000 ML 113.35 70.9900 73.68 85.01 Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intramuscular use 1.0000 each 17.85 11.1800 11.60 13.39 Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use 0.5000 ML 397.15 248.7400 258.15 297.86 Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use 0.5000 ML 17.85 11.1800 11.60 13.39 Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use 1.0000 each 461.20 288.8500 299.78 345.90 Zoster (shingles) vaccine (HZV), live, for subcutaneous injection 1.0000 each 705.00 441.5400 458.25 528.75 Hepatitis B vaccine (HepB), pediatric/adolescent dosage, 3 dose schedule, for intramuscular use 1.0000 DOSE 17.85 11.1800 11.60 13.39 Hepatitis B vaccine (HepB), adult dosage, 3 dose schedule, for intramuscular use 20.0000 MCG 290.75 182.1000 188.99 218.06 Psychiatric diagnostic evaluation 1.0000 Each 203.05 127.1700 123.42 203.05 Psychiatric diagnostic evaluation with medical services 1.0000 Each 35.00 21.9200 24.50 132.05 Psychotherapy, 30 minutes with patient 30.0000 min 143.50 89.8700 77.70 143.50 Psychotherapy, 30 minutes with patient when performed with an evaluation and management service (List separately in addition to the code for primary procedure) 30.0000 min 88.75 55.5800 53.25 71.00 Psychotherapy, 45 minutes with patient 45.0000 min 220.50 138.1000 102.94 220.50 Psychotherapy, 60 minutes with patient 60.0000 min 187.25 117.2700 123.42 187.25 Family psychotherapy (without the patient present), 50 minutes 50.0000 min 257.80 161.4600 99.14 246.00 Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes 50.0000 min 515.58 322.9100 102.68 412.46 Multiple-family group psychotherapy 1.0000 each 143.50 89.8700 34.92 143.50 Group psychotherapy (other than of a multiple-family group) 1.0000 Each 164.30 102.9000 27.49 164.30 Environmental intervention for medical management purposes on a psychiatric patient's behalf with agencies, employers, or institutions 1.0000 each 100.00 62.6300 60.00 80.00 Unlisted psychiatric service or procedure 1.0000 each 175.80 110.1000 24.22 140.64 Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient 15.0000 min 114.40 71.6500 80.08 91.52 Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (List separately in addition to code for primary procedure) 15.0000 min 63.45 39.7400 31.83 50.76 Hemodialysis procedure with single evaluation by a physician or other qualified health care professional 1.0000 each 1364.50 854.5900 604.32 1091.60 Esophagus, gastroesophageal reflux test; with mucosal attached telemetry pH electrode placement, recording, analysis and interpretation 1.0000 each 1012.95 634.4100 450.49 810.36 Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), esophagus through ileum, with interpretation and report Each 1850.15 1158.7500 747.71 1480.12 Determination of refractive state 1.0000 each 110.00 68.8900 77.00 88.00 Gonioscopy (separate procedure) 1.0000 each 62.00 38.8300 43.40 110.63 Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent) Each 153.00 95.8200 51.41 122.40 Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (eg, at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33) Each 204.00 127.7700 51.41 163.20 Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30 degrees or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2) Each 232.00 145.3000 103.39 185.60 Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation Each 151.00 94.5700 103.39 120.80 Fundus photography with interpretation and report Each 189.00 118.3700 103.39 151.20 Ophthalmodynamometry 1.0000 each 31.05 19.4500 21.74 33.44 External ocular photography with interpretation and report for documentation of medical progress (eg, close-up photography, slit lamp photography, goniophotography, stereo-photography) Each 109.75 68.7400 51.41 87.80 Anterior segment imaging with interpretation and report; with specular microscopy and endothelial cell analysis Each 309.00 193.5300 103.39 247.20 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual Each 258.95 162.1800 76.33 213.00 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals Each 61.35 38.4200 23.44 102.00 Nasopharyngoscopy with endoscope (separate procedure) Each 391.05 244.9100 151.82 1050.00 Evaluation of speech fluency (eg, stuttering, cluttering) Each 292.25 183.0400 102.00 216.26 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); Each 281.85 176.5200 102.00 213.00 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) Each 500.25 313.3100 102.00 370.18 Behavioral and qualitative analysis of voice and resonance Each 244.40 153.0700 102.00 213.00 Treatment of swallowing dysfunction and/or oral function for feeding Each 225.70 141.3600 84.39 180.56 Screening test, pure tone, air only 1.0000 each 55.10 34.5100 38.57 44.08 Pure tone audiometry (threshold); air only 1.0000 each 114.40 71.6500 80.08 110.63 Bekesy audiometry; screening 1.0000 each 80.10 50.1700 56.07 64.08 Tympanometry (impedance testing) 1.0000 each 170.55 106.8200 31.25 136.44 Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the presence or absence of hearing disorder, 3-6 frequencies) or transient evoked otoacoustic emissions, with interpretation and report 1.0000 each 78.00 48.8500 54.60 261.33 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech Each 367.10 229.9100 70.94 293.68 Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour Each 244.40 153.0700 124.44 195.52 Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with the patient; each additional 30 minutes (List separately in addition to code for primary procedure) 30.0000 min 122.70 76.8500 49.80 98.16 Therapeutic services for the use of speech-generating device, including programming and modification Each 244.40 153.0700 103.97 195.52 Evaluation of oral and pharyngeal swallowing function 1.0000 each 244.40 153.0700 84.33 195.52 Motion fluoroscopic evaluation of swallowing function by cine or video recording 1.0000 each 258.95 162.1800 91.11 207.16 Cardiopulmonary resuscitation (eg, in cardiac arrest) 1.0000 each 761.00 476.6100 244.24 608.80 Temporary transcutaneous pacing 1.0000 each 821.35 514.4100 518.96 821.35 Cardioversion, elective, electrical conversion of arrhythmia; external 1.0000 Each 796.65 498.9400 518.96 637.32 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report Each 194.50 121.8200 136.15 155.60 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report Each 256.90 160.9000 51.41 205.52 Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharmacological stress; tracing only, without interpretation and report Each 844.50 528.9100 244.24 675.60 Rhythm ECG, 1-3 leads; with interpretation and report Each 91.50 57.3100 64.05 73.20 Rhythm ECG, 1-3 leads; tracing only without interpretation and report Each 53.05 33.2300 37.14 55.00 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection) Each 227.80 142.6700 103.39 182.24 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report Each 301.60 188.8900 103.39 241.28 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional 1.0000 each 87.35 54.7100 61.14 69.88 Signal-averaged electrocardiography (SAECG), with or without ECG Each 575.10 360.1900 51.41 460.08 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system Each 290.65 182.0300 34.31 232.52 Transthoracic echocardiography for congenital cardiac anomalies; complete Each 368.85 231.0100 258.20 477.20 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography Each 2414.90 1512.4500 445.98 1931.92 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, without spectral or color Doppler echocardiography Each 1093.05 684.5800 212.54 874.44 Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, follow-up or limited study Each 370.25 231.8900 212.54 296.20 Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report Each 3014.95 1888.2600 445.98 2411.96 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to codes for echocardiographic imaging); complete 1.0000 each 1050.40 657.8700 735.28 840.32 Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) 1.0000 each 411.85 257.9400 288.30 329.48 Echocardiography, transesophageal (TEE) for guidance of a transcatheter intracardiac or great vessel(s) structural intervention(s) (eg,TAVR, transcatheter pulmonary valve replacement, mitral valve repair, paravalvular regurgitation repair, left atrial appendage occlusion/closure, ventricular septal defect closure) (peri-and intra-procedural), real-time image acquisition and documentation, guidance with quantitative measurements, probe manipulation, interpretation, and report, including diagnostic transesophageal echocardiography and, when performed, administration of ultrasound contrast, Doppler, color flow, and 3D 1.0000 each 3120.00 1954.0600 2184.00 2496.00 Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (List separately in addition to codes for echocardiography imaging) 1.0000 each 946.40 592.7300 662.48 757.12 Physician or other qualified health care professional services for outpatient cardiac rehabilitation; with continuous ECG monitoring (per session) 1.0000 Session 187.20 117.2400 107.19 149.76 Duplex scan of extracranial arteries; complete bilateral study Each 1289.60 807.6800 212.54 1031.68 Duplex scan of extracranial arteries; unilateral or limited study Each 518.95 325.0200 100.64 415.16 Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with, transcutaneous oxygen tension measurement at 1-2 levels) Each 227.80 142.6700 103.39 182.24 Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia) Each 434.70 272.2500 128.88 347.76 Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (ie, bidirectional Doppler waveform or volume plethysmography recording and analysis at rest with ankle/brachial indices immediately after and at timed intervals following performance of a standardized protocol on a motorized treadmill plus recording of time of onset of claudication or other symptoms, maximal walking time, and time to recovery) complete bilateral study Each 403.50 252.7100 244.24 322.80 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study Each 835.10 523.0200 212.54 668.08 Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study Each 809.10 506.7400 100.64 647.28 Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study Each 835.10 523.0200 212.54 668.08 Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study Each 735.30 460.5200 100.64 588.24 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study Each 835.10 523.0200 212.54 668.08 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study Each 713.45 446.8300 100.64 570.76 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study Each 1168.95 732.1100 212.54 935.16 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study Each 988.00 618.7800 100.64 790.40 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study Each 1017.10 637.0100 212.54 813.68 Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow) Each 391.05 244.9100 100.64 312.84 Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, initial day 1.0000 each 352.55 220.8000 246.78 479.54 Ventilation assist and management, initiation of pressure or volume preset ventilators for assisted or controlled breathing; hospital inpatient/observation, each subsequent day 1.0000 Day(s) 226.70 141.9800 158.69 479.54 Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation 1.0000 each 172.65 108.1300 120.86 138.12 Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration 1.0000 each 275.60 172.6100 192.92 261.33 Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (eg, antigen[s], cold air, methacholine) 1.0000 each 1094.10 685.2300 244.24 875.28 Vital capacity, total (separate procedure) 1.0000 each 80.10 50.1700 56.07 137.90 Maximum breathing capacity, maximal voluntary ventilation 1.0000 each 312.00 195.4100 51.41 249.60 Exercise test for bronchospasm, including pre- and post-spirometry and pulse oximetry; with electrocardiographic recording(s) 1.0000 each 312.00 195.4100 103.39 249.60 Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed 1.0000 each 191.35 119.8400 103.39 153.08 Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device 1.0000 Each 33.30 20.8600 23.31 185.66 Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or prophylaxis 1.0000 each 96.00 60.1200 67.20 185.66 Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour 1.0000 hr 185.10 115.9300 103.39 148.08 Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour (List separately in addition to code for primary procedure) 1.0000 hr 185.10 115.9300 129.57 148.08 Continuous positive airway pressure ventilation (CPAP), initiation and management 1.0000 each 226.70 141.9800 158.69 185.66 Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device 1.0000 each 86.30 54.0500 60.41 185.66 Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; initial demonstration and/or evaluation 1.0000 each 45.80 28.6800 32.06 110.63 Manipulation chest wall, such as cupping, percussing, and vibration to facilitate lung function; subsequent 1.0000 Each 45.80 28.6800 32.06 110.63 Plethysmography for determination of lung volumes and, when performed, airway resistance 1.0000 each 275.60 172.6100 192.92 261.33 Diffusing capacity (eg, carbon monoxide, membrane) (List separately in addition to code for primary procedure) 1.0000 Each 275.60 172.6100 192.92 220.48 Noninvasive ear or pulse oximetry for oxygen saturation; single determination 1.0000 each 46.80 29.3100 32.76 37.44 Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise) 1.0000 each 281.85 176.5200 197.30 225.48 Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight monitoring (separate procedure) 1.0000 each 535.60 335.4500 128.88 428.48 Unlisted pulmonary service or procedure 1.0000 Each 26.90 16.8500 18.83 137.90 Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests 1.0000 Each 180.95 113.3300 126.66 908.97 Nitric oxide expired gas determination 1.0000 each 84.25 52.7700 31.25 67.40 Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction, including test interpretation and report, specify number of tests 1.0000 Each 106.10 66.4500 51.41 84.88 Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection 1.0000 Each 81.10 50.7900 36.94 64.88 Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections 1.0000 Each 58.25 36.4800 36.94 46.60 Professional services for the supervision of preparation and provision of antigens for allergen immunotherapy; single or multiple antigens (specify number of doses) 1.0000 Each 81.10 50.7900 36.94 64.88 Electroencephalogram (EEG); including recording awake and asleep 1.0000 each 944.30 591.4200 244.24 755.44 Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side 1.0000 each 61.35 38.4200 17.76 49.08 Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with brain, cranial nerve, spinal cord, peripheral nerve, or sacral nerve, neurostimulator pulse generator/transmitter, without programming 1.0000 each 237.00 148.4300 103.39 189.60 Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with simple spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional 1.0000 each 494.00 309.3900 92.64 395.20 Electronic analysis of implanted neurostimulator pulse generator/transmitter (eg, contact group[s], interleaving, amplitude, pulse width, frequency [Hz], on/off cycling, burst, magnet mode, dose lockout, patient selectable parameters, responsive neurostimulation, detection algorithms, closed loop parameters, and passive parameters) by physician or other qualified health care professional; with complex spinal cord or peripheral nerve (eg, sacral nerve) neurostimulator pulse generator/transmitter programming by physician or other qualified health care professional 1.0000 hr 453.45 284.0000 92.64 362.76 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; 1.0000 each 338.00 211.6900 236.60 307.09 Refilling and maintenance of implantable pump or reservoir for drug delivery, spinal (intrathecal, epidural) or brain (intraventricular), includes electronic analysis of pump, when performed; requiring skill of a physician or other qualified health care professional Each 368.00 230.4800 241.21 294.40 Canalith repositioning procedure(s) (eg, Epley maneuver, Semont maneuver), per day 1.0000 Day(s) 125.85 78.8200 43.55 100.68 Assessment of aphasia (includes assessment of expressive and receptive speech and language function, language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour 1.0000 hr 266.25 166.7500 99.01 213.00 Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument 1.0000 Hour(s) 191.35 119.8400 9.72 153.08 Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report Each 281.85 176.5200 104.33 225.48 Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument 1.0000 each 51.60 32.3200 4.65 41.28 Psychological testing evaluation services by physician or other qualified health care professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour 1.0000 hr 18.70 11.7100 13.09 257.42 Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making) 1.0000 each 171.00 107.1000 69.15 136.80 Administration of patient-focused health risk assessment instrument (eg, health hazard appraisal) with scoring and documentation, per standardized instrument 1.0000 each 58.25 36.4800 24.22 46.60 Administration of caregiver-focused health risk assessment instrument (eg, depression inventory) for the benefit of the patient, with scoring and documentation, per standardized instrument 1.0000 each 58.25 36.4800 24.22 46.60 Intravenous infusion, hydration; initial, 31 minutes to 1 hour 1.0000 Hour(s) 518.95 325.0200 187.94 518.95 Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure) 1.0000 hr 198.65 124.4100 36.94 158.92 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour 1.0000 Hour(s) 367.10 229.9100 187.94 293.68 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) 1.0000 hr 140.40 87.9300 36.94 112.32 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure) 1.0000 Hour(s) 101.90 63.8200 57.23 81.52 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure) 1.0000 Hour(s) 93.60 58.6200 60.84 74.88 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); initial, up to 1 hour, including pump set-up and establishment of subcutaneous infusion site(s) 1.0000 Hour(s) 244.40 153.0700 158.86 201.10 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) 1.0000 hr 93.60 58.6200 36.94 74.88 Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); additional pump set-up with establishment of new subcutaneous infusion site(s) (List separately in addition to code for primary procedure) 1.0000 Hour(s) 116.50 72.9600 57.23 93.20 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular 1.0000 Each 50.95 31.9100 33.12 61.24 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); intravenous push, single or initial substance/drug 1.0000 Each 200.70 125.7000 130.46 201.10 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure) 1.0000 Each 109.20 68.3900 36.94 87.36 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure) 1.0000 Each 200.70 125.7000 130.46 160.56 Application of on-body injector (includes cannula insertion) for timed subcutaneous injection 1.0000 each 59.30 37.1400 36.94 1050.00 Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic 1.0000 Each 140.40 87.9300 57.23 112.32 Chemotherapy administration, subcutaneous or intramuscular; hormonal anti-neoplastic 1.0000 Each 126.90 79.4800 57.23 101.52 Chemotherapy administration; intralesional, up to and including 7 lesions Each 182.40 114.2400 57.23 145.92 Chemotherapy administration; intralesional, more than 7 lesions Each 182.40 114.2400 127.68 201.10 Chemotherapy administration; intravenous, push technique, single or initial substance/drug 1.0000 Each 350.50 219.5200 187.94 280.40 Chemotherapy administration; intravenous, push technique, each additional substance/drug (List separately in addition to code for primary procedure) 1.0000 Each 350.50 219.5200 57.23 280.40 Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug 1.0000 Hour(s) 494.00 309.3900 287.00 395.20 Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure) 1.0000 hr 238.15 149.1500 57.23 190.52 Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump 1.0000 Hour(s) 370.25 231.8900 259.18 307.09 Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to 1 hour (List separately in addition to code for primary procedure) 1.0000 Hour(s) 118.55 74.2500 57.23 94.84 Chemotherapy administration into pleural cavity, requiring and including thoracentesis 1.0000 Hour(s) 370.25 231.8900 259.18 307.09 Chemotherapy administration into the peritoneal cavity via indwelling port or catheter 1.0000 each 234.80 147.0600 164.36 307.09 Chemotherapy administration, into CNS (eg, intrathecal), requiring and including spinal puncture 1.0000 Hour(s) 370.25 231.8900 259.18 307.09 Refilling and maintenance of portable pump 1.0000 each 309.90 194.0900 187.94 247.92 Refilling and maintenance of implantable pump or reservoir for drug delivery, systemic (eg, intravenous, intra-arterial) 1.0000 each 206.70 129.4600 144.69 201.10 Irrigation of implanted venous access device for drug delivery systems 1.0000 each 154.95 97.0500 51.41 123.96 Chemotherapy injection, subarachnoid or intraventricular via subcutaneous reservoir, single or multiple agents 1.0000 each 167.45 104.8700 117.22 201.10 Application of a modality to 1 or more areas; hot or cold packs 1.0000 each 67.40 42.2100 6.02 102.00 Application of a modality to 1 or more areas; traction, mechanical Each 157.05 98.3600 14.65 157.05 Application of a modality to 1 or more areas; vasopneumatic devices Each 75.90 47.5400 11.87 102.00 Application of a modality to 1 or more areas; paraffin bath Each 104.25 65.2900 5.69 104.25 Application of a modality to 1 or more areas; whirlpool Each 164.30 102.9000 17.52 164.30 Application of a modality to 1 or more areas; infrared Each 70.70 44.2800 6.35 102.00 Application of a modality to 1 or more areas; ultraviolet Each 143.50 89.8700 8.05 143.50 Application of a modality to 1 or more areas; electrical stimulation (manual), each 15 minutes Each 82.15 51.4500 14.65 102.00 Application of a modality to 1 or more areas; iontophoresis, each 15 minutes Each 82.15 51.4500 20.00 102.00 Application of a modality to 1 or more areas; contrast baths, each 15 minutes Each 70.70 44.2800 14.59 102.00 Application of a modality to 1 or more areas; ultrasound, each 15 minutes Each 82.15 51.4500 14.25 102.00 Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility Each 79.05 49.5100 29.56 102.00 Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities Each 79.05 49.5100 34.30 102.00 Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises Each 70.70 44.2800 37.27 102.00 Therapeutic procedure, 1 or more areas, each 15 minutes; gait training (includes stair climbing) Each 70.70 44.2800 29.56 102.00 Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) Each 79.05 49.5100 28.80 102.00 Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; initial 15 minutes 15.0000 min 61.35 38.4200 22.97 49.08 Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing, and sequencing tasks), direct (one-on-one) patient contact; each additional 15 minutes (List separately in addition to code for primary procedure) 15.0000 min 59.50 37.2600 22.27 47.60 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), 1 or more regions, each 15 minutes Each 82.15 51.4500 27.19 102.00 Therapeutic procedure(s), group (2 or more individuals) Each 70.70 44.2800 17.71 102.00 Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family. Each 235.05 147.2100 99.37 213.00 Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family. Each 273.50 171.2900 99.37 213.00 Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family. Each 310.95 194.7500 99.37 230.10 Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use of standardized tests and measures is required; and Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome Typically, 20 minutes are spent face-to-face with the patient and/or family. Each 143.50 89.8700 67.87 143.50 Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (eg, physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family. Each 202.80 127.0100 96.37 202.80 Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family. Each 236.10 147.8700 96.37 213.00 Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family. Each 270.40 169.3500 96.37 213.00 Re-evaluation of occupational therapy established plan of care, requiring these components: An assessment of changes in patient functional or medical status with revised plan of care; An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required. Typically, 30 minutes are spent face-to-face with the patient and/or family. Each 123.80 77.5400 64.87 133.00 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes Each 100.90 63.1900 38.20 102.00 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 15 minutes Each 61.35 38.4200 42.94 102.00 Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 15 minutes Each 88.40 55.3600 32.89 102.00 Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes Each 70.70 44.2800 31.60 102.00 Wheelchair management (eg, assessment, fitting, training), each 15 minutes Each 85.30 53.4200 31.94 102.00 Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq cm or less Each 454.22 284.4800 165.83 1050.00 Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 1.0000 Session 202.80 127.0100 141.96 1050.00 Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (eg, wet-to-moist dressings, enzymatic, abrasion, larval therapy), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session 1.0000 Session(s) 454.22 284.4800 165.83 454.22 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area less than or equal to 50 square centimeters 1.0000 Session(s) 272.60 170.7300 165.83 218.08 Negative pressure wound therapy (eg, vacuum assisted drainage collection), utilizing durable medical equipment (DME), including topical application(s), wound assessment, and instruction(s) for ongoing care, per session; total wound(s) surface area greater than 50 square centimeters 1.0000 Session(s) 498.42 312.1600 319.40 398.74 Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 15 minutes Each 34.55 21.6400 24.18 102.00 Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes Each 126.90 79.4800 48.63 126.90 Prosthetic(s) training, upper and/or lower extremity(ies), initial prosthetic(s) encounter, each 15 minutes Each 108.15 67.7300 41.30 108.15 Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes Each 135.20 84.6800 53.26 135.20 Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes 15.0000 min 52.00 32.5700 36.40 41.60 Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes 15.0000 min 52.00 32.5700 31.56 41.60 Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes 30.0000 min 100.90 63.1900 16.65 80.72 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient 30.0000 min 93.60 58.6200 65.52 74.88 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 2-4 patients 30.0000 min 47.85 29.9700 33.50 38.28 Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; 5-8 patients 30.0000 min 23.90 14.9700 16.73 19.12 Handling and/or conveyance of specimen for transfer from the office to a laboratory 1.0000 Each 226.70 141.9800 63.02 170.02 Handling and/or conveyance of specimen for transfer from the patient in other than an office to a laboratory (distance may be indicated) 1.0000 each 215.30 134.8400 59.85 161.48 Handling, conveyance, and/or any other service in connection with the implementation of an order involving devices (eg, designing, fitting, packaging, handling, delivery or mailing) when devices such as orthotics, protectives, prosthetics are fabricated by an outside laboratory or shop but which items have been designed, and are to be fitted and adjusted by the attending physician or other qualified health care professional 1.0000 each 100.90 63.1900 70.63 83.39 Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service 1.0000 each 72.80 45.5900 50.96 58.24 Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service 1.0000 each 72.80 45.5900 50.96 58.24 Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided) 1.0000 Each 23.90 14.9700 16.73 19.12 Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form 1.0000 each 71.80 44.9700 50.26 57.44 Unusual travel (eg, transportation and escort of patient) 1.0000 each 215.30 134.8400 150.71 172.24 Visual function screening, automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates, and field of vision (may include all or some screening of the determination[s] for contrast sensitivity, vision under glare) 1.0000 each 116.50 72.9600 81.55 93.20 Screening test of visual acuity, quantitative, bilateral 1.0000 each 47.85 29.9700 33.50 38.28 Phlebotomy, therapeutic (separate procedure) 1.0000 each 369.20 231.2300 103.39 369.20 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15-29 minutes of total time is spent on the date of the encounter. 20.0000 min 138.30 86.6200 72.47 138.30 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30-44 minutes of total time is spent on the date of the encounter. 30.0000 min 203.85 127.6700 111.62 203.85 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45-59 minutes of total time is spent on the date of the encounter. 45.0000 min 347.35 217.5500 167.05 277.88 Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60-74 minutes of total time is spent on the date of the encounter. 60.0000 min 656.00 410.8500 220.62 524.80 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. 5.0000 min 313.05 196.0600 22.51 250.44 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10-19 minutes of total time is spent on the date of the encounter. 10.0000 min 174.70 109.4100 55.83 174.70 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter. 15.0000 min 147.70 92.5000 90.89 147.70 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter. 25.0000 min 228.80 143.3000 129.10 228.80 Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40-54 minutes of total time is spent on the date of the encounter. 40.0000 min 331.80 207.8100 180.34 265.44 Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." To report services to a patient designated as "observation status" or "inpatient status" and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.]) 1.0000 each 162.65 101.8700 100.84 162.65 Initial hospital care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit. 1.0000 Day(s) 260.00 162.8400 99.61 208.00 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering or improving. Typically, 15 minutes are spent at the bedside and on the patient's hospital floor or unit. 1.0000 Day(s) 172.65 108.1300 38.01 138.12 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit. 1.0000 Day(s) 102.20 64.0100 71.10 81.76 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) requiring admission are of low severity. Typically, 40 minutes are spent at the bedside and on the patient's hospital floor or unit. 40.0000 min 189.75 118.8400 117.64 189.75 Observation or inpatient hospital care, for the evaluation and management of a patient including admission and discharge on the same date, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually the presenting problem(s) requiring admission are of moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit. 50.0000 min 223.70 140.1000 138.69 223.70 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. 1.0000 each 971.35 608.3600 67.05 971.35 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. 1.0000 each 839.30 525.6500 121.53 843.61 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. 1.0000 each 1066.00 667.6400 213.90 1066.00 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician, or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function. 1.0000 each 1344.70 842.1900 335.94 1344.70 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function. 1.0000 each 1676.50 1049.9900 482.21 1676.50 Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes 1.0000 each 1865.80 1168.5500 639.73 1752.00 Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) 30.0000 min 2331.70 1460.3400 843.61 1752.00 Initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit. 1.0000 Day(s) 79.50 49.7900 55.65 79.50 Nursing facility discharge day management; 30 minutes or less 1.0000 each 159.10 99.6400 72.01 127.28 Nursing facility discharge day management; more than 30 minutes 1.0000 each 194.50 121.8200 103.79 155.60 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Typically, 20 minutes are spent face-to-face with the patient and/or family. 20.0000 min 91.20 57.1200 53.97 72.96 Home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family. 30.0000 min 136.80 85.6800 76.32 109.44 Home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family. 45.0000 min 201.10 125.9500 126.09 160.88 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family. 15.0000 min 72.50 45.4100 50.75 58.00 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family. 25.0000 min 113.40 71.0200 79.38 90.72 Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family. 40.0000 min 173.00 108.3500 121.10 138.40 Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care professional 30.0000 min 180.95 113.3300 42.44 144.76 Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by physician 30.0000 min 180.95 113.3300 55.84 144.76 Medical team conference with interdisciplinary team of health care professionals, patient and/or family not present, 30 minutes or more; participation by nonphysician qualified health care professional 30.0000 min 180.95 113.3300 36.27 144.76 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year) 1.0000 each 198.65 124.4100 110.25 158.92 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years) 1.0000 each 212.15 132.8700 115.15 169.72 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; late childhood (age 5 through 11 years) 1.0000 each 224.65 140.7000 119.62 179.72 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years) 1.0000 each 265.20 166.0900 134.49 212.16 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years 1.0000 each 254.80 159.5800 130.71 203.84 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years 1.0000 each 308.90 193.4600 151.36 247.12 Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older 1.0000 each 332.80 208.4300 163.98 266.24 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year) 1.0000 each 182.00 113.9900 99.05 145.60 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years) 1.0000 each 198.65 124.4100 105.86 158.92 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years) 1.0000 each 198.65 124.4100 105.53 158.92 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years) 1.0000 each 224.65 140.7000 115.58 179.72 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years 1.0000 each 231.90 145.2400 118.02 185.52 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years 1.0000 each 251.70 157.6400 125.61 201.36 Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older 1.0000 each 265.20 166.0900 134.83 212.16 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes 15.0000 min 80.10 50.1700 39.00 64.08 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes 30.0000 min 138.30 86.6200 64.44 110.64 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes 45.0000 min 203.85 127.6700 88.91 163.08 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes 60.0000 min 296.40 185.6400 113.19 237.12 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes 1.0000 each 78.00 48.8500 15.44 62.40 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes 1.0000 each 130.00 81.4200 24.22 104.00 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; 15 to 30 minutes 1.0000 each 105.05 65.7900 35.81 84.04 Alcohol and/or substance (other than tobacco) abuse structured screening (eg, AUDIT, DAST), and brief intervention (SBI) services; greater than 30 minutes 1.0000 each 226.70 141.9800 68.86 181.36 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion 1.0000 each 33.75 21.1400 23.62 33.75 Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates. 1.0000 each 106.10 66.4500 0.01 84.88 Work related or medical disability examination by the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report. 1.0000 each 106.10 66.4500 0.01 84.88 Work related or medical disability examination by other than the treating physician that includes: Completion of a medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report. 1.0000 each 110.25 69.0500 0.01 88.20 Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center 1.0000 Day(s) 142.65 89.3400 90.91 114.12 Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home, with all of the following required elements: Cognition-focused evaluation including a pertinent history and examination; Medical decision making of moderate or high complexity; Functional assessment (eg, basic and instrumental activities of daily living), including decision-making capacity; Use of standardized instruments for staging of dementia (eg, functional assessment staging test [FAST], clinical dementia rating [CDR]); Medication reconciliation and review for high-risk medications; Evaluation for neuropsychiatric and behavioral symptoms, including depression, including use of standardized screening instrument(s); Evaluation of safety (eg, home), including motor vehicle operation; Identification of caregiver(s), caregiver knowledge, caregiver needs, social supports, and the willingness of caregiver to take on caregiving tasks; Development, updating or revision, or review of an Advance Care Plan; Creation of a written care plan, including initial plans to address any neuropsychiatric symptoms, neuro-cognitive symptoms, functional limitations, and referral to community resources as needed (eg, rehabilitation services, adult day programs, support groups) shared with the patient and/or caregiver with initial education and support. Typically, 50 minutes are spent face-to-face with the patient and/or family or caregiver. 50.0000 min 421.20 263.8000 69.15 336.96 Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales; behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes; facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation; and continuity of care with a designated member of the care team. 1.0000 each 52.05 32.6000 24.22 41.64 Complex chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored, moderate or high complexity medical decision making; first 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. 1.0000 each 123.80 77.5400 86.66 132.05 Complex chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored, moderate or high complexity medical decision making; each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure) 30.0000 Minutes 61.35 38.4200 42.94 49.08 Chronic care management services with the following required elements: multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, comprehensive care plan established, implemented, revised, or monitored; first 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. 1.0000 each 155.00 97.0800 40.56 124.00 Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: outreach to and engagement in treatment of a patient directed by the treating physician or other qualified health care professional; initial assessment of the patient, including administration of validated rating scales, with the development of an individualized treatment plan; review by the psychiatric consultant with modifications of the plan if recommended; entering patient in a registry and tracking patient follow-up and progress using the registry, with appropriate documentation, and participation in weekly caseload consultation with the psychiatric consultant; and provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies. 70.0000 min 119.20 74.6500 69.15 95.36 Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional, with the following required elements: tracking patient follow-up and progress using the registry, with appropriate documentation; participation in weekly caseload consultation with the psychiatric consultant; ongoing collaboration with and coordination of the patient's mental health care with the treating physician or other qualified health care professional and any other treating mental health providers; additional review of progress and recommendations for changes in treatment, as indicated, including medications, based on recommendations provided by the psychiatric consultant; provision of brief interventions using evidence-based techniques such as behavioral activation, motivational interviewing, and other focused treatment strategies; monitoring of patient outcomes using validated rating scales; and relapse prevention planning with patients as they achieve remission of symptoms and/or other treatment goals and are prepared for discharge from active treatment. 60.0000 min 119.20 74.6500 69.15 95.36 Transitional Care Management Services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge Medical decision making of at least moderate complexity during the service period Face-to-face visit, within 14 calendar days of discharge 1.0000 each 317.20 198.6600 109.66 253.76 Permanent, long-term, nondissolvable lacrimal duct implant, each 1.0000 Each 73.95 46.3100 51.76 61.12 Implantable access total catheter, port/reservoir (e.g., venous, arterial, epidural, subarachnoid, peritoneal, etc.) 1.0000 Each 490.50 307.2000 343.35 405.40 Surgical trays 1.0000 Each 1248.50 781.9400 873.95 998.80 Pessary, rubber, any type 1.0000 Each 159.10 99.6400 111.37 127.28 Pessary, nonrubber, any type 1.0000 Each 112.65 70.5500 78.86 90.12 Slings 1.0000 Each 21.20 13.2800 14.84 16.96 Tracheal suction catheter, closed system, each 1.0000 Each 41.60 26.0500 29.12 33.28 Radiopharmaceutical, diagnostic, not otherwise classified 1.0000 Each 1272.00 796.6500 826.80 941.28 Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 mCi 1.0000 Each 1976.90 1238.1300 1284.98 1462.91 Tissue marker, implantable, any type, each 1.0000 Each 209.50 131.2100 146.65 173.15 Alginate or other fiber gelling dressing, wound cover, sterile, pad size more than 16 sq in but less than or equal to 48 sq in, each dressing 1.0000 Each 28.10 17.6000 19.67 22.48 Contact layer, sterile, 16 sq in or less, each dressing 1.0000 Each 11.45 7.1700 8.02 9.16 Foam dressing, wound cover, sterile, pad size 16 sq in or less, without adhesive border, each dressing 1.0000 Each 7.30 4.5700 5.11 5.84 Skin sealants, protectants, moisturizers, ointments, any type, any size 1.0000 Each 104.00 65.1400 72.80 83.20 High compression bandage, elastic, knitted/woven, load resistance greater than or equal to 1.35 ft lbs at 50% maximum stretch, width greater than or equal to 3 in and less than 5 in, per yd 1.0000 yd 23.90 14.9700 16.73 19.12 Gradient compression stocking, waist length, 18-30 mm Hg, each 1.0000 Each 8.30 5.2000 5.81 6.64 Tracheostomy/laryngectomy tube, noncuffed, polyvinyl chloride (PVC), silicone or equal, each 1.0000 Each 79.70 49.9200 55.79 63.76 Tracheostomy/laryngectomy tube, cuffed, polyvinyl chloride (PVC), silicone or equal, each 1.0000 Each 69.90 43.7800 48.93 55.92 Technetium Tc-99m sestamibi, diagnostic, per study dose 1.0000 Each 772.70 483.9400 502.26 571.80 Technetium Tc-99m tetrofosmin, diagnostic, per study dose 1.0000 Each 639.60 400.5800 415.74 473.30 Technetium Tc-99m medronate, diagnostic, per study dose, up to 30 mCi 30.0000 Dose(s) 177.85 111.3900 115.60 131.61 Thallium Tl-201 thallous chloride, diagnostic, per mCi 1.0000 mCi 322.00 201.6700 209.30 238.28 Technetium Tc-99m pertechnetate, diagnostic, per mCi 1.0000 mCi 33.30 20.8600 21.64 24.64 Iodine I-123 sodium iodide, diagnostic, per 100 mcCi, up to 999 mcCi 100.0000 Microcuries 92.55 57.9600 60.16 68.49 Technetium Tc-99m, tilmanocept, diagnostic, up to 0.5 mCi 1.0000 Dose(s) 1816.90 1137.9200 1180.98 1362.68 Technetium Tc-99m exametazime, diagnostic, per study dose, up to 25 mCi 1.0000 Dose(s) 3043.05 1905.8600 1977.98 2251.86 Technetium Tc-99m mebrofenin, diagnostic, per study dose, up to 15 mCi 1.0000 Dose(s) 179.90 112.6700 116.94 133.13 Technetium Tc-99m pyrophosphate, diagnostic, per study dose, up to 25 mCi 1.0000 Dose(s) 66.55 41.6800 43.26 49.25 Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 mCi 1.0000 Dose(s) 49.90 31.2500 32.44 36.93 Technetium Tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 mCi 1.0000 Dose(s) 29.10 18.2300 18.92 21.53 Technetium Tc-99m sulfur colloid, diagnostic, per study dose, up to 20 mCi 1.0000 Dose(s) 288.10 180.4400 187.26 213.19 Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 mCi 1.0000 Dose(s) 689.50 431.8300 448.18 510.23 Gallium Ga-67 citrate, diagnostic, per mCi 1.0000 mCi 334.00 209.1800 217.10 247.16 Technetium Tc-99m mertiatide, diagnostic, per study dose, up to 15 mCi 1.0000 Dose(s) 392.10 245.5700 254.86 290.15 Technetium Tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 mCi 1.0000 Dose(s) 69.70 43.6500 45.30 51.58 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (NOS), per ml 1.0000 ML 376.50 235.8000 263.55 301.20 Injection, gadoxetate disodium, 1 ml 1.0000 ML 47.58 29.8000 33.31 38.06 Injection, gadobutrol, 0.1 ml 0.1000 ML 13.26 8.3000 9.28 10.61 Gastrostomy/jejunostomy tube, standard, any material, any type, each 1.0000 Each 452.90 283.6500 317.03 362.32 Parenteral nutrition solution: amino acid, greater than 8.5% (500 ml = 1 unit) - home mix 500.0000 ML 49.05 30.7200 34.34 39.24 Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable) 1.0000 Each 448.30 280.7700 313.81 370.52 Catheter, balloon dilatation, nonvascular 1.0000 Each 475.60 297.8700 332.92 393.08 Catheter, brachytherapy seed administration 1.0000 Each 3852.05 2412.5400 2696.44 3183.72 Catheter, drainage 1.0000 Each 220.15 137.8800 154.10 181.95 Catheter, hemodialysis/peritoneal, long-term 1.0000 Each 705.70 441.9800 493.99 583.26 Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) 1.0000 Each 800.25 501.2000 560.18 661.41 Catheter, thrombectomy/embolectomy 1.0000 Each 286.25 179.2800 200.38 236.59 Catheter, ureteral 1.0000 Each 253.50 158.7700 177.45 209.52 Connective tissue, human (includes fascia lata) 1.0000 Each 619.30 387.8700 433.51 511.85 Connective tissue, nonhuman (includes synthetic) 1.0000 Each 3521.60 2205.5800 2465.12 2910.60 Event recorder, cardiac (implantable) 1.0000 Each 4924.50 3084.2100 3447.15 4070.10 Adhesion barrier 1.0000 Each 753.80 472.1000 527.66 623.02 Graft, vascular 1.0000 Each 1129.75 707.5600 790.82 933.74 Guide wire 1.0000 Each 153.60 96.2000 107.52 126.95 Repair device, urinary, incontinence, with sling graft 1.0000 Each 1042.65 653.0100 729.86 861.75 Joint device (implantable) 1.0000 Each 853.30 534.4200 597.31 705.25 Lead, neurostimulator (implantable) 1.0000 Each 5600.00 3507.2800 3920.00 4628.40 Lead, pacemaker, transvenous VDD single pass 1.0000 Each 1488.25 932.0900 1041.78 1230.04 Lens, intraocular (new technology) 1.0000 Each 419.30 262.6100 293.51 346.55 Mesh (implantable) 1.0000 Each 698.70 437.6000 489.09 577.48 Morcellator 1.0000 Each 928.75 581.6800 650.12 767.61 Pacemaker, dual chamber, rate-responsive (implantable) 1.0000 Each 10290.00 6444.6300 7203.00 8504.68 Pacemaker, single chamber, rate-responsive (implantable) 1.0000 Each 7987.65 5002.6700 5591.36 6601.79 Patient programmer, neurostimulator 1.0000 Each 1580.80 990.0600 1106.56 1306.53 Port, indwelling (implantable) 1.0000 Each 613.25 384.0800 429.28 506.85 Prosthesis, breast (implantable) 1.0000 Each 2528.65 1583.6900 1770.06 2089.93 Surgical tissue localization and excision device (implantable) 1.0000 Each 59.70 37.3900 41.79 49.34 Generator, neurostimulator (implantable), with rechargeable battery and charging system 1.0000 Each 21560.00 13503.0300 15092.00 17819.34 Interspinous process distraction device (implantable) 1.0000 Each 7704.05 4825.0500 5392.84 6367.40 Powered bone marrow biopsy needle 1.0000 each 397.30 248.8300 278.11 317.84 Stent, coated/covered, with delivery system 1.0000 Each 4031.20 2524.7400 2821.84 3331.79 Stent, noncoated/noncovered, with delivery system 1.0000 Each 2431.25 1522.6900 1701.88 2009.43 Stent, noncoated/noncovered, without delivery system 1.0000 Each 301.75 188.9900 211.22 249.40 Vena cava filter 1.0000 Each 1686.62 1056.3300 1180.63 1393.99 Adaptor/extension, pacing lead or neurostimulator lead (implantable) 1.0000 Each 3179.65 1991.4100 2225.76 2627.98 Catheter, extravascular tissue ablation, any modality (insertable) 1.0000 each 1613.05 1010.2500 1129.14 1333.19 Catheter, guiding (may include infusion/perfusion capability) 1.0000 Each 645.00 403.9600 451.50 533.09 Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away 1.0000 Each 199.20 124.7600 139.44 164.64 Introducer/sheath, other than guiding, other than intracardiac electrophysiological, nonlaser 1.0000 Each 251.60 157.5800 176.12 207.95 Lead, neurostimulator test kit (implantable) 1.0000 Each 1424.55 892.2000 997.18 1177.39 Lead, pacemaker, other than transvenous VDD single pass 1.0000 Each 1758.80 1101.5400 1231.16 1453.65 Stent, noncoronary, temporary, without delivery system 1.0000 Each 379.25 237.5200 265.48 313.45 Pacemaker, dual chamber, nonrate-responsive (implantable) 1.0000 Each 6885.15 4312.1700 4819.60 5690.58 Pacemaker, single chamber, nonrate-responsive (implantable) 1.0000 Each 4128.90 2585.9300 2890.23 3412.54 Stent, noncoronary, temporary, with delivery system 1.0000 Each 433.70 271.6300 303.59 358.45 Catheter, suprapubic/cystoscopic 1.0000 Each 164.30 102.9000 115.01 135.79 Repair device, urinary, incontinence, without sling graft 1.0000 Each 1200.45 751.8400 840.32 992.17 Brachytherapy source, stranded, iodine-125, per source 1.0000 Each 76.00 47.6000 37.40 62.81 Brachytherapy source, nonstranded, iodine-125, per source 1.0000 Each 30.00 18.7900 21.00 36.49 Magnetic resonance angiography with contrast, abdomen 1.0000 each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance angiography without contrast followed by with contrast, abdomen 1.0000 each 4336.80 2716.1400 339.98 3469.44 Magnetic resonance imaging with contrast, breast; unilateral 1.0000 each 3329.05 2084.9800 164.90 2663.24 Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral 1.0000 each 4336.80 2716.1400 339.98 3469.44 Magnetic resonance imaging with contrast, breast; bilateral 1.0000 each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral 1.0000 each 3943.70 2469.9400 339.98 3154.96 Magnetic resonance angiography with contrast, chest (excluding myocardium) 1.0000 each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium) 1.0000 each 4336.80 2716.1400 339.98 3469.44 Magnetic resonance angiography with contrast, lower extremity 1.0000 each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance angiography without contrast followed by with contrast, lower extremity 1.0000 each 8673.60 5432.2800 339.98 6938.88 Magnetic resonance angiography with contrast, pelvis 1.0000 each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance angiography without contrast followed by with contrast, pelvis 1.0000 each 4336.80 2716.1400 339.98 3469.44 Magnetic resonance angiography with contrast, spinal canal and contents 1.0000 each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance angiography without contrast, spinal canal and contents 1.0000 each 3329.05 2084.9800 212.54 2663.24 Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents 1.0000 each 4385.70 2746.7600 339.98 3508.56 Magnetic resonance angiography with contrast, upper extremity 1.0000 each 3329.05 2084.9800 339.98 2663.24 Magnetic resonance angiography without contrast, upper extremity 1.0000 each 3329.05 2084.9800 212.54 2663.24 Magnetic resonance angiography without contrast followed by with contrast, upper extremity 1.0000 each 4384.65 2746.1100 339.98 3507.72 Injection, pantoprazole sodium, per vial 1.0000 Vial 9.96 6.2400 6.47 7.47 Injection, bupivacaine liposome, 1 mg 1.0000 mg 1518.70 951.1600 987.16 1139.02 Collagen nerve cuff (NeuroMatrix), per 0.5 cm length 0.5000 cm 1800.15 1127.4300 1260.10 1440.12 Collagen matrix nerve wrap (NeuroMend Collagen Nerve Wrap), per 0.5 cm length 0.5000 cm 1448.05 906.9100 941.23 1086.04 Unclassified drugs or biologicals 1.0000 Each 323.50 202.6100 210.28 242.63 periodontal scaling & root 1.0000 each 2881.81 1804.8800 2017.27 2881.81 bone graft repair perimplant 1.0000 each 2495.88 1563.1700 1747.11 2495.88 extraction erupted tooth/exr 1.0000 each 5685.68 3560.9400 1287.01 4548.54 rem imp tooth w mucoper flp 1.0000 each 6370.91 3990.1000 1287.01 5096.73 impact tooth remov comp bony 1.0000 each 6094.05 3816.7000 1287.01 4875.24 impact tooth rem bony w/comp 1.0000 each 2282.37 1429.4500 1287.01 2282.37 oral antral fistula closure 1.0000 each 2428.18 1520.7700 1287.01 2428.18 alveoplasty w/ extraction 1.0000 each 1614.92 1011.4300 1130.45 1614.92 alveoloplasty w/extract 1-3 1.0000 each 2313.33 1448.8400 1619.33 2313.33 rad exc lesion up to 1.25 cm 1.0000 each 5690.68 3564.0700 1954.00 4552.54 excision benign lesion>1.25c 1.0000 each 1505.66 942.9900 1053.96 1505.66 rem odontogen cyst to 1.25cm 1.0000 each 2828.28 1771.3500 1954.00 2262.62 rem odontogen cyst > 1.25 cm 1.0000 each 2495.88 1563.1700 1747.11 1996.70 rem nonodonto cyst to 1.25cm 1.0000 each 2838.50 1777.7500 1986.95 2270.80 remove torus mandibularis 1.0000 each 2561.55 1604.3000 1793.08 2049.24 tmj reshaping components 1.0000 each 7093.31 4442.5400 4965.31 5674.64 bone replacement graft 1.0000 each 2280.75 1428.4300 1596.52 2280.75 buccal/labial frenectomy 1.0000 each 1096.59 686.8000 767.61 877.27 lingual frenectomy 1.0000 each 576.11 360.8200 403.28 460.89 Positioning cushion/pillow/wedge, any shape or size, includes all components and accessories 1.0000 Each 228.90 143.3600 160.23 183.12 Breast pump, manual, any type 1.0000 Each 51.30 32.1300 34.36 41.04 Administration of influenza virus vaccine 1.0000 each 60.30 37.7700 36.94 48.24 Administration of pneumococcal vaccine 1.0000 each 60.30 37.7700 36.94 48.24 Administration of hepatitis B vaccine 1.0000 each 60.30 37.7700 36.94 48.24 Cervical or vaginal cancer screening; pelvic and clinical breast examination 1.0000 each 221.50 138.7300 69.15 177.20 Prostate cancer screening; prostate specific antigen test (PSA) 1.0000 each 158.10 99.0200 19.31 118.58 Colorectal cancer screening; flexible sigmoidoscopy Each 1270.00 795.4000 325.00 1270.00 Colorectal cancer screening; colonoscopy on individual at high risk Each 5185.50 3247.6800 732.98 4148.40 Diabetes outpatient self-management training services, individual, per 30 minutes 30.0000 min 102.95 64.4800 54.71 82.36 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk Each 5185.50 3247.6800 732.98 4148.40 Unscheduled or emergency dialysis treatment for an ESRD patient in a hospital outpatient department that is not certified as an ESRD facility 1.0000 each 1451.85 909.2900 604.32 1161.48 Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography Each 2409.70 1509.2000 586.08 2323.00 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face-to-face with the patient, each 15 minutes 15.0000 min 42.65 26.7100 29.86 34.12 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066) 1.0000 each 107.10 67.0800 51.62 85.68 Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care Each 79.00 49.4800 12.87 63.20 Hospital observation service, per hour 1.0000 hr 78.00 48.8500 48.36 78.00 Direct admission of patient for hospital observation care 1.0000 each 112.30 70.3300 69.63 515.96 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes 1.0000 each 172.65 108.1300 24.22 138.12 Alcohol and/or substance (other than tobacco) misuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes 1.0000 each 262.10 164.1500 66.83 209.68 Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of Medicare enrollment 1.0000 each 197.60 123.7600 109.66 158.08 Infectious agent antibody detection by rapid antibody test, HIV-1 and/or HIV-2, screening 1.0000 each 64.50 40.4000 11.98 48.38 Annual wellness visit; includes a personalized prevention plan of service (PPS), initial visit 1.0000 Each 299.50 187.5800 164.64 239.60 Annual wellness visit, includes a personalized prevention plan of service (PPS), subsequent visit 1.0000 Each 202.80 127.0100 129.72 162.24 Annual depression screening, 15 minutes 15.0000 min 68.65 43.0000 24.22 54.92 Molecular pathology procedure; physician interpretation and report 1.0000 each 1096.15 686.5200 304.73 822.11 Hospital outpatient clinic visit for assessment and management of a patient 1.0000 each 99.85 62.5400 69.90 117.34 Hepatitis C antibody screening for individual at high risk and other covered indication(s) 1.0000 each 208.00 130.2700 46.35 156.00 Drug test(s), definitive, utilizing (1) drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to, GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (e.g., IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (e.g., alcohol dehydrogenase)), (2) stable isotope or other universally recognized internal standards in all samples (e.g., to control for matrix effects, interferences and variations in signal strength), and (3) method or drug-specific calibration and matrix-matched quality control material (e.g., to control for instrument variations and mass spectral drift); qualitative or quantitative, all sources, includes specimen validity testing, per day; 1-7 drug class(es), including metabolite(s) if performed 1.0000 Day(s) 297.45 186.2900 82.69 223.09 Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a Medicare-enrolled opioid treatment program) 1.0000 each 323.70 202.7300 212.00 258.96 Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional 30.0000 min 116.80 73.1500 69.15 93.44 Ultrasonic guidance for placement of radiation therapy fields 1.0000 each 155.60 97.4500 87.14 124.48 Screening for depression is documented as being positive and a follow-up plan is documented 1.0000 each 0.01 0.0100 0.01 0.01 Screening for depression is documented as negative, a follow-up plan is not required 1.0000 each 0.01 0.0100 0.01 0.01 Behavioral health counseling and therapy, per 15 minutes 15.0000 min 116.45 72.9300 69.87 93.16 Alcohol and/or drug services; methadone administration and/or service (provision of the drug by a licensed program) 1.0000 each 93.60 58.6200 20.00 74.88 Assertive community treatment program, per diem 1.0000 Day(s) 474.00 296.8700 284.40 379.20 Alcohol and/or drug screening 1.0000 each 115.45 72.3100 69.27 92.36 Alcohol and/or drug services, brief intervention, per 15 minutes 15.0000 Minutes 77.40 48.4800 46.44 61.92 Crisis intervention service, per 15 minutes 15.0000 Minutes 45.45 28.4700 27.27 36.36 Comprehensive community support services, per diem 1.0000 Day(s) 18.00 11.2700 10.80 14.40 Therapeutic behavioral services, per 15 minutes 15.0000 Minutes 397.00 248.6400 238.20 317.60 Supported employment, per diem 1.0000 Day(s) 338.00 211.6900 202.80 270.40 Injection, abatacept, 10 mg (code may be used for Medicare when drug administered under the direct supervision of a physician, not for use when drug is self-administered) 10.0000 MG 1561.22 977.7900 45.27 1155.31 Injection, acetylcysteine, 100 mg 100.0000 MG 117.88 73.8300 1.04 87.23 Injection, acyclovir, 5 mg 5.0000 MG 63.10 39.5200 0.05 46.69 Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds) 1.0000 mg 59.49 37.2600 0.61 44.02 Injection, adrenalin, epinephrine, 0.1 mg 0.1000 MG 1.40 0.8800 0.91 1.04 Injection, amikacin sulfate, 100 mg 100.0000 MG 33.41 20.9200 21.72 25.06 Injection, aminophyllin, up to 250 mg 250.0000 MG 11.35 7.1100 7.38 11.37 Injection, amiodarone HCl, 30 mg 30.0000 MG 86.12 53.9400 0.38 63.73 Injection, ampicillin sodium, 500 mg 500.0000 MG 14.29 8.9500 0.97 10.58 Injection, ampicillin sodium/sulbactam sodium, per 1.5 g 1.5000 GM 33.95 21.2600 2.71 25.12 Injection, succinylcholine chloride, up to 20 mg 20.0000 MG 3.40 2.1300 1.23 2.52 Injection, anidulafungin, 1 mg 1.0000 MG 182.58 114.3500 0.60 135.11 Injection, hydralazine HCl, up to 20 mg 20.0000 MG 17.55 10.9900 3.24 12.99 Injection, aripiprazole, extended release, 1 mg 1.0000 mg 4913.24 3077.1600 5.99 3635.80 Injection, azithromycin, 500 mg 500.0000 MG 9.73 6.1000 3.63 7.20 Injection, atropine sulfate, 0.01 mg 0.0100 MG 20.70 12.9600 0.09 15.32 Injection, dicyclomine HCl, up to 20 mg 20.0000 MG 0.10 0.0600 0.06 38.10 Injection, benztropine mesylate, per 1 mg 1.0000 MG 200.10 125.3200 18.88 148.07 Injection, benralizumab, 1 mg 1.0000 mg 17893.65 11206.7900 170.80 13241.30 Injection, penicillin G benzathine and penicillin G procaine, 100,000 units 100000.0000 Unit(s) 47.85 29.9700 11.43 35.41 Injection, penicillin G benzathine, 100,000 units 100000.0000 Unit(s) 0.20 0.1300 0.13 17.14 Buprenorphine implant, 74.2 mg 74.2000 mg 38.50 24.1100 25.02 1616.38 Buprenorphine, oral, 1 mg 1.0000 mg 1.55 0.9700 1.01 1.16 Buprenorphine/naloxone, oral, greater than 3 mg, but less than or equal to 6 mg buprenorphine 1.0000 each 14.15 8.8600 9.20 10.61 Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg buprenorphine 1.0000 each 15.95 9.9900 10.37 11.96 Injection, onabotulinumtoxinA, 1 unit 1.0000 Unit(s) 1993.05 1248.2500 6.08 1474.86 Injection, butorphanol tartrate, 1 mg 1.0000 MG 10.75 6.7300 3.26 7.96 Injection, calcium gluconate, per 10 ml 10.0000 ML 4.50 2.8200 2.92 4.23 Injection, calcitonin salmon, up to 400 units 400.0000 UNITS 0.10 0.0600 0.06 3317.85 Injection, leucovorin calcium, per 50 mg 50.0000 MG 44.76 28.0300 3.01 33.12 Injection, levoleucovorin, not otherwise specified, 0.5 mg 0.5000 MG 427.46 267.7200 0.09 316.32 Injection, mepivacaine HCl, per 10 ml 10.0000 ML 11.95 7.4800 3.31 8.84 Injection, cefazolin sodium, 500 mg 500.0000 MG 2.70 1.6900 0.90 2.00 Injection, cefepime HCl, 500 mg 500.0000 MG 14.02 8.7800 1.99 10.37 Injection, ceftriaxone sodium, per 250 mg 250.0000 MG 5.20 3.2600 0.61 3.85 Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg 3.0000 MG 49.75 31.1600 7.93 36.82 Injection, ceftazidime, per 500 mg 500.0000 MG 82.25 51.5100 2.18 60.86 Injection, clonidine HCl, 1 mg 1.0000 MG 65.62 41.1000 24.83 48.56 Injection, cilastatin sodium; imipenem, per 250 mg 250.0000 MG 21.35 13.3700 7.74 15.80 Injection, ciprofloxacin for intravenous infusion, 200 mg 200.0000 MG 9.20 5.7600 1.09 6.81 Injection, prochlorperazine, up to 10 mg 10.0000 MG 30.06 18.8300 5.58 22.24 Injection, cosyntropin, 0.25 mg 0.2500 MG 320.20 200.5400 35.48 236.95 Injection, daptomycin, 1 mg 1.0000 MG 297.10 186.0700 0.14 219.85 Injection, darbepoetin alfa, 1 mcg (non-ESRD use) 1.0000 MCG 6524.60 4086.3600 3.15 4828.20 Injection, epoetin alfa, (for non-ESRD use), 1000 units 1000.0000 Unit(s) 40.05 25.0800 8.15 30.04 Injection, decitabine, 1 mg 1.0000 MG 488.95 306.2300 3.45 361.82 Injection, luspatercept-aamt, 0.25 mg 0.2500 mg 38350.85 24019.1400 36.84 28763.14 Injection, denosumab, 1 mg 1.0000 MG 6506.50 4075.0200 20.24 4814.81 Injection, methylprednisolone acetate, 20 mg 20.0000 MG 18.00 11.2700 3.68 13.32 Injection, methylprednisolone acetate, 40 mg 40.0000 MG 1.30 0.8100 0.84 6.38 Injection, methylprednisolone acetate, 80 mg 80.0000 MG 23.45 14.6900 11.83 17.35 Injection, medroxyprogesterone acetate, 1 mg 1.0000 MG 15.30 9.5800 0.63 11.32 Injection, testosterone cypionate, 1 mg 1.0000 mg 28.35 17.7600 0.04 20.98 Injection, dexamethasone sodium phosphate, 1 mg 1.0000 MG 3.48 2.1800 0.16 2.57 Injection, acetazolamide sodium, up to 500 mg 500.0000 MG 74.45 46.6300 25.71 55.09 Injection, digoxin, up to 0.5 mg 0.5000 MG 16.60 10.4000 5.44 12.28 Injection, digoxin immune fab (ovine), per vial 1.0000 VIAL 14404.83 9021.7400 3969.20 10659.57 Injection, phenytoin sodium, per 50 mg 50.0000 MG 9.60 6.0100 0.62 7.10 Injection, hydromorphone, up to 4 mg 4.0000 MG 1.82 1.1400 1.18 3.01 Injection, diphenhydramine HCl, up to 50 mg 50.0000 MG 5.86 3.6700 0.68 4.34 Injection, dobutamine HCl, per 250 mg 250.0000 MG 14.57 9.1300 7.91 10.78 Injection, dolasetron mesylate, 10 mg 10.0000 MG 173.55 108.6900 5.63 128.43 Injection, dopamine HCl, 40 mg 40.0000 MG 15.95 9.9900 0.73 11.81 Injection, ertapenem sodium, 500 mg 500.0000 MG 117.03 73.3000 35.40 86.60 Injection, erythromycin lactobionate, per 500 mg 500.0000 MG 0.05 0.0300 0.03 93.95 Injection, estrogen conjugated, per 25 mg 25.0000 MG 0.05 0.0300 0.03 383.07 Injection, ferric carboxymaltose, 1 mg 1.0000 mg 2665.21 1669.2200 1.12 1972.26 Injection, filgrastim (G-CSF), excludes biosimilars, 1 mcg 1.0000 mcg 639.86 400.7400 0.97 473.49 Injection, tbo-filgrastim, 1 mcg 1.0000 mcg 644.75 403.8100 0.46 477.12 Injection, fluconazole, 200 mg 200.0000 MG 24.50 15.3400 3.65 18.13 Injection, fosaprepitant, 1 mg 1.0000 MG 978.48 612.8200 0.24 724.08 Injection, immune globulin (Privigen), intravenous, nonlyophilized (e.g., liquid), 500 mg 500.0000 MG 11175.45 6999.1800 42.13 8269.83 Injection, gamma globulin, intramuscular, 1 cc 1.0000 CC 337.00 211.0600 41.90 249.38 Injection, immune globulin, (Gamunex/Gamunex-C/Gammaked), nonlyophilized (e.g., liquid), 500 mg 500.0000 MG 187.75 117.5900 41.10 140.81 Injection, immune globulin, (Gammagard liquid), nonlyophilized, (e.g., liquid), 500 mg 500.0000 MG 7037.60 4407.6500 39.34 5207.82 Injection, garamycin, gentamicin, up to 80 mg 80.0000 MG 5.08 3.1800 1.96 3.76 Injection, glucagon HCl, per 1 mg 1.0000 MG 253.80 158.9500 164.97 247.10 Injection, granisetron HCl, 100 mcg 100.0000 MCG 33.15 20.7600 0.24 24.53 Injection, haloperidol, up to 5 mg 5.0000 MG 7.90 4.9500 0.98 5.85 Injection, haloperidol decanoate, per 50 mg 50.0000 MG 136.10 85.2400 15.57 100.71 Injection, heparin sodium, (heparin lock flush), per 10 units 10.0000 Unit(s) 1.90 1.1900 0.02 1.41 Injection, Heparin sodium, per 1000 units 1000.0000 Unit(s) 7.25 4.5400 0.35 5.36 Injection, enoxaparin sodium, 10 mg 10.0000 MG 7.10 4.4500 0.88 5.26 Injection, fondaparinux sodium, 0.5 mg 0.5000 MG 90.25 56.5200 1.88 66.78 Injection, tetanus immune globulin, human, up to 250 units 250.0000 UNITS 791.00 495.4000 441.70 585.34 Injection, hydrocortisone sodium succinate, up to 100 mg 100.0000 MG 0.05 0.0300 0.03 15.57 Injection, hydroxyprogesterone caproate, (Makena), 10 mg 10.0000 mg 2029.10 1270.8300 16.82 1501.53 Injection, ibandronate sodium, 1 mg 1.0000 MG 289.34 181.2200 37.09 214.11 Injection, ibuprofen, 100 mg 100.0000 mg 37.98 23.7800 2.17 28.10 Injection, infliximab, excludes biosimilar, 10 mg 10.0000 MG 2187.21 1369.8500 39.53 1618.54 Injection, iron sucrose, 1 mg 1.0000 MG 236.31 148.0000 0.24 174.87 Injection, insulin, per 5 units 5.0000 Unit(s) 0.45 0.2800 0.29 0.98 Insulin for administration through DME (i.e., insulin pump) per 50 units 50.0000 Unit(s) 0.45 0.2800 0.29 0.34 Injection, ketorolac tromethamine, per 15 mg 15.0000 MG 3.85 2.4100 0.42 2.85 Injection, furosemide, up to 20 mg 20.0000 MG 6.30 3.9500 0.71 4.66 Injection, leuprolide acetate (for depot suspension), per 3.75 mg 3.7500 MG 526.75 329.9100 342.39 1740.35 Injection, levetiracetam, 10 mg 10.0000 MG 99.97 62.6100 0.13 73.97 Injection, levofloxacin, 250 mg 250.0000 MG 9.60 6.0100 0.42 7.10 Injection, lidocaine HCl for intravenous infusion, 10 mg 10.0000 MG 8.50 5.3200 0.03 6.29 Injection, linezolid, 200 mg 200.0000 MG 163.10 102.1500 7.78 120.69 Injection, lorazepam, 2 mg 2.0000 MG 4.78 2.9900 0.79 3.53 Injection, mannitol, 25% in 50 ml 50.0000 ML 11.15 6.9800 2.61 8.25 Injection, meperidine HCl, per 100 mg 100.0000 MG 3.30 2.0700 2.14 5.88 Injection, mepolizumab, 1 mg 1.0000 mg 9377.60 5873.1900 28.29 6939.42 Injection, meropenem, 100 mg 100.0000 MG 10.88 6.8100 0.84 8.05 Injection, methylergonovine maleate, up to 0.2 mg 0.2000 MG 21.30 13.3400 13.84 21.24 Injection, methylnaltrexone, 0.1 mg 0.1000 mg 0.05 0.0300 0.03 1.00 Injection, micafungin sodium, 1 mg 1.0000 MG 3.75 2.3500 0.97 2.81 Injection, midazolam HCl, per 1 mg 1.0000 MG 1.82 1.1400 0.13 1.35 Injection, morphine sulfate, up to 10 mg 10.0000 MG 3.60 2.2500 2.34 3.46 Injection, morphine sulfate, preservative free for epidural or intrathecal use, 10 mg 10.0000 mg 3.75 2.3500 2.44 12.66 Injection, moxifloxacin, 100 mg 100.0000 MG 10.15 6.3600 6.60 7.61 Injection, naloxone HCl, per 1 mg 1.0000 MG 16.55 10.3700 10.76 13.14 Injection, naltrexone, depot form, 1 mg 1.0000 MG 2596.23 1626.0200 3.41 1921.21 Injection, natalizumab, 1 mg 1.0000 MG 5022.75 3145.7500 21.25 3716.83 Injection, octreotide, depot form for intramuscular injection, 1 mg 1.0000 MG 5322.97 3333.7800 205.37 3939.00 Injection, octreotide, nondepot form for subcutaneous or intravenous injection, 25 mcg 25.0000 MCG 68.19 42.7000 0.81 50.46 Injection, oprelvekin, 5 mg 5.0000 MG 1193.20 747.3000 172.18 894.90 Injection, omalizumab, 5 mg 5.0000 MG 1674.80 1048.9300 37.67 1239.35 Injection, orphenadrine citrate, up to 60 mg 60.0000 MG 25.13 15.7400 7.52 18.60 Injection, phenylephrine HCl, up to 1 ml 1.0000 ML 11.95 7.4800 3.52 8.84 Injection, chloroprocaine HCl, per 30 ml 30.0000 ML 97.55 61.1000 34.54 72.19 Injection, ondansetron HCl, per 1 mg 1.0000 MG 0.63 0.4000 0.10 0.47 Injection, paliperidone palmitate extended release, 1 mg 1.0000 MG 4864.17 3046.4300 12.21 3599.48 Injection, pamidronate disodium, per 30 mg 30.0000 MG 75.97 47.5800 11.77 56.22 Injection, palonosetron HCl, 25 mcg 25.0000 MCG 38.36 24.0200 3.50 28.39 Injection, pegfilgrastim, 6 mg 6.0000 MG 11404.97 7142.9300 2221.63 8439.68 Injection, penicillin G potassium, up to 600,000 units 600000.0000 UNITS 25.18 15.7700 16.37 18.88 Injection, piperacillin sodium/tazobactam sodium, 1 g/0.125 g (1.125 g) 1.1250 g 52.62 32.9500 1.77 38.94 Injection, promethazine HCl, up to 50 mg 50.0000 MG 1.65 1.0300 1.07 2.55 Injection, phenobarbital sodium, up to 120 mg 120.0000 MG 53.10 33.2600 34.52 50.22 Injection, oxytocin, up to 10 units 10.0000 UNITS 59.37 37.1800 0.83 43.93 Injection, desmopressin acetate, per 1 mcg 1.0000 MCG 453.94 284.3000 9.40 335.91 Injection, fluphenazine decanoate, up to 25 mg 25.0000 MG 2.53 1.5800 1.64 12.78 Injection, propofol, 10 mg 10.0000 mg 6.35 3.9800 0.13 4.70 Injection, neostigmine methylsulfate, up to 0.5 mg 0.5000 MG 102.60 64.2600 1.66 75.92 Injection, protamine sulfate, per 10 mg 10.0000 MG 114.20 71.5200 1.13 84.51 Injection, metoclopramide HCl, up to 10 mg 10.0000 MG 4.90 3.0700 1.19 3.63 Injection, ranitidine HCl, 25 mg 25.0000 MG 22.90 14.3400 6.73 16.95 Injection, rasburicase, 0.5 mg 0.5000 MG 991.49 620.9700 304.31 733.70 Injection, regadenoson, 0.1 mg 0.1000 MG 697.42 436.7900 65.31 516.09 Injection, Rho D immune globulin, human, full dose, 300 mcg (1500 IU) 300.0000 MCG 358.00 224.2200 88.40 264.92 Injection, Rho D immune globulin (human), (Rhophylac), intramuscular or intravenous, 100 IU 100.0000 IU 365.90 229.1600 5.22 270.77 Injection, Rho D immune globulin, intravenous, human, solvent detergent, 100 IU 100.0000 IU 35.85 22.4500 23.30 36.93 Injection, risperidone (RISPERDAL CONSTA), 0.5 mg 0.5000 MG 1729.44 1083.1500 10.55 1279.79 Injection, ropivacaine HCl, 1 mg 1.0000 MG 2152.05 1347.8300 0.07 1592.52 Injection, romiplostim, 10 mcg 10.0000 MCG 3993.62 2501.2000 77.99 2955.28 Injection, sincalide, 5 mcg 5.0000 MCG 447.90 280.5200 127.11 331.45 Injection, methylprednisolone sodium succinate, up to 40 mg 40.0000 MG 1.95 1.2200 1.27 4.81 Injection, methylprednisolone sodium succinate, up to 125 mg 125.0000 MG 4.40 2.7600 2.86 6.04 Injection, alteplase recombinant, 1 mg 1.0000 MG 175.30 109.7900 87.75 129.72 Injection, fentanyl citrate, 0.1 mg 0.1000 MG 4.05 2.5400 0.79 3.00 Injection, chlorpromazine HCl, up to 50 mg 50.0000 MG 72.21 45.2200 39.48 53.43 Injection, tobramycin sulfate, up to 80 mg 80.0000 MG 130.05 81.4500 5.06 96.24 Injection, tocilizumab, 1 mg 1.0000 MG 5025.75 3147.6200 5.21 3719.05 Injection, triamcinolone acetonide, not otherwise specified, 10 mg 10.0000 MG 13.05 8.1700 1.51 9.66 Injection, triptorelin pamoate, 3.75 mg 3.7500 MG 1900.00 1189.9700 271.68 1406.00 Injection, diazepam, up to 5 mg 5.0000 MG 85.35 53.4500 7.86 63.16 Injection, vancomycin HCl, 500 mg 500.0000 MG 29.32 18.3600 2.88 21.69 Injection, vedolizumab, 1 mg 1.0000 mg 18285.61 11452.2800 20.86 13531.35 Injection, hydroxyzine HCl, up to 25 mg 25.0000 MG 17.05 10.6800 9.13 12.62 Injection, thiamine HCl, 100 mg 100.0000 MG 14.92 9.3400 2.80 11.04 Injection, vitamin B-12 cyanocobalamin, up to 1,000 mcg 1000.0000 MCG 8.80 5.5100 2.03 6.51 Injection, phytonadione (vitamin K), per 1 mg 1.0000 MG 95.81 60.0100 4.24 70.90 Injection, hyaluronidase, recombinant, 1 USP unit 1.0000 UNIT 181.95 113.9600 0.39 134.64 Injection, magnesium sulfate, per 500 mg 500.0000 MG 2.53 1.5900 0.69 1.87 Injection, potassium chloride, per 2 mEq 2.0000 MEQ 9.20 5.7600 0.18 6.81 Injection, zoledronic acid, 1 mg 1.0000 mg 212.69 133.2000 11.33 157.39 Unclassified drugs 1.0000 Unit(s) 13.95 8.7400 9.07 10.46 Drug administered through a metered dose inhaler 1.0000 Each 11.43 7.1600 7.43 8.57 Infusion, normal saline solution, 1,000 cc 1000.0000 cc 4.20 2.6300 2.73 3.15 Infusion, normal saline solution, sterile (500 ml=1 unit) 500.0000 ML 10.92 6.8400 1.50 8.08 5% dextrose/normal saline (500 ml = 1 unit) 500.0000 ML 7.40 4.6300 1.33 5.48 Infusion, normal saline solution, 250 cc 250.0000 cc 1.37 0.8600 0.75 1.02 5% dextrose/water (500 ml = 1 unit) 500.0000 ML 9.35 5.8600 2.18 6.92 Ringers lactate infusion, up to 1,000 cc 1000.0000 CC 10.13 6.3400 2.74 7.49 Hypertonic saline solution, 1 ml 1.0000 ML 0.88 0.5500 0.03 0.65 Levonorgestrel-releasing intrauterine contraceptive system (Mirena), 52 mg 52.0000 mg 1531.10 958.9300 953.51 1133.01 Mometasone furoate sinus implant, (Sinuva), 10 mcg 10.0000 mcg 967.70 606.0700 10.56 774.16 Azathioprine, oral, 50 mg 50.0000 MG 1.15 0.7200 0.75 0.86 Tacrolimus, immediate release, oral, 1 mg 1.0000 MG 5.15 3.2300 3.35 3.86 Methylprednisolone, oral, per 4 mg 4.0000 MG 2.75 1.7200 1.79 2.06 Prednisolone, oral, per 5 mg 5.0000 MG 3.05 1.9100 1.98 2.29 Prednisone, immediate release or delayed release, oral, 1 mg 1.0000 mg 0.67 0.4200 0.44 0.50 Mycophenolate mofetil, oral, 250 mg 250.0000 MG 0.25 0.1600 0.16 0.19 Formoterol fumarate, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, 20 mcg 20.0000 MCG 0.10 0.0600 0.06 0.08 Acetylcysteine, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, per g 1.0000 g 21.80 13.6500 6.32 16.13 Albuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, concentrated form, 1 mg 1.0000 MG 33.85 21.2000 22.00 25.39 Albuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 1 mg 1.0000 MG 0.65 0.4100 0.42 0.49 Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 0.5 mg 0.5000 MG 1.75 1.1000 1.14 1.31 Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, FDA-approved final product, noncompounded, administered through DME 2.5000 MG 1.15 0.7200 0.75 0.86 Budesonide, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, up to 0.5 mg 0.5000 MG 4.35 2.7200 2.83 3.26 Dornase alfa, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, per mg 1.0000 MG 86.50 54.1700 56.22 64.88 Ipratropium bromide, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, per mg 1.0000 MG 1.20 0.7500 0.78 0.90 Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg 1.0000 MG 258.15 161.6800 0.85 191.03 Compounded drug, not otherwise classified 1.0000 each 5.40 3.3800 3.51 4.05 Aprepitant, oral, 5 mg 5.0000 MG 25.20 15.7800 16.38 18.90 Capecitabine, oral, 150 mg 150.0000 MG 2.25 1.4100 1.46 1.69 Capecitabine, oral, 500 mg 500.0000 MG 145.40 91.0600 94.51 109.05 Dexamethasone, oral, 0.25 mg 0.2500 MG 1.35 0.8500 0.12 1.00 Melphalan, oral, 2 mg 2.0000 MG 4.95 3.1000 3.22 14.88 Methotrexate, oral, 2.5 mg 2.5000 MG 13.02 8.1500 8.46 9.76 Prescription drug, oral, chemotherapeutic, NOS 1.0000 Unit(s) 15.80 9.9000 10.27 11.85 Injection, doxorubicin HCl, 10 mg 10.0000 MG 57.83 36.2200 2.75 42.80 Injection, atezolizumab, 10 mg 10.0000 mg 23280.55 14580.6100 79.75 17227.61 Injection, azacitidine, 1 mg 1.0000 MG 685.78 429.5000 0.93 507.48 BCG live intravesical instillation, 1 mg 1.0000 mg 472.30 295.8000 2.96 349.50 Injection, bendamustine HCl (Treanda), 1 mg 1.0000 MG 88.45 55.4000 22.01 66.34 Injection, bendamustine HCl (Bendeka), 1 mg 1.0000 mg 5702.19 3571.2800 19.65 4219.62 Injection, bevacizumab, 10 mg 10.0000 MG 10704.62 6704.3000 70.41 7921.42 Injection, bleomycin sulfate, 15 units 15.0000 Unit(s) 81.48 51.0300 29.71 60.30 Injection, bortezomib (Velcade), 0.1 mg 0.1000 MG 4359.25 2730.2000 45.16 3225.84 Injection, brentuximab vedotin, 1 mg 1.0000 MG 15237.60 9543.3100 170.56 11428.20 Injection, cabazitaxel, 1 mg 1.0000 MG 31645.08 19819.3100 182.35 23417.36 Injection, carboplatin, 50 mg 50.0000 MG 13.68 8.5700 2.95 10.12 Injection, carfilzomib, 1 mg 1.0000 mg 108.70 68.0800 39.48 80.44 Injection, cetuximab, 10 mg 10.0000 MG 4207.32 2635.0500 65.15 3113.42 Injection, cisplatin, powder or solution, 10 mg 10.0000 MG 67.25 42.1200 1.85 49.77 Injection, cladribine, per 1 mg 1.0000 MG 122.75 76.8800 18.02 92.06 Cyclophosphamide, 100 mg 100.0000 MG 1184.93 742.1200 29.15 876.85 Injection, cytarabine liposome, 10 mg 10.0000 MG 2304.65 1443.4000 85.49 1728.49 Dacarbazine, 100 mg 100.0000 MG 23.82 14.9200 5.33 17.62 Injection, docetaxel, 1 mg 1.0000 MG 37.15 23.2700 0.79 27.49 Injection, durvalumab, 10 mg 10.0000 mg 12997.06 8140.0600 76.86 9617.82 Injection, epirubicin HCl, 2 mg 2.0000 MG 39.85 24.9600 1.66 29.49 Injection, eribulin mesylate, 0.1 mg 0.1000 MG 434.65 272.2200 119.99 321.64 Injection, etoposide, 10 mg 10.0000 MG 18.02 11.2900 0.82 13.33 Injection, fludarabine phosphate, 50 mg 50.0000 MG 654.75 410.0700 425.59 491.06 Injection, fluorouracil, 500 mg 500.0000 MG 15.07 9.4400 1.85 11.15 Injection, gemcitabine HCl, not otherwise specified, 200 mg 200.0000 MG 139.34 87.2700 4.36 103.11 Goserelin acetate implant, per 3.6 mg 3.6000 MG 2489.25 1559.0200 522.60 1866.94 Injection, irinotecan liposome, 1 mg 1.0000 mg 6270.32 3927.1000 52.41 4640.04 Injection, irinotecan, 20 mg 20.0000 MG 44.85 28.0900 2.69 33.19 Injection, ixabepilone, 1 mg 1.0000 MG 287.15 179.8400 95.62 212.49 Injection, ifosfamide, 1 g 1.0000 g 238.20 149.1800 28.79 176.27 Injection, mesna, 200 mg 200.0000 MG 239.45 149.9700 2.41 177.19 Injection, interferon, alfa-2b, recombinant, 1 million units 1.0000 MIL 359.45 225.1200 33.24 265.99 Leuprolide acetate (for depot suspension), 7.5 mg 7.5000 MG 2006.60 1256.7300 139.09 1484.88 Leuprolide acetate, per 1 mg 1.0000 MG 181.00 113.3600 117.65 135.75 Histrelin implant (Vantas), 50 mg 50.0000 MG 11596.00 7262.5700 4289.89 8581.04 Injection, ipilimumab, 1 mg 1.0000 MG 97765.71 61230.6700 158.65 72346.63 Injection, mechlorethamine HCl, (nitrogen mustard), 10 mg 10.0000 MG 682.15 427.2300 11.74 511.61 Methotrexate sodium, 5 mg 5.0000 MG 12.65 7.9200 8.22 9.49 Methotrexate sodium, 50 mg 50.0000 MG 6.60 4.1300 4.29 4.95 Injection, oxaliplatin, 0.5 mg 0.5000 MG 70.99 44.4600 46.15 53.24 Injection, paclitaxel protein-bound particles, 1 mg 1.0000 MG 3425.76 2145.5600 13.14 2535.06 Injection, paclitaxel, 1 mg 1.0000 mg 31.89 19.9700 20.73 23.92 Injection, pembrolizumab, 1 mg 1.0000 mg 17130.80 10729.0200 51.86 12676.79 Injection, mitomycin, 5 mg 5.0000 MG 1255.06 786.0400 38.63 928.74 Injection, mitoxantrone HCl, per 5 mg 5.0000 MG 67.60 42.3400 26.28 50.70 Injection, nivolumab, 1 mg 1.0000 mg 22520.24 14104.4300 28.86 16664.98 Injection, panitumumab, 10 mg 10.0000 MG 13305.18 8333.0300 125.02 9845.83 Injection, pemetrexed, NOS, 10 mg 10.0000 MG 8374.15 5244.7300 72.95 6196.87 Injection, pertuzumab, 1 mg 1.0000 mg 16425.41 10287.2300 12.90 12154.80 Injection, ramucirumab, 5 mg 5.0000 mg 3498.78 2191.2900 61.34 2589.10 Injection, rituximab 10 mg and hyaluronidase 10.0000 mg 16014.00 10029.5700 37.94 11850.36 Injection, rituximab, 10 mg 10.0000 mg 7069.22 4427.4500 86.94 5231.22 Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg 10.0000 mg 24350.00 15250.4000 72.15 18262.50 Injection, streptozocin, 1 g 1.0000 g 1290.65 808.3300 348.51 967.99 Injection, temsirolimus, 1 mg 1.0000 MG 226.25 141.7000 38.25 169.69 Injection, thiotepa, 15 mg 15.0000 MG 471.25 295.1400 305.84 501.31 Injection, topotecan, 0.1 mg 0.1000 MG 105.85 66.2900 1.23 78.33 Injection, ado-trastuzumab emtansine, 1 mg 1.0000 mg 103.55 64.8500 32.93 77.66 Injection, trastuzumab, excludes biosimilar, 10 mg 10.0000 MG 3449.66 2160.5200 89.81 2552.75 Injection, valrubicin, intravesical, 200 mg 200.0000 MG 6273.00 3928.7800 1425.37 4642.02 Injection, vinblastine sulfate, 1 mg 1.0000 MG 8.98 5.6200 4.05 6.65 Vincristine sulfate, 1 mg 1.0000 MG 35.97 22.5300 5.54 26.61 Injection, vinorelbine tartrate, 10 mg 10.0000 MG 270.65 169.5100 10.50 200.28 Injection, fulvestrant, 25 mg 25.0000 MG 1860.61 1165.3000 15.98 1376.85 Injection, ziv-aflibercept, 1 mg 1.0000 mg 12355.35 7738.1600 8.42 9266.51 Not otherwise classified, antineoplastic drugs 1.0000 Unit(s) 27960.70 17511.7900 18174.46 20970.52 Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf 1.0000 Each 66.85 41.8700 46.80 89.77 Breast prosthesis, silicone or equal, without integral adhesive 1.0000 Each 1191.30 746.1100 323.42 984.61 Implantable breast prosthesis, silicone or equal 1.0000 Each 1370.50 858.3400 959.35 1132.72 Injectable bulking agent, synthetic implant, urinary tract, 1 ml syringe, includes shipping and necessary supplies 1.0000 ML 839.35 525.6800 587.54 693.72 Metatarsal joint implant 1.0000 Each 2511.60 1573.0200 1758.12 2075.84 Prosthetic implant, not otherwise specified 1.0000 Each 5014.45 3140.5500 3510.12 4144.44 Patient screened for future fall risk 1.0000 each 0.01 0.0100 0.01 0.01 Screening Papanicolaou smear, cervical or vaginal, up to three smears, by technician under physician supervision 1.0000 each 119.60 74.9100 15.15 89.70 Blood (whole), for transfusion, per unit 1.0000 Unit(s) 549.10 343.9000 150.14 411.82 Cryoprecipitate, each unit 1.0000 Unit(s) 126.90 79.4800 45.68 95.18 Red blood cells, leukocytes reduced, each unit 1.0000 Unit(s) 575.10 360.1900 188.51 431.32 Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit 1.0000 Unit(s) 56.40 35.3200 20.30 88.45 Platelets, each unit 1.0000 Unit(s) 121.30 75.9700 43.67 90.98 Red blood cells, each unit 1.0000 Unit(s) 566.80 354.9900 137.63 425.10 Red blood cells, washed, each unit 1.0000 Unit(s) 603.20 377.7800 217.15 452.40 Platelets, leukocytes reduced, each unit 1.0000 Unit(s) 246.50 154.3800 88.74 184.88 Platelets, irradiated, each unit 1.0000 Unit(s) 181.95 113.9600 65.50 151.61 Platelets, leukocytes reduced, irradiated, each unit 1.0000 Unit(s) 260.00 162.8400 93.60 228.11 Platelets, pheresis, each unit 1.0000 Unit(s) 611.90 383.2300 220.28 458.92 Platelets, pheresis, leukocytes reduced, each unit 1.0000 Unit(s) 937.05 586.8700 337.34 702.79 Platelets, pheresis, irradiated, each unit 1.0000 Unit(s) 633.95 397.0400 228.22 647.23 Platelets, pheresis, leukocytes reduced, irradiated, each unit 1.0000 Unit(s) 1162.70 728.2000 418.57 872.02 Red blood cells, irradiated, each unit 1.0000 Unit(s) 619.85 388.2100 169.31 464.89 Red blood cells, leukocytes reduced, irradiated, each unit 1.0000 Unit(s) 751.90 470.9100 260.55 563.92 Infusion, plasma protein fraction (human), 5%, 50 ml 50.0000 ML 240.35 150.5300 7.99 180.26 Infusion, albumin (human), 25%, 50 ml 50.0000 ML 254.80 159.5800 52.45 191.10 Whole blood or red blood cells, leukocytes reduced, CMV-negative, each unit 1.0000 Unit(s) 618.80 387.5500 212.23 464.10 Platelets, HLA-matched leukocytes reduced, apheresis/pheresis, each unit 1.0000 Unit(s) 1291.70 808.9900 465.01 968.78 Whole blood or red blood cells, leukocytes reduced, frozen, deglycerol, washed, each unit 1.0000 Unit(s) 442.70 277.2600 159.37 332.45 Platelets, leukocytes reduced, CMV-negative, apheresis/pheresis, each unit 1.0000 Unit(s) 1009.85 632.4700 363.55 757.39 Fresh frozen plasma between 8-24 hours of collection, each unit 1.0000 Unit(s) 199.70 125.0700 71.15 149.78 Platelets, pheresis, pathogen-reduced, each unit 1.0000 Unit(s) 915.20 573.1900 329.47 686.40 Blood component or product not otherwise classified 1.0000 each 0.01 0.0100 0.01 8.55 Travel allowance, one way in connection with medically necessary laboratory specimen collection drawn from homebound or nursing homebound patient; prorated trip charge 1.0000 each 55.10 34.5100 38.57 44.08 Catheterization for collection of specimen, single patient, all places of service 1.0000 each 35.35 22.1400 3.00 1050.00 Infusion therapy, using other than chemotherapeutic drugs, per visit 1.0000 Visit 119.15 74.6200 77.45 95.32 Screening Papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory 1.0000 each 48.90 30.6300 13.59 36.68 Wet mounts, including preparations of vaginal, cervical or skin specimens 1.0000 each 43.70 27.3700 12.15 32.78 Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (non-ESRD use) 1.0000 MG 1046.40 655.3600 1.00 784.80 Injection, ferumoxytol, for treatment of iron deficiency anemia, 1 mg (for ESRD on dialysis) 1.0000 MG 1537.60 963.0000 1.00 1153.20 Chlorpromazine HCl, 5 mg, oral, FDA-approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 5.0000 mg 2.49 1.5600 1.62 1.87 Diphenhydramine HCl, 50 mg, oral, FDA-approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at time of chemotherapy treatment not to exceed a 48-hour dosage regimen 50.0000 MG 0.20 0.1300 0.13 0.15 Prochlorperazine maleate, 5 mg, oral, FDA-approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 48-hour dosage regimen 5.0000 MG 0.85 0.5300 0.55 0.64 Granisetron HCl, 1 mg, oral, FDA-approved prescription antiemetic, for use as a complete therapeutic substitute for an IV antiemetic at the time of chemotherapy treatment, not to exceed a 24-hour dosage regimen 1.0000 MG 1.65 1.0300 1.07 1.24 Injection, fosphenytoin, 50 mg phenytoin equivalent 50.0000 MG 484.66 303.5400 315.03 363.50 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone) 0.5000 ML 44.70 28.0000 29.06 33.52 Influenza virus vaccine, not otherwise specified 1.0000 each 34.30 21.4800 22.30 25.72 Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion 1.0000 eA 167320.20 104792.6400 48692.91 125490.15 Injection, doxorubicin HCl, liposomal, not otherwise specified, 10 mg 10.0000 mg 1781.49 1115.7500 234.03 1336.12 Injection, interferon beta-1a, 1 mcg for intramuscular use 1.0000 mcg 4282.00 2681.8200 55.29 3211.50 Injection, epoetin alfa, 100 units (for ESRD on dialysis) 100.0000 Unit(s) 455.85 285.5000 296.30 341.89 Apligraf, per sq cm 1.0000 SQ CM 1867.45 1169.5800 1213.84 1400.59 Dermagraft, per sq cm 1.0000 SQ CM 2337.30 1463.8500 1519.24 1752.98 AlloDerm, per sq cm 1.0000 SQ CM 5756.55 3605.3300 3741.76 4317.41 TheraSkin, per sq cm 1.0000 SQ CM 210.70 131.9600 136.96 158.02 ArthroFlex, per sq cm 1.0000 Sq Cm 4548.20 2848.5400 2956.33 3411.15 Epifix, per sq cm 1.0000 Sq cm 3332.00 2086.8300 2165.80 2499.00 Injection, filgrastim-sndz, biosimilar, (Zarxio), 1 mcg 1.0000 mcg 505.60 316.6600 0.32 379.20 Injection, infliximab-dyyb, biosimilar, (Inflectra), 10 mg 10.0000 mg 1566.48 981.0900 41.19 1174.86 Injection, infliximab-abda, biosimilar, (Renflexis), 10 mg 10.0000 mg 1597.65 1000.6100 38.79 1198.24 Injection, pegfilgrastim-cbqv, biosimilar, (Udenyca), 0.5 mg 0.5000 mg 8522.15 5337.4200 222.38 6391.61 Injection, trastuzumab-qyyp, biosimilar, (Trazimera), 10 mg 10.0000 mg 13.86 8.6800 9.01 64.13 Injection, bevacizumab-bvzr, biosimilar, (Zirabev), 10 mg 10.0000 mg 3347.78 2096.7100 52.37 2510.84 Injection, rituximab-pvvr, biosimilar, (RUXIENCE), 10 mg 10.0000 mg 5804.21 3635.1800 58.80 4353.16 High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml 1.0000 ML 37.30 23.3600 26.11 29.84 Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml 1.0000 ML 64.16 40.1800 44.91 51.33 Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml 1.0000 ML 179.90 112.6700 125.93 143.92 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml 1.0000 ML 31.60 19.7900 22.12 25.28 Injection, nonradioactive, noncontrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg 1.0000 mg 1995.11 1249.5400 6.73 1596.09 Injection, PEGylated interferon alfa-2B, 10 mcg 10.0000 MCG 675.75 423.2200 439.24 506.81 Colonoscopy consultation performed prior to a screening colonoscopy procedure Each 95.70 59.9400 66.99 76.56 Routine ophthalmological examination including refraction; new patient 1.0000 each 299.00 187.2600 209.30 239.20 Routine ophthalmological examination including refraction; established patient 1.0000 each 235.00 147.1800 164.50 188.00 Childbirth preparation/Lamaze classes, nonphysician provider, per session 1.0000 Session 79.05 49.5100 55.34 63.24 Lactation classes, nonphysician provider, per session 1.0000 Session 12.50 7.8300 8.75 10.00 Patient education, not otherwise classified, nonphysician provider, individual, per session 1.0000 Session 80.10 50.1700 56.07 64.08 Patient education, not otherwise classified, nonphysician provider, group, per session 1.0000 Session 72.80 45.5900 50.96 58.24 Crisis intervention mental health services, per diem 1.0000 Day(s) 408.75 256.0000 231.00 327.00 Screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol, per encounter 1.0000 each 194.50 121.8200 136.15 155.60 Case management, per month 1.0000 Month 246.00 154.0700 172.20 196.80 Anterior chamber intraocular lens 1.0000 Each 349.45 218.8600 244.62 288.82 Posterior chamber intraocular lens 1.0000 Each 271.80 170.2300 190.26 224.64 Astigmatism correcting function of intraocular lens 1.0000 lens 897.75 562.2600 628.42 741.99 Presbyopia correcting function of intraocular lens 1.0000 each 889.20 556.9100 622.44 734.92 Amniotic membrane for surgical reconstruction, per procedure 1.0000 Each 1670.50 1046.2300 1169.35 1336.40 seizures without mcc Each 16982.15 12164.3200 6311.06 7284.88 orbital procedures without cc/mcc Each 8886.36 6365.3000 10283.53 11870.32 acute major eye infections without cc/mcc Each 7682.84 5503.2200 4585.54 5293.10 neurological eye disorders Each 20011.73 14334.4000 5447.23 6287.76 other disorders of the eye without mcc Each 15790.71 11310.8800 5945.92 6863.40 major head and neck procedures without cc/mcc Each 89626.25 64199.2800 64199.2800 64199.2800 cranial/facial procedures without cc/mcc Each 10460.79 7493.0600 7493.0600 7493.0600 other ear, nose, mouth and throat o.r. procedures without cc/mcc Each 16743.89 11993.6500 11993.6500 11993.6500 sinus and mastoid procedures without cc/mcc Each 22856.05 16371.7900 8918.88 10295.10 salivary gland procedures Each 15834.75 11342.4300 8766.86 10119.62 dysequilibrium Each 34693.99 24851.3000 5235.54 6043.40 epistaxis without mcc Each 25066.71 17955.2800 5245.48 6054.88 other ear, nose, mouth and throat diagnoses without cc/mcc Each 17095.76 12245.6900 4677.17 5398.88 pulmonary embolism without mcc Each 14649.69 10493.5700 6306.80 7279.96 respiratory infections and inflammations without cc/mcc Each 14869.75 10651.2000 6199.53 7156.14 pulmonary edema and respiratory failure Each 28758.05 20599.3900 8710.03 10054.02 chronic obstructive pulmonary disease without cc/mcc Each 10916.06 7819.1800 4941.44 5703.92 simple pneumonia and pleurisy without cc/mcc Each 22690.33 16253.0800 4729.74 5459.56 pneumothorax without cc/mcc Each 12753.39 9135.2500 5040.89 5818.72 bronchitis and asthma without cc/mcc Each 16048.97 11495.8800 5022.42 5797.40 other respiratory system diagnoses without mcc Each 13315.35 9537.7900 6294.01 7265.20 respiratory system diagnosis with ventilator support >96 hours Each 154399.17 110596.1300 40748.39 47036.02 respiratory system diagnosis with ventilator support < = 96 hours Each 56411.02 40407.2100 18077.88 20867.36 cardiac valve and other major cardiothoracic procedures without cardiac catheterization without cc/mcc Each 25910.89 18559.9700 32534.92 37555.18 cardiac defibrillator implant with cardiac catheterization with acute myocardial infarction, heart failure or shock without mcc Each 16825.58 12052.1600 41192.38 47548.52 cardiac defibrillator implant with cardiac catheterization without acute myocardial infarction, heart failure or shock without mcc Each 23256.43 16658.5800 39908.01 46065.96 other cardiothoracic procedures without mcc Each 25143.96 18010.6200 24445.77 28217.84 amputation for circulatory system disorders except upper limb and toe without cc/mcc Each 22113.99 15840.2500 11312.17 13057.68 permanent cardiac pacemaker implant without cc/mcc Each 14772.52 10581.5600 14657.37 16919.06 aicd generator procedures Each 26833.40 19220.7600 38487.24 44425.96 percutaneous cardiovascular procedures with drug-eluting stent without mcc Each 16110.68 11540.0800 14017.32 16180.24 percutaneous cardiovascular procedures with non drug-eluting stent without mcc Each 18375.10 13162.0900 13310.48 15364.34 other vascular procedures without cc/mcc Each 25694.76 18405.1600 12899.88 14890.38 vein ligation and stripping Each 32731.45 23445.5400 16432.63 18968.24 other circulatory system o.r. procedures Each 15450.95 11067.5200 23113.09 26679.52 acute myocardial infarction, discharged alive without cc/mcc Each 15915.99 11400.6200 5158.11 5954.02 heart failure and shock without cc/mcc Each 15963.89 11434.9400 4190.56 4837.18 ecmo or tracheostomy with mechanical ventilation >96 hours or principal diagnosis except face, mouth and neck with major o.r. procedures Each 365120.28 261535.6500 135722.61 156665.10 spinal procedures without cc/mcc Each 9795.60 7016.5900 16742.35 19325.76 peripheral vascular disorders without cc/mcc Each 18194.44 13032.6800 5278.87 6093.42 atherosclerosis without mcc Each 38272.15 27414.3400 4813.57 5556.32 hypertension without mcc Each 24827.99 17784.2900 5256.14 6067.18 cardiac arrhythmia and conduction disorders without cc/mcc Each 18244.68 13068.6600 3972.47 4585.44 syncope and collapse Each 18738.34 13422.2700 5958.00 6877.34 chest pain Each 17302.18 12393.5500 5124.72 5915.48 other circulatory system diagnoses without cc/mcc Each 13221.76 9470.7500 5138.93 5931.88 other endovascular cardiac valve procedures without mcc Each 25835.51 18505.9700 17089.02 19725.92 major small and large bowel procedures without cc/mcc Each 23124.84 16564.3200 12151.14 14026.10 anal and stomal procedures without cc/mcc Each 11271.35 8073.6700 6956.80 8030.26 inguinal and femoral hernia procedures without cc/mcc Each 14610.42 10465.4500 7845.49 9056.08 major esophageal disorders without cc/mcc Each 15789.97 11310.3500 5314.39 6134.42 major gastrointestinal disorders and peritoneal infections without cc/mcc Each 6108.84 4375.7600 5289.53 6105.72 digestive malignancy without cc/mcc Each 2915.24 2088.1900 6385.65 7370.98 gastrointestinal hemorrhage without cc/mcc Each 12080.13 8652.9900 4526.57 5225.04 inflammatory bowel disease without cc/mcc Each 13686.46 9803.6100 5077.12 5860.54 esophagitis, gastroenteritis and miscellaneous digestive disorders without mcc Each 20233.74 14493.4300 5440.13 6279.56 other digestive system diagnoses without cc/mcc Each 24652.75 17658.7600 4628.16 5342.30 tracheostomy with mechanical ventilation >96 hours or principal diagnosis except face, mouth and neck without major o.r. procedures Each 133546.26 95659.1800 84695.65 97764.50 laparoscopic cholecystectomy without c.d.e. without cc/mcc Each 26064.51 18670.0100 9343.69 10785.46 peripheral, cranial nerve and other nervous system procedures without cc/mcc Each 75143.83 53825.5300 13505.84 15589.84 hepatobiliary diagnostic procedures without cc/mcc Each 19027.13 13629.1300 10326.16 11919.52 other hepatobiliary or pancreas o.r. procedures without cc/mcc Each 53401.06 38251.1800 10959.11 12650.14 disorders of pancreas except malignancy without cc/mcc Each 15596.35 11171.6700 4307.06 4971.66 disorders of liver except malignancy, cirrhosis, or alcoholic hepatitis without cc/mcc Each 17665.09 12653.5000 4711.27 5438.24 disorders of the biliary tract without cc/mcc Each 18894.40 13534.0600 5801.00 6696.12 combined anterior and posterior spinal fusion without cc/mcc Each 34111.20 24433.8500 33965.64 39206.66 spinal fusion except cervical without mcc Each 31658.66 22677.1000 27923.10 32231.74 bilateral or multiple major joint procedures of lower extremity without mcc Each 38081.73 27277.9400 22316.03 25759.48 wound debridement and skin graft except hand for musculoskeletal and connective tissue disorders without cc/mcc Each 13842.83 9915.6200 13100.21 15121.62 revision of hip or knee replacement without cc/mcc Each 20224.07 14486.5000 19907.83 22979.68 major hip and knee joint replacement or reattachment of lower extremity without mcc Each 28359.90 20314.2000 13499.45 15582.46 cervical spinal fusion without cc/mcc Each 17385.15 12452.9800 18036.68 20819.80 hip and femur procedures except major joint without cc/mcc Each 23094.86 16542.8500 11691.52 13495.56 major joint or limb reattachment procedures of upper extremities Each 20248.37 14503.9100 16947.65 19562.74 knee procedures with principal diagnosis of infection without cc/mcc Each 23766.96 17024.2700 11651.73 13449.64 lower extremity and humerus procedures except hip, foot, femur without cc/mcc Each 28734.92 20582.8200 13154.20 15183.94 hip replacement with principal diagnosis of hip fracture without mcc Each 31428.26 22512.0600 15553.17 17953.08 spinal disorders and injuries without cc/mcc Each 19681.27 14097.6900 8072.82 9318.48 fractures of femur without mcc Each 17334.94 12417.0200 5613.46 6479.64 fractures of hip and pelvis without mcc Each 13684.96 9802.5300 5482.04 6327.94 osteomyelitis without cc/mcc Each 11016.60 7891.1900 5989.97 6914.24 pathological fractures and musculoskeletal and connective tissue malignancy without cc/mcc Each 12011.75 8604.0200 5524.66 6377.14 connective tissue disorders without cc/mcc Each 7302.87 5231.0400 5921.77 6835.52 medical back problems without mcc Each 17931.15 12844.0800 6701.77 7735.88 bone diseases and arthropathies without mcc Each 17721.99 12694.2600 5629.80 6498.50 signs and symptoms of musculoskeletal system and connective tissue without mcc Each 37017.40 26515.5600 5744.88 6631.34 tendonitis, myositis and bursitis without mcc Each 40445.82 28971.3400 6119.26 7063.48 aftercare, musculoskeletal system and connective tissue without cc/mcc Each 11194.14 8018.3600 5629.09 6497.68 fracture, sprain, strain and dislocation except femur, hip, pelvis and thigh without mcc Each 10402.93 7451.6200 6195.98 7152.04 other musculoskeletal system and connective tissue diagnoses without cc/mcc Each 7340.55 5258.0300 5341.38 6165.58 degenerative nervous system disorders without mcc Each 33711.28 24147.3900 9004.13 10393.50 other skin, subcutaneous tissue and breast procedures without cc/mcc Each 3029.48 2170.0100 9780.58 11289.76 cellulitis without mcc Each 19747.59 14145.2000 6063.85 6999.52 trauma to the skin, subcutaneous tissue & breast without mcc Each 7247.47 5191.3600 6421.17 7411.98 o.r. procedures for obesity without cc/mcc Each 2171.95 1555.7700 11345.56 13096.22 thyroid, parathyroid and thyroglossal procedures without cc/mcc Each 6013.40 4307.4000 8402.43 9698.96 diabetes without cc/mcc Each 4060.25 2908.3600 4330.51 4998.72 miscellaneous disorders of nutrition, metabolism, and fluids and electrolytes without mcc Each 18400.57 13180.3300 5357.72 6184.44 inborn and other disorders of metabolism Each 11392.76 8160.6300 9162.55 10576.36 endocrine disorders without cc/mcc Each 22204.40 15905.0100 5460.02 6302.52 kidney transplant with hemodialysis without mcc Each 12647.94 9059.7200 26272.88 30326.88 intracranial hemorrhage or cerebral infarction without cc/mcc Each 21872.34 15667.1500 5055.10 5835.12 kidney and ureter procedures for non-neoplasm without cc/mcc Each 19146.01 13714.2900 7556.37 8722.34 nonspecific cerebrovascular accident and precerebral occlusion without infarction without mcc Each 19082.40 13668.7200 6314.61 7288.98 renal failure without cc/mcc Each 24013.70 17201.0100 4318.43 4984.78 transient ischemia without thrombolytic Each 16342.43 11706.0800 5591.44 6454.22 kidney and urinary tract infections without mcc Each 13302.55 9528.6200 5640.46 6510.80 urinary stones without mcc Each 47735.50 34192.9400 5478.49 6323.84 penis procedures without cc/mcc Each 27482.54 19685.7400 11377.53 13133.12 transurethral prostatectomy without cc/mcc Each 22933.39 16427.1900 6598.06 7616.16 malignancy, male reproductive system without cc/mcc Each 12501.10 8954.5400 4604.01 5314.42 cranial and peripheral nerve disorders without mcc Each 23704.89 16979.8200 7238.82 8355.80 other female reproductive system o.r. procedures without cc/mcc Each 11426.83 8185.0400 10398.62 12003.16 malignancy, female reproductive system without cc/mcc Each 8368.85 5994.6100 6524.18 7530.88 cesarean section without cc/mcc Each 12209.18 8745.4400 8745.4400 8745.4400 abortion with d&c, aspiration curettage or hysterotomy Each 10472.54 7501.4800 6321.01 7296.36 vaginal delivery with complicating diagnoses Each 8200.53 5874.0400 5874.0400 5874.0400 vaginal delivery without complicating diagnoses Each 11069.85 7929.3300 7929.3300 7929.3300 postpartum and postabortion diagnoses without o.r. procedures Each 8045.23 5762.8000 5501.93 6350.90 cesarean section with sterilization without cc/mcc Each 12209.18 8745.4400 6512.81 7517.76 cesarean section without sterilization without cc/mcc Each 13011.85 9320.3900 6303.96 7276.68 prematurity with major problems Each 14738.20 9230.5347 10316.74 11790.56 vaginal delivery without sterilization or d&c without cc/mcc Each 11069.85 7929.3300 4562.80 5266.86 major hematological and immunological diagnoses except sickle cell crisis and coagulation disorders without cc/mcc Each 22952.22 16440.6800 6831.77 7885.94 red blood cell disorders without mcc Each 17734.65 12703.3300 6253.52 7218.46 coagulation disorders Each 13274.48 9508.5100 10976.16 12669.82 reticuloendothelial and immunity disorders without cc/mcc Each 10046.32 7196.1800 4696.36 5421.02 acute leukemia without major o.r. procedures without cc/mcc Each 33671.16 24118.6500 8336.37 9622.70 postoperative and posttraumatic infections without mcc Each 11865.19 8499.0300 7184.83 8293.48 fever and inflammatory conditions Each 11720.70 8395.5400 6226.52 7187.30 septicemia or severe sepsis with mechanical ventilation >96 hours Each 102957.44 73748.4100 45741.69 52799.80 septicemia or severe sepsis without mechanical ventilation >96 hours without mcc Each 22650.48 16224.5400 7290.68 8415.66 acute adjustment reaction and psychosocial dysfunction Each 21876.80 15670.3500 6141.28 14172.00 depressive neuroses Each 8829.13 6324.3100 3543.00 6096.10 neuroses except depressive Each 6972.85 4994.6500 3543.00 6260.28 disorders of personality and impulse control Each 17243.30 12351.3800 1181.00 12023.45 organic disturbances and intellectual disability Each 17847.30 12784.0200 2362.00 11001.10 psychoses Each 8015.82 5741.7300 3543.00 9420.83 behavioral and developmental disorders Each 12156.46 8707.6700 7086.00 9301.49 alcohol, drug abuse or dependence, left against medical advice Each 9069.20 6496.2700 1782.00 4173.01 alcohol, drug abuse or dependence with rehabilitation therapy Each 32270.35 23115.2500 11360.48 14256.00 alcohol, drug abuse or dependence without rehabilitation therapy without mcc Each 16817.86 12046.6300 1782.00 6286.13 poisoning and toxic effects of drugs without mcc Each 8190.73 5867.0200 5623.41 6491.12 complications of treatment without cc/mcc Each 8986.04 6436.7000 4957.78 5722.78 signs and symptoms without mcc Each 23524.52 16850.6100 5591.44 6454.22 aftercare without cc/mcc Each 61015.16 43705.1600 5258.27 6069.64 other factors influencing health status Each 51870.01 37154.4800 3975.31 4588.72 limb reattachment, hip and femur procedures for multiple significant trauma Each 35180.74 25199.9700 27349.82 31570.00 semi private room 1936.50 1212.83 1026.3450 1549.2000 private room 2210.00 1384.12 1171.3000 1768.0000 room rate 1936.50 1212.83 1026.3450 1549.2000 private room 400.00 250.52 212.0000 320.0000 private room-patient request 400.00 250.52 212.0000 320.0000 pvt room 375.00 234.86 198.7500 300.0000 semi private room 375.00 234.86 198.7500 300.0000 alcohol detox-private 293.00 183.51 155.2900 234.4000 alcohol detox-semi 275.00 172.23 145.7500 220.0000 alternate level of care 375.00 234.86 198.7500 300.0000 detox charge diff 25.00 15.66 13.2500 20.0000 detox/private 293.00 183.51 155.2900 234.4000 detox/semi-private 275.00 172.23 145.7500 220.0000 charge explosion, rebab pvt rm 79.00 49.48 41.8700 63.2000 semi private room 2392.00 1498.11 1267.7600 1913.6000 ar private room 1258.40 788.14 666.9520 1006.7200 ar semi private room 1144.00 716.49 606.3200 915.2000 pt req - priv room 96.70 60.56 51.2510 77.3600 private room 2500.50 1566.06 1325.2650 2000.4000 pmr overflow/t-bed 2392.00 1498.11 1267.7600 1913.6000 room rate 2137.20 1338.53 1132.7160 1709.7600 semi private alc 358.00 224.22 189.7400 286.4000 alc-private 268.00 167.85 142.0400 214.4000 alc-semi private 250.00 156.58 132.5000 200.0000 alternate level care-private 268.00 167.85 142.0400 214.4000 alternate level care-semi 250.00 156.58 132.5000 200.0000 lomotil 1mg/5ml 4.15 2.60 2.1995 3.3200 norm sal.w/20meq kcl 1000ml 6.70 4.20 3.5510 5.3600 kit sl fibrin evicel 5ml ster 853.85 534.77 452.5405 683.0800 dex 5% in 1/2 sal 500ml 4.15 2.60 2.1995 3.3200 dex 5% in 1/4 sal 1000ml 4.65 2.91 2.4645 3.7200 dex5%in n sal.w/20meqkcl1000ml 7.05 4.42 3.7365 5.6400 dextrose 5% in water 250ml 3.55 2.22 1.8815 2.8400 pepcid 20 mg iv 2.90 1.82 1.5370 2.3200 pharmacy 4 14.20 8.89 7.5260 11.3600 ivf 0.9% ns with 40 meq kcl 6.55 4.10 3.4715 5.2400 sealant fibrn flex evicel 45cm 66.30 41.52 35.1390 53.0400 pharmacy 5 3.65 2.29 1.9345 2.9200 pharmacy 7 32.40 20.29 17.1720 25.9200 pharmacy 8 6.95 4.35 3.6835 5.5600 sodium chl p.f. 50ml 4.65 2.91 2.4645 3.7200 sodium chloride 20 ml 2.10 1.32 1.1130 1.6800 tuberculin ppd 5 units 150.30 94.13 79.6590 120.2400 vitamin a 100,000 units/2ml 40.14 25.14 21.2742 32.1120 cystografin 40.40 25.30 21.4120 32.3200 d5%/0.9% saline 1000ml 21.70 13.59 11.5010 17.3600 er/or/rr oxygen 36.40 22.80 19.2920 29.1200 ampicillin (500 mg) 8.55 5.35 4.5315 6.8400 5% dextrose/.045% sodium chlor 5.20 3.26 2.7560 4.1600 measles (attenuvax) 48.55 30.41 25.7315 38.8400 k phos 4.4 meq/50ml 8.35 5.23 4.4255 6.6800 kefzol (1 gm) 8.10 5.07 4.2930 6.4800 pharmacy 40 10.20 6.39 5.4060 8.1600 pharmacy 41 24.15 15.13 12.7995 19.3200 pharmacy 31 8.35 5.23 4.4255 6.6800 pharmacy 21 3.70 2.32 1.9610 2.9600 pharmacy 22 3.80 2.38 2.0140 3.0400 pharmacy 23 3.95 2.47 2.0935 3.1600 pharmacy 24 4.15 2.60 2.1995 3.3200 pharmacy 26 4.45 2.79 2.3585 3.5600 pharmacy 27 4.15 2.60 2.1995 3.3200 pharmacy 3 17.70 11.09 9.3810 14.1600 pharmacy 36 7.75 4.85 4.1075 6.2000 pharmacy 37 5.20 3.26 2.7560 4.1600 pharmacy 39 3.35 2.10 1.7755 2.6800 pharmacy 10 4.45 2.79 2.3585 3.5600 pharmacy 15 13.40 8.39 7.1020 10.7200 oxygen 63.45 39.74 33.6285 50.7600 potassium phos. 3mm\ml 5 ml vi 61.35 38.42 32.5155 49.0800 ribavirin therapy 64.85 40.62 34.3705 51.8800 rocephin (1 gm) 101.62 63.64 53.8586 81.2960 rocephin (250 mg) 30.00 18.79 15.9000 24.0000 rocephine (1 gm) 97.70 61.19 51.7810 78.1600 pharmacy 43 13.40 8.39 7.1020 10.7200 bicillin la (1.2 mu) 36.65 22.95 19.4245 29.3200 iv infus not chemo ea addl hr 54.26 33.98 28.7578 43.4080 iv infus other than chemo 1hr 134.00 83.92 71.0200 107.2000 iv infusion oth chemo, 1 hr 134.00 83.92 71.0200 107.2000 iv infusion oth than chemo 1hr 173.75 108.82 92.0875 139.0000 iv set up 115.45 72.31 61.1885 92.3600 iv set-up outpatient 64.25 40.24 34.0525 51.4000 iv daily set-up inpat 101.30 63.44 53.6890 81.0400 catheter leg strap 7.80 4.89 4.1340 6.2400 cane with tip 28.55 17.88 15.1315 22.8400 blade, deep cutting 136.10 85.24 72.1330 108.8800 blood iv set 88.20 55.24 46.7460 70.5600 blood warming coil 88.20 55.24 46.7460 70.5600 bur, dental, all sizes 63.40 39.71 33.6020 50.7200 compression boot/foot 70.85 44.37 37.5505 56.6800 compression sleeve/leg 180.20 112.86 95.5060 144.1600 cement restrictor buck #4674 295.15 184.85 156.4295 236.1200 catheter, thoracic st 16.25 10.18 8.6125 13.0000 on wire piston 150.30 94.13 79.6590 120.2400 p.t. soft goods 127.80 80.04 67.7340 102.2400 pall filter 25.85 16.19 13.7005 20.6800 pall filter for packed cells 59.55 37.30 31.5615 47.6400 pall filter for platelets 113.85 71.30 60.3405 91.0800 fluorescent imaging pack 1390.50 870.87 736.9650 1112.4000 fuller shield-ea 21.20 13.28 11.2360 16.9600 heelbos, all sizes 14.60 9.14 7.7380 11.6800 hypothermia 77.75 48.69 41.2075 62.2000 nail cannulated humeral 250mm 2446.00 1531.93 1296.3800 1956.8000 light source 687.50 430.58 364.3750 550.0000 lifeport catheter 733.75 459.55 388.8875 587.0000 nasal splint 12.30 7.70 6.5190 9.8400 noz stop 56.60 35.45 29.9980 45.2800 electrode pac,defib. 47.55 29.78 25.2015 38.0400 alcon blade 41.65 26.09 22.0745 33.3200 cast shoe 59.45 37.23 31.5085 47.5600 casting fibrglss all size 24.20 15.16 12.8260 19.3600 clavicle straps-mcleod 67.95 42.56 36.0135 54.3600 enema barium xray 18.45 11.56 9.7785 14.7600 endoscopic rental cervical 5250.00 3288.08 2782.5000 4200.0000 eye shield 5.30 3.32 2.8090 4.2400 fiber, laser slim-line #365 320.80 200.92 170.0240 256.6400 fixation device rental 960.25 601.40 508.9325 768.2000 collar cerv./phil 67.95 42.56 36.0135 54.3600 belt-rib 47.55 29.78 25.2015 38.0400 binder-abdominal 77.75 48.69 41.2075 62.2000 ankle distractor foot srp#4590 109.20 68.39 57.8760 87.3600 auto suture ta 30 123.95 77.63 65.6935 99.1600 sex offense evidence kit 27.75 17.38 14.7075 22.2000 unna boot/supply 32.90 20.61 17.4370 26.3200 airway, esophageal 97.30 60.94 51.5690 77.8400 rental sys recon 494.05 309.42 261.8465 395.2400 post op knee brace 113.00 70.77 59.8900 90.4000 simpulse 106.80 66.89 56.6040 85.4400 sling arm velpeau all sz 37.00 23.17 19.6100 29.6000 splint fast 3x12 #4578 14.50 9.08 7.6850 11.6000 splint fast 4x15 #4579 17.05 10.68 9.0365 13.6400 splint fast 5x15 #6035 321.45 201.32 170.3685 257.1600 splint rich forearm-adult 52.45 32.85 27.7985 41.9600 splint rich forearm-child 25.75 16.13 13.6475 20.6000 stocking thigh lge long # 915 17.20 10.77 9.1160 13.7600 stocking thigh lge regulr #916 10.80 6.76 5.7240 8.6400 stocking thigh lge short #917 11.35 7.11 6.0155 9.0800 stocking thigh med long #918 11.08 6.94 5.8724 8.8640 stocking thigh med regulr #919 11.35 7.11 6.0155 9.0800 stocking thigh med short #920 17.20 10.77 9.1160 13.7600 stocking thigh small short#924 17.20 10.77 9.1160 13.7600 stockings-below knee ted 40.85 25.58 21.6505 32.6800 stockings-thigh ted 65.50 41.02 34.7150 52.4000 shoe post op all size 40.70 25.49 21.5710 32.5600 suction set-up 81.65 51.14 43.2745 65.3200 sur-fit urostomy bag 6.50 4.07 3.4450 5.2000 sur-fit irrigation bag 10.70 6.70 5.6710 8.5600 suture cutter knot pusher 415.50 260.23 220.2150 332.4000 suspensory 24.65 15.44 13.0645 19.7200 suspensory large #721 11.80 7.39 6.2540 9.4400 suspensory medium #722 12.25 7.67 6.4925 9.8000 suspensory x-large #724 11.80 7.39 6.2540 9.4400 sut fbwr 4-0 12.3mm 3/8 503.90 315.59 267.0670 403.1200 tape casting 3x4yds #766 7.30 4.57 3.8690 5.8400 tape casting 4x4yds #768 10.40 6.51 5.5120 8.3200 suction tube attch device 4.95 3.10 2.6235 3.9600 voldyne 33.30 20.86 17.6490 26.6400 skin prep wipes 1.05 0.66 0.5565 0.8400 recharger mri intellis 1370.50 858.34 726.3650 1096.4000 aerochamber 17.00 10.65 9.0100 13.6000 adapter multi-tap kypan sz2 86.95 54.46 46.0835 69.5600 coloplast all in one 10.40 6.51 5.5120 8.3200 coloplast anitfungal 8.30 5.20 4.3990 6.6400 coloplast barrier cream 7.30 4.57 3.8690 5.8400 bis quatro sensor 44.75 28.03 23.7175 35.8000 bit drill 4.2mm 3 fluted 486.60 304.76 257.8980 389.2800 biopsy kit cartlage-not implnt 781.35 489.36 414.1155 625.0800 biopsy needle cut non-sterile 40.50 25.37 21.4650 32.4000 bit drill cann asnis 2.7 488.80 306.14 259.0640 391.0400 electrode return omega 85cmx4m 470.10 294.42 249.1530 376.0800 pad pos supine boot insert dis 226.70 141.98 120.1510 181.3600 device locking 7fr 15cm 44.45 27.84 23.5585 35.5600 controller intellis neurstim 1570.50 983.60 832.3650 1256.4000 converters 32.35 20.26 17.1455 25.8800 cooled rf kit - sterile 1019.05 638.23 540.0965 815.2400 cooled rf kit 75mm sterile 1019.05 638.23 540.0965 815.2400 cord inst energy bipolar 17ft 490.50 307.20 259.9650 392.4000 connector suture passer 416.85 261.07 220.9305 333.4800 constant care 2 oz. 11.75 7.36 6.2275 9.4000 cotton balls/lambswool 3.55 2.22 1.8815 2.8400 countersink 3.0mm cannulated 415.30 260.10 220.1090 332.2400 countersink bone cann 4mm 415.45 260.20 220.1885 332.3600 cr sut m conn smartstich 138.70 86.87 73.5110 110.9600 cr sut mag m wire m conn smstc 503.80 315.53 267.0140 403.0400 crossflow arthroscopy tubing 401.75 251.62 212.9275 321.4000 crystal cannula 64.00 40.08 33.9200 51.2000 device reduction push-pull 1sz 433.80 271.69 229.9140 347.0400 ct injection kit 69.70 43.65 36.9410 55.7600 ct closesure system 313.20 196.16 165.9960 250.5600 demineralized bone matrix 10cc 1221.30 764.90 647.2890 977.0400 dialysis repair kit 325.15 203.64 172.3295 260.1200 diamond shrll abrasor ball tip 634.50 397.39 336.2850 507.6000 diego diamond ball burr 423.70 265.36 224.5610 338.9600 dilation syringe 332.80 208.43 176.3840 266.2400 dilation sys relieva 6x24mm 2345.00 1468.67 1242.8500 1876.0000 dilator spinal seq set sterile 380.50 238.31 201.6650 304.4000 dilator spinal seq single use 435.80 272.94 230.9740 348.6400 dilator vessel all sizes 12.00 7.52 6.3600 9.6000 device tissue removal myosure 1354.33 848.21 717.7949 1083.4640 disc shim disposable 704.05 440.95 373.1465 563.2400 * dressing abd st-ea 1.15 0.72 0.6095 0.9200 * dressing fluffs pk 4.80 3.01 2.5440 3.8400 * dressing telfa all 1.15 0.72 0.6095 0.9200 * dressing wet-saline ea 5.95 3.73 3.1535 4.7600 device biopsy bone size 2 239.10 149.75 126.7230 191.2800 device endoscopic us 22ga 718.10 449.75 380.5930 574.4800 device endoscopic us 25ga 690.50 432.46 365.9650 552.4000 depth gauge 687.55 430.61 364.4015 550.0400 depth gauge 23mm 390.75 244.73 207.0975 312.6000 dermabond 67.75 42.43 35.9075 54.2000 dermacarries (item #007423) 60.30 37.77 31.9590 48.2400 dermatone blade/head disp 46.75 29.28 24.7775 37.4000 catheter,groshong,cv 458.20 286.97 242.8460 366.5600 catheter-lapidis 63.40 39.71 33.6020 50.7200 catheter-self cath 2.45 1.53 1.2985 1.9600 cautery disp 34.70 21.73 18.3910 27.7600 catheter trocar 20fr #161 48.50 30.38 25.7050 38.8000 catheter trocar 28fr #1405 48.50 30.38 25.7050 38.8000 catheter trocar 32fr 16 #5287 48.50 30.38 25.7050 38.8000 catheter trocar 32fr 20 #5288 48.50 30.38 25.7050 38.8000 catheter trocar 36fr #5286 48.50 30.38 25.7050 38.8000 catheter ureteral 20.15 12.62 10.6795 16.1200 cement simplex p surg ful#1793 210.70 131.96 111.6710 168.5600 cervical pudendal phar 44.50 27.87 23.5850 35.6000 cemenh syringe 76.25 47.76 40.4125 61.0000 cement bone inj traumacem 660.65 413.77 350.1445 528.5200 cement restrictor buck #2226 295.10 184.82 156.4030 236.0800 centesis tray safety 6fr#10126 174.70 109.41 92.5910 139.7600 charging system kit 1701.55 1065.68 901.8215 1361.2400 chia suture passer #9631 286.75 179.59 151.9775 229.4000 chiba needle set 102.70 64.32 54.4310 82.1600 cholang balloon cath set 174.50 109.29 92.4850 139.6000 cholangiogram catheter 35.30 22.11 18.7090 28.2400 confidence spinal cement 1685.30 1055.50 893.2090 1348.2400 connect tube 3/16x72-ea 5.25 3.29 2.7825 4.2000 compression implant size guide 121.00 75.78 64.1300 96.8000 compression lag screw 221.70 138.85 117.5010 177.3600 compression screw 18.95 11.87 10.0435 15.1600 comp tube/plate 2-7 holes 319.85 200.32 169.5205 255.8800 comp tube/plate 8-9 holes 579.60 363.00 307.1880 463.6800 lap dis hnd access dv sm #8356 138.30 86.62 73.2990 110.6400 lap disc device med #8857 121.00 75.78 64.1300 96.8000 lap hernia staples 802.05 502.32 425.0865 641.6400 lap sponge 18x18 (5's) 25.60 16.03 13.5680 20.4800 large angle transconnector 489.30 306.45 259.3290 391.4400 lasso banana #7181 349.45 218.86 185.2085 279.5600 lavage hose pak 55.35 34.67 29.3355 44.2800 lead blank 96.95 60.72 51.3835 77.5600 colpo pneumo occluder #5842 156.45 97.98 82.9185 125.1600 combi drive unit (burr) 720.50 451.25 381.8650 576.4000 kit everest min invas 21.4mm 720.50 451.25 381.8650 576.4000 kit procedure crossfix ii disp 396.45 248.30 210.1185 317.1600 kit spinal reline mas disp 1215.50 761.27 644.2150 972.4000 kit stylet avamax bone cement 68.25 42.74 36.1725 54.6000 kii b alloon blunt tip system 92.55 57.96 49.0515 74.0400 kii fios abdominal access 12x1 81.10 50.79 42.9830 64.8800 kii fios abdominal access 5x10 55.95 35.04 29.6535 44.7600 kirschner wire 12.15 7.61 6.4395 9.7200 kirschner wire 2mmx150mm lth 27.60 17.29 14.6280 22.0800 kit anterior lig transtibial 386.05 241.78 204.6065 308.8400 kit anterior w/o sawblade 386.05 241.78 204.6065 308.8400 kit arthroscopic spear 467.50 292.80 247.7750 374.0000 kit bit drill speed 2.65mm 513.00 321.29 271.8900 410.4000 kit blood processing platelets 515.50 322.86 273.2150 412.4000 kit bone dust collector 437.30 273.88 231.7690 349.8400 knee durasoft cold wrap #4865 67.20 42.09 35.6160 53.7600 knee wrap w/ 2 gel bags 60.30 37.77 31.9590 48.2400 knee wrap w/gel bag 47.20 29.56 25.0160 37.7600 knife bayonet surgical 188mm 530.15 332.03 280.9795 424.1200 knife microsurgical disp. 16.95 10.62 8.9835 13.5600 knot pusher #010902 436.30 273.25 231.2390 349.0400 knot pusher/suture cutter 489.30 306.45 259.3290 391.4400 kt acp series i 411.30 257.60 217.9890 329.0400 kt drill elite 3mm 542.25 339.61 287.3925 433.8000 kt drilling template s shaped 197.15 123.48 104.4895 157.7200 kt guid osteotomy cutting std 166.40 104.22 88.1920 133.1200 kt pacer wrench disp 100.70 63.07 53.3710 80.5600 kt tamp bne kyphon 2x15mm 4007.95 2510.18 2124.2135 3206.3600 kuntscher rod 161.75 101.30 85.7275 129.4000 kwire .035 dbl ended(not an im 41.95 26.27 22.2335 33.5600 kwire sngle troc tip 1.6x150mm 67.20 42.09 35.6160 53.7600 kwire sngle troc tip 2.3x230mm 99.85 62.54 52.9205 79.8800 l-hook #9565 137.95 86.40 73.1135 110.3600 l.t.d.ii kit 27.90 17.47 14.7870 22.3200 brush intramed howmedica 24.15 15.13 12.7995 19.3200 brush spinal tissue extractor 293.30 183.69 155.4490 234.6400 bur coated ball tip 2mmx7.5cm 340.60 213.32 180.5180 272.4800 bur diamond coated ball long 340.60 213.32 180.5180 272.4800 bur diamond disc 276.50 173.17 146.5450 221.2000 bur disct 7.5cm x 4mm 327.50 205.11 173.5750 262.0000 bur disct 7.5cm x 6mm 316.60 198.29 167.7980 253.2800 bur disct midas 4mm x 7.5cm 320.95 201.01 170.1035 256.7600 bur dissecting 2.5mm x 14cm 314.95 197.25 166.9235 251.9600 bur dissecting 4mm x 10cm 262.55 164.44 139.1515 210.0400 bur dissecting ball 2.1mmx7cm 397.95 249.24 210.9135 318.3600 bur dissecting ball 2mm x 7.5 396.80 248.52 210.3040 317.4400 bur dissecting ball 2x7.5 396.80 248.52 210.3040 317.4400 bur dissecting midas rex 1mm 327.50 205.11 173.5750 262.0000 bur dissecting midas rex 201mm 397.95 249.24 210.9135 318.3600 bur dmd ball legend 7.5x5mm 263.50 165.03 139.6550 210.8000 bur dmd ball legend 7.5x4mm 267.10 167.28 141.5630 213.6800 bur dmd ball legend 7.5x5mm 400.50 250.83 212.2650 320.4000 bur dmd ball legend 7.5x6mm 416.50 260.85 220.7450 333.2000 bur dmd ball legnd 7.5cm x 4mm 399.35 250.11 211.6555 319.4800 bur midas rex 7.5x2mm dissect 241.30 151.13 127.8890 193.0400 bur neuro 2.0mm 496.65 311.05 263.2245 397.3200 bur neuro drl 3mmx3.8mm 301.95 189.11 160.0335 241.5600 bur neuro matchstick2mm#010843 292.45 183.16 154.9985 233.9600 bur neuro mis curved 3.0mm 290.35 181.85 153.8855 232.2800 bur presision acorn 6.0mm 301.95 189.11 160.0335 241.5600 bur rex legend ball 4mm x 10cm 262.50 164.40 139.1250 210.0000 bur rnd 12 flt 4mm 130.05 81.45 68.9265 104.0400 bur round 24.14 15.12 12.7942 19.3120 bur round 5mm #010842 292.45 183.16 154.9985 233.9600 bur round 6 flute 5.5mm 496.60 311.02 263.1980 397.2800 bur round orthopedic #9309 33.60 21.04 17.8080 26.8800 bur shaver arthoscopic 169.00 105.84 89.5700 135.2000 bur side cutting 18.90 11.84 10.0170 15.1200 bur side cutting #9166 40.35 25.27 21.3855 32.2800 bur side cutting dr.rad 40.35 25.27 21.3855 32.2800 bur surg abrasion 3mm diam 130.05 81.45 68.9265 104.0400 bur surg hooded red 3mm 483.35 302.72 256.1755 386.6800 blue rhino trach set sz6 #9069 622.85 390.09 330.1105 498.2800 blue rhino trach set sz8 #9070 622.85 390.09 330.1105 498.2800 blade (bill proc not used) 76.20 47.72 40.3860 60.9600 blade 2.0/2.3 x 94mm 293.00 183.51 155.2900 234.4000 blade 40d concave #10061 370.60 232.11 196.4180 296.4800 blade abrader 4.0 strght #1424 450.50 282.15 238.7650 360.4000 blade abrader 5.5 #4475 170.60 106.85 90.4180 136.4800 blade acrominizer burr5.5#4727 123.70 77.47 65.5610 98.9600 blade aver med (tps) 24.50 15.34 12.9850 19.6000 blade aver med tps #5625 90.50 56.68 47.9650 72.4000 blade beaver 64 4.15 2.60 2.1995 3.3200 blade beaver mini 3.95 2.47 2.0935 3.1600 blade beaver tympanoplasty 39.10 24.49 20.7230 31.2800 blade clearcit 2.4mm #9997 137.02 85.82 72.6206 109.6160 blade clearcit hp 2.8mm #9795 137.02 85.82 72.6206 109.6160 blade clearcit sideport #9794 36.40 22.80 19.2920 29.1200 blade cresentic #7591 306.45 191.93 162.4185 245.1600 blade cutter tomcat 3.5mm 123.15 77.13 65.2695 98.5200 blade dissector 4mm #10060 364.35 228.19 193.1055 291.4800 blade ectr #5022 123.40 77.29 65.4020 98.7200 blade full radius 3.5 #5421 128.65 80.57 68.1845 102.9200 blade full radius shv 5.5#4473 128.65 80.57 68.1845 102.9200 blade heavy duty system 149.80 93.82 79.3940 119.8400 blade helicial 11.0mm 973.70 609.83 516.0610 778.9600 blade incisor plus 4.5 #4474 170.60 106.85 90.4180 136.4800 blade tricut 4mm #6446 417.50 261.48 221.2750 334.0000 blade w/alc 10mm (tps) 18.80 11.77 9.9640 15.0400 blade w/alc 10mm (tps) #5623 95.05 59.53 50.3765 76.0400 blade stonecutter 4.0 #3539 170.60 106.85 90.4180 136.4800 blade surgical 180 deg 294.06 184.17 155.8518 235.2480 pencil electro rocker switch 7.55 4.73 4.0015 6.0400 pencil with blade 15.00 9.39 7.9500 12.0000 percutaneous trach set 553.35 346.56 293.2755 442.6800 perfect passer connectr #10090 442.85 277.36 234.7105 354.2800 perfect passer smrt stch#10091 502.90 314.97 266.5370 402.3200 peritoneal dialysis catheter 142.10 89.00 75.3130 113.6800 cann 6.5mm twist drill 606.85 380.07 321.6305 485.4800 cann arthro tib 9-12mm d 48.65 30.47 25.7845 38.9200 cann passport btn 12mmx3cm 228.95 143.39 121.3435 183.1600 introducer lead 9fr #6553 30.85 19.32 16.3505 24.6800 introducer lead 9fr long #6909 35.00 21.92 18.5500 28.0000 introducer-sorenson 60.15 37.67 31.8795 48.1200 introducer/diag 73.50 46.03 38.9550 58.8000 button plasma super pulse 3049.20 1909.71 1616.0760 2439.3600 c-wires 16.85 10.55 8.9305 13.4800 cable 2 x 8 441.55 276.54 234.0215 353.2400 cable surgical disp sm 12 ft 167.75 105.06 88.9075 134.2000 ipasiii diamond accessory inst 495.00 310.02 262.3500 396.0000 irr starter set-7722-box 78.65 49.26 41.6845 62.9200 irrigation tubing 137.55 86.15 72.9015 110.0400 catheter mallecot 24.05 15.06 12.7465 19.2400 catheter multi-lumen cvc #162 296.40 185.64 157.0920 237.1200 catheter phillips flwer12#2587 40.85 25.58 21.6505 32.6800 catheter phillips flwer14#2588 49.55 31.03 26.2615 39.6400 catheter phillips flwer16#2755 40.85 25.58 21.6505 32.6800 catheter phillips flwer18#2586 40.85 25.58 21.6505 32.6800 catheter phillips flwer20#1775 40.85 25.58 21.6505 32.6800 catheter phillips flwer22 #563 42.90 26.87 22.7370 34.3200 catheter pigtail xr 44.90 28.12 23.7970 35.9200 catheter sinus balloon 011075 1140.62 714.37 604.5286 912.4960 catheter sinus balloon 011076 1140.62 714.37 604.5286 912.4960 catheter sub-claven-ea 31.30 19.60 16.5890 25.0400 catheter suction-ea 3.55 2.22 1.8815 2.8400 cath set percut 14.0 spub 9386 165.55 103.68 87.7415 132.4400 cath tray a 20.15 12.62 10.6795 16.1200 catheter ivad 6fr tray 623.00 390.18 330.1900 498.4000 catheter ivad 8.5fr tray 593.30 371.58 314.4490 474.6400 catheter trocar 10fr #5285 48.50 30.38 25.7050 38.8000 catheter trocar 16fr 26.70 16.72 14.1510 21.3600 catheter trocar 16fr #4713 48.50 30.38 25.7050 38.8000 cath,bipolar,pacing,fr.5 149.50 93.63 79.2350 119.6000 cath-biliary irrig 66.65 41.74 35.3245 53.3200 cath-coude-vactrol 14tr 5.90 3.70 3.1270 4.7200 catheter 2-way foley 30cc 31.30 19.60 16.5890 25.0400 catheter coude straight 26.65 16.69 14.1245 21.3200 catheter coude-foley 39.75 24.90 21.0675 31.8000 catheter epidural 20x36 42.00 26.30 22.2600 33.6000 catheter ez-cath-ea 28.10 17.60 14.8930 22.4800 catheter filiform olive3fr1774 26.55 16.63 14.0715 21.2400 catheter filiform olive4fr1740 26.55 16.63 14.0715 21.2400 catheter filiform olive5fr3079 26.55 16.63 14.0715 21.2400 catheter filiform olive6fr4692 26.55 16.63 14.0715 21.2400 catheter filiform sprl3fr#2252 31.20 19.54 16.5360 24.9600 catheter filiform sprl4fr#1773 31.20 19.54 16.5360 24.9600 catheter filiform sprl5fr#1390 31.20 19.54 16.5360 24.9600 catheter fogarty irrigat 69.50 43.53 36.8350 55.6000 catheter foley 3 way 30cc 52.45 32.85 27.7985 41.9600 catheter foley 5cc 28.00 17.54 14.8400 22.4000 jejunal feeding tube 480.10 300.69 254.4530 384.0800 jejunostomy kit 79.50 49.79 42.1350 63.6000 jelenko arch bar 46.70 29.25 24.7510 37.3600 jet-lavage orifice tip 15.85 9.93 8.4005 12.6800 jewett ostomy plates 262.80 164.59 139.2840 210.2400 ivas system kit 10g 10mm 1378.65 863.45 730.6845 1102.9200 ivas system kit 10g 15mm 1378.65 863.45 730.6845 1102.9200 cath foley 2-way 3cc/ea 28.10 17.60 14.8930 22.4800 cath irrigation set 25.75 16.13 13.6475 20.6000 cath olive tup w/pugtail 30.70 19.23 16.2710 24.5600 jumbo snare-endo do not inac 102.45 64.16 54.2985 81.9600 k-wire 74.25 46.50 39.3525 59.4000 k-wire 1.2x150mm(not implant) 57.15 35.79 30.2895 45.7200 k-wire 1.6mm 209.65 131.30 111.1145 167.7200 k-wire 10/10-70mm 107.55 67.36 57.0015 86.0400 k-wire 2.0x150mm(not inplant) 60.50 37.89 32.0650 48.4000 k-wire 2.5x120 w/stop 230.90 144.61 122.3770 184.7200 k-wire bayonet tip 2.0mm 75.50 47.29 40.0150 60.4000 k-wire blunt #010867 230.90 144.61 122.3770 184.7200 k-wire spinal bevel tip#010950 201.60 126.26 106.8480 161.2800 k-wire standard 40.35 25.27 21.3855 32.2800 kamvac mini suction tube 77.90 48.79 41.2870 62.3200 pain relief system 339.88 212.86 180.1364 271.9040 pak needle 349.45 218.86 185.2085 279.5600 paracentesis tray 115.30 72.21 61.1090 92.2400 parachute basket o tip #4647 450.30 282.02 238.6590 360.2400 passer suture 45 degree 437.30 273.88 231.7690 349.8400 passer suture braided loop sz2 133.10 83.36 70.5430 106.4800 passer suture cartridge 427.45 267.71 226.5485 341.9600 passing elevator 94.10 58.93 49.8730 75.2800 pasta repair kit 2465.00 1543.83 1306.4500 1972.0000 pacemaker tray 85.10 53.30 45.1030 68.0800 eye cataract knife blade 34.20 21.42 18.1260 27.3600 eye irrigation tray 19.95 12.49 10.5735 15.9600 eye ocutome pack 202.55 126.86 107.3515 162.0400 p.e.g.tray 334.55 209.53 177.3115 267.6400 pack back table cover 5.60 3.51 2.9680 4.4800 pack basic 6.75 4.23 3.5775 5.4000 pack c-section 108.20 67.77 57.3460 86.5600 pack cysto 14.10 8.83 7.4730 11.2800 pack delivery room 34.80 21.80 18.4440 27.8400 pack eent 14.70 9.21 7.7910 11.7600 pack laporoscopy 19.85 12.43 10.5205 15.8800 pack ortho lower extremity 41.65 26.09 22.0745 33.3200 pack shoulder 175.90 110.17 93.2270 140.7200 pack trans lap 16.10 10.08 8.5330 12.8800 packing nasal sinus 4x4cm 239.40 149.94 126.8820 191.5200 pad arthroscopic 20.60 12.90 10.9180 16.4800 express fracturekit10/2 010813 4873.40 3052.21 2582.9020 3898.7200 express fracturekit10/2 010814 4809.05 3011.91 2548.7965 3847.2400 express introducer sz 3 010820 1313.85 822.86 696.3405 1051.0800 extractor proximate 14.70 9.21 7.7910 11.7600 extractor retrieval balloon 275.80 172.73 146.1740 220.6400 gavage set 8 fr 8.70 5.45 4.6110 6.9600 gelport laparoscopic system 804.95 504.14 426.6235 643.9600 gentle touch 1-3/4 #1666 14.65 9.18 7.7645 11.7200 gentle touch 2-3/4 #2748 16.65 10.43 8.8245 13.3200 gentle touch 4 #2453 30.42 19.05 16.1226 24.3360 gia 60 368.15 230.57 195.1195 294.5200 gia 80 448.25 280.74 237.5725 358.6000 gia reload 60 149.80 93.82 79.3940 119.8400 gia reload 80 222.55 139.38 117.9515 178.0400 flexiflo pump set 19.40 12.15 10.2820 15.5200 flexiseal signal fecal mgt kit 470.10 294.42 249.1530 376.0800 flip cutter 3 drill 846.05 529.88 448.4065 676.8400 flip cutter 8.5mm-not implant 719.80 450.81 381.4940 575.8400 flip cutter 9.5mm 572.80 358.74 303.5840 458.2400 flipcutter 10mm 719.80 450.81 381.4940 575.8400 flipcutter 8mm 572.80 358.74 303.5840 458.2400 flipcutter 9mm 354.80 222.21 188.0440 283.8400 flipcutter iii 846.05 529.88 448.4065 676.8400 floseal 1630.70 1021.31 864.2710 1304.5600 flatus catch-ea 5.25 3.29 2.7825 4.2000 flex reamer w/guide pin 10mm 749.30 469.29 397.1290 599.4400 flex tightrope drill pin 499.50 312.84 264.7350 399.6000 pedicle acess disposable kit 1176.55 736.87 623.5715 941.2400 floseal matrix sealant #6253 441.15 276.29 233.8095 352.9200 flowtron knee cmprssionlg#7192 23.05 14.44 12.2165 18.4400 food bolus net 251.50 157.51 133.2950 201.2000 forcep biopsy 008571 (yf) 36.50 22.86 19.3450 29.2000 forcep biopsy multibite dispos 109.90 68.83 58.2470 87.9200 forcep biopsy rad jaw lg#8571 28.70 17.97 15.2110 22.9600 forcep biopsy rad jaw max#9421 67.25 42.12 35.6425 53.8000 forcep endowrist 8mm 3931.20 2462.11 2083.5360 3144.9600 forcep endowrist prograsp 8mm 3931.20 2462.11 2083.5360 3144.9600 forcep grasp mini prong #5001 439.80 275.45 233.0940 351.8400 forcep surg fenestrated 4076.80 2553.30 2160.7040 3261.4400 forcep surg maryland bipolar 4790.25 3000.13 2538.8325 3832.2000 on-q post-op pain relief #7066 282.25 176.77 149.5925 225.8000 on-q post-op pain rlf sys#7288 426.66 267.22 226.1298 341.3280 on-q post-op pain rlf sys#9066 400.60 250.90 212.3180 320.4800 one step introducer sz3 010819 1300.50 814.50 689.2650 1040.4000 olive wire 132.00 82.67 69.9600 105.6000 encore 26 inflation device 206.95 129.61 109.6835 165.5600 end cap 194.45 121.78 103.0585 155.5600 endo avitene 10mm #3532 251.60 157.58 133.3480 201.2800 endo clip 256.37 160.56 135.8761 205.0960 opening drill 5.5mm 782.60 490.14 414.7780 626.0800 opening drill bit reamer 2462.45 1542.23 1305.0985 1969.9600 ophthalmic dilation microcath 1054.40 660.37 558.8320 843.5200 ophthalmic knife pack 119.85 75.06 63.5205 95.8800 optimesh portal tube 435.80 272.94 230.9740 348.6400 optivac vacuum mixing kit#9605 421.20 263.80 223.2360 336.9600 opus m-connector #10065 403.20 252.52 213.6960 322.5600 opus smart stitch #10088 483.55 302.85 256.2815 386.8400 or cable 383.05 239.90 203.0165 306.4400 orthopedic suction tube 41.85 26.21 22.1805 33.4800 oscill sawblade 1.35mm fan str 146.65 91.85 77.7245 117.3200 oscillating saw large bone 66.65 41.74 35.3245 53.3200 osteotomy kit accu cut #7590 169.40 106.10 89.7820 135.5200 ess balloon catheter handle 177.60 111.23 94.1280 142.0800 ess balloon inflation device 240.75 150.78 127.5975 192.6000 ess balloon sinuplasty product 2815.80 1763.54 1492.3740 2252.6400 owens gauze 5.40 3.38 2.8620 4.3200 esi kit-disposable 14.95 9.36 7.9235 11.9600 evac fltr trilumen w/airseal 231.10 144.74 122.4830 184.8800 evacuator bladder w/adapter 48.50 30.38 25.7050 38.8000 evacuator drain kit 400ml 22.90 14.34 12.1370 18.3200 exacto cold snare 66.55 41.68 35.2715 53.2400 exchange transfusion tray 87.50 54.80 46.3750 70.0000 hip joint access kit 420.50 263.36 222.8650 336.4000 holder surg needle drive 3822.00 2393.72 2025.6600 3057.6000 holder surg needle large 3712.80 2325.33 1967.7840 2970.2400 hydroflex irrigation 148.90 93.26 78.9170 119.1200 impact open oral lig 18cm 13mm 850.95 532.95 451.0035 680.7600 implate drill uncortical 3x41m 319.90 200.35 169.5470 255.9200 implate reamer 2,metacarpal 319.90 200.35 169.5470 255.9200 implate reamer 3,metacarpal 319.90 200.35 169.5470 255.9200 implate reamer1,metacarpal 319.90 200.35 169.5470 255.9200 implt system ligament bio kit 3110.00 1947.79 1648.3000 2488.0000 indermil 71.15 44.56 37.7095 56.9200 infant feeding device 15.95 9.99 8.4535 12.7600 infl bilary dilation ballon 191.10 119.69 101.2830 152.8800 bit drill quick mini 1.5x96mm 332.65 208.34 176.3045 266.1200 bit drill quick relese 3mmx5in 326.55 204.52 173.0715 261.2400 bit drill scaled 2x135mm 381.00 238.62 201.9300 304.8000 bit drill scaled ao 2.6x135mm 352.15 220.55 186.6395 281.7200 bit drill spnl sys 16mm 128.00 80.17 67.8400 102.4000 bit drill surgibit 3.5mm 314.20 196.78 166.5260 251.3600 bit drill tri-flat 128.00 80.17 67.8400 102.4000 bit drill twist 1.5x50 304.15 190.49 161.1995 243.3200 bit drill twist 3.8mm 217.75 136.38 115.4075 174.2000 bit drill twist 7mm 1.1x50mm 278.50 174.42 147.6050 222.8000 bit drill twist 7mm stop 1.5x5 304.15 190.49 161.1995 243.3200 bit drill twist j latch 1.5x50 278.50 174.42 147.6050 222.8000 bit drill twist w/notch 278.50 174.42 147.6050 222.8000 bit twist drill 1.1x50mm 278.50 174.42 147.6050 222.8000 bitdrill twistw/notch 5mm stop 289.65 181.41 153.5145 231.7200 bladder evacuator 50.55 31.66 26.7915 40.4400 blade long med tps #5627 95.05 59.53 50.3765 76.0400 blade long medium (tps) 24.50 15.34 12.9850 19.6000 blade long narrow (tps) 24.50 15.34 12.9850 19.6000 blade long narrow tps #5626 90.50 56.68 47.9650 72.4000 blade long narrow tps #5629 95.05 59.53 50.3765 76.0400 blade medium (tps) 18.80 11.77 9.9640 15.0400 blade medium narrow (tps) 24.50 15.34 12.9850 19.6000 blade medium tps #5624 95.05 59.53 50.3765 76.0400 blade micro fne 18.10 11.34 9.5930 14.4800 blade micro sagittal 18.05 11.30 9.5665 14.4400 blade mill medium 444.90 278.64 235.7970 355.9200 blade mini 2,9 abrader #4659 185.50 116.18 98.3150 148.4000 blade mini 2.9 full rad #4658 142.50 89.25 75.5250 114.0000 blade mini beaver #64 #1239 94.65 59.28 50.1645 75.7200 blade mini beaver #69 #1238 84.30 52.80 44.6790 67.4400 blade nail 105mm titanium 768.60 481.37 407.3580 614.8800 blade nail intramed 90mm 799.35 500.63 423.6555 639.4800 blade notchblaster 5.5 #1425 117.80 73.78 62.4340 94.2400 blade orbit full rad 4.2 #7471 161.30 101.02 85.4890 129.0400 blade orbit incsr 4.4 crv#4747 164.05 102.74 86.9465 131.2400 blade oscillating 20.15 12.62 10.6795 16.1200 blade oscillating fine 18.80 11.77 9.9640 15.0400 blade oscillating #6133 25.15 15.75 13.3295 20.1200 blade oscillating #6560 25.15 15.75 13.3295 20.1200 blade oscillating fine #5870 25.15 15.75 13.3295 20.1200 blade oscillating flat fine 18.80 11.77 9.9640 15.0400 blade oscillating large bone 107.55 67.36 57.0015 86.0400 blade oscillating micro 18.80 11.77 9.9640 15.0400 blade oscillating micro #5979 25.15 15.75 13.3295 20.1200 blade oscillator #010886 37.65 23.58 19.9545 30.1200 blade osteotome 25mm 381.70 239.06 202.3010 305.3600 blade plantor #6750 204.35 127.98 108.3055 163.4800 blade rasp lrg #5698 307.50 192.59 162.9750 246.0000 blade rasp sm #5630 307.50 192.59 162.9750 246.0000 blade recip long #6760 124.45 77.94 65.9585 99.5600 blade recip. long 33.55 21.01 17.7815 26.8400 blade reciprocator 19.55 12.24 10.3615 15.6400 blade reciprocator #010885 26.90 16.85 14.2570 21.5200 blade sagittal #6090 25.15 15.75 13.3295 20.1200 blade sagittal micro #6246 23.95 15.00 12.6935 19.1600 blade sagittal micro fine 18.80 11.77 9.9640 15.0400 blade satin split 2.75mm #9996 56.80 35.57 30.1040 45.4400 blade saw 100 #2529 79.26 49.64 42.0078 63.4080 blade saw 110 #2059 79.26 49.64 42.0078 63.4080 blade saw 115 #2531 79.26 49.64 42.0078 63.4080 blade saw 155 #2530 79.26 49.64 42.0078 63.4080 blade saw recip 11x77.5x1.23mm 76.70 48.04 40.6510 61.3600 blade saw recip hd 74.06 106.40 66.64 56.3920 85.1200 blade saw sag 1.27x73x12.5mm 65.30 40.90 34.6090 52.2400 blade saw sag 79.5x12.5x1.27 64.00 40.08 33.9200 51.2000 blade saw sag 90mm l 1.27mm t 149.80 93.82 79.3940 119.8400 blade saw sag 90mm length 136.20 85.30 72.1860 108.9600 blade saw sag micro fine #5034 22.40 14.03 11.8720 17.9200 blade saw small bone 18x5.5 23.30 14.59 12.3490 18.6400 blade saw surgical #6761 103.85 65.04 55.0405 83.0800 blade screwdriver ao t10 542.70 339.89 287.6310 434.1600 blade screwdriver ao t8 542.70 339.89 287.6310 434.1600 blade shaver 2.9mm 330.25 206.84 175.0325 264.2000 blade shaver mesh 6.5mm ster 595.90 373.21 315.8270 476.7200 blade short narrow (tps) 173.05 108.38 91.7165 138.4400 blade short narrow tps #5628 95.05 59.53 50.3765 76.0400 blade shrill bone abraser 546.55 342.30 289.6715 437.2400 blade shrill bone cutter 568.40 355.99 301.2520 454.7200 blade shrill bone trimmer 546.55 342.30 289.6715 437.2400 blade shrill diamond cutter 641.05 401.49 339.7565 512.8400 blade shrill tissue cutter 546.55 342.30 289.6715 437.2400 blade shrill tissue resector 546.55 342.30 289.6715 437.2400 blade shrill tissue trimmer 546.55 342.30 289.6715 437.2400 blade single use sterile 319.30 199.98 169.2290 255.4400 blade sinus 40d 4mm #6447 414.85 259.82 219.8705 331.8800 heimlich chest valve 18.05 11.30 9.5665 14.4400 helical basket #4999 447.40 280.21 237.1220 357.9200 helical basket pair wire #5513 447.40 280.21 237.1220 357.9200 hem-o-lok l 85.85 53.77 45.5005 68.6800 hem-o-lok ml 85.85 53.77 45.5005 68.6800 hemoclip 22.85 14.31 12.1105 18.2800 hemodialysis catheter 737.40 461.83 390.8220 589.9200 hemorroidal liagtor multiband 89.60 56.12 47.4880 71.6800 hemospary 7fr 220cm 1752.90 1097.84 929.0370 1402.3200 hemospray 10fr 220cm 1752.90 1097.84 929.0370 1402.3200 hemostatic clip device #9420 412.30 258.22 218.5190 329.8400 hemovacs 242.30 151.75 128.4190 193.8400 hex wrench 95.53 59.83 50.6309 76.4240 hexsnare 13mm 557.95 349.44 295.7135 446.3600 hexsnare 27mm 536.50 336.01 284.3450 429.2000 hip artho kit w/banana blade 595.50 372.96 315.6150 476.4000 peg driver fast 2.0mm 96.80 60.63 51.3040 77.4400 gloves ex ster sgls-ea 2.80 1.75 1.4840 2.2400 gloves surg sterile-pr 3.55 2.22 1.8815 2.8400 glycene-3000 ml 48.30 30.25 25.5990 38.6400 gold probe 341.05 213.60 180.7565 272.8400 gold probe 10fr #9621 358.55 224.56 190.0315 286.8400 gold probe 7fr #9622 391.55 245.23 207.5215 313.2400 gown surgeon 6.75 4.23 3.5775 5.4000 grafton gel dbm 10cc 1163.10 728.45 616.4430 930.4800 peg kit 20 fr #1769 196.95 123.35 104.3835 157.5600 peg kit 20 fr pull #9437 189.40 118.62 100.3820 151.5200 peg kit 24 fr #5424 196.95 123.35 104.3835 157.5600 electrode roller 24-48 fr 211.85 132.68 112.2805 169.4800 electrode sd needle recording 741.85 464.62 393.1805 593.4800 electrode subdermal 12mm 230.15 144.14 121.9795 184.1200 electrodes simplicity iii 545.50 341.65 289.1150 436.4000 emergency cirothyroidotomy kit 380.40 238.24 201.6120 304.3200 electrode premiere90 vapr 553.10 346.41 293.1430 442.4800 electrode resectn 24-28fr 7239 181.95 113.96 96.4335 145.5600 empimed coude 132.80 83.17 70.3840 106.2400 emtact septal stapler 380.50 238.31 201.6650 304.4000 endo egia handle standard#6605 259.95 162.81 137.7735 207.9600 endo egia60 articulating#10539 503.55 315.37 266.8815 402.8400 endo gia ii 45 3.5 blue #6602 427.65 267.84 226.6545 342.1200 endo gia long 266.45 166.88 141.2185 213.1600 endo gia long #7046 244.40 153.07 129.5320 195.5200 endo gia reload 390.10 244.32 206.7530 312.0800 endo gia reload 45 green #6603 211.55 132.49 112.1215 169.2400 endo gia rotic stplr red #8336 329.00 206.05 174.3700 263.2000 endo gia short 225.70 141.36 119.6210 180.5600 endo kit 533.00 333.82 282.4900 426.4000 endo linear cutter scb45 909.30 569.49 481.9290 727.4400 endo linear cutter scg45 774.40 485.01 410.4320 619.5200 endo linear reload 3.5 tr45b 445.95 279.30 236.3535 356.7600 edoclip 5mm 904.40 566.43 479.3320 723.5200 eea 1138.40 712.98 603.3520 910.7200 eea 25 1308.30 819.39 693.3990 1046.6400 eea 29 976.35 611.49 517.4655 781.0800 eea 33 976.35 611.49 517.4655 781.0800 echotip fiducial needle 749.30 469.29 397.1290 599.4400 elec fulgurating sht 3fr x 105 283.40 177.49 150.2020 226.7200 elect pr 4 chnl 12mm sterile 344.00 215.45 182.3200 275.2000 electrode 13mm 27g 1.5m 22.60 14.15 11.9780 18.0800 electrode autolith 460.15 288.19 243.8795 368.1200 electrode autolith 9fr #1528 395.50 247.70 209.6150 316.4000 electrode cylinder 24-28fr 435.30 272.63 230.7090 348.2400 electrode dual 1.5x2cm 2.5 61.35 38.42 32.5155 49.0800 electrode dual 13mm 27g 2.5m 59.70 37.39 31.6410 47.7600 electrode dual 13mm 27g 1.5m 51.65 32.35 27.3745 41.3200 electrode emg m5 monitoring sy 1253.10 784.82 664.1430 1002.4800 electrode internal h.p. 22.30 13.97 11.8190 17.8400 drill surgibit 2.0mm 190.15 119.09 100.7795 152.1200 drill surgibit 2.8mm 162.20 101.59 85.9660 129.7600 drill surgibit qr 2.8mm 262.80 164.59 139.2840 210.2400 drill tip 192.00 120.25 101.7600 153.6000 drill tip guide wire 2.5 x 300 203.60 127.51 107.9080 162.8800 drill twist 1.5mmx115mm 351.65 220.24 186.3745 281.3200 drill twist 4.0 mm diam 70mml 256.20 160.46 135.7860 204.9600 drill w/sleeve 1.4mm surelock 373.90 234.17 198.1670 299.1200 driver mini qc t-7 295.70 185.20 156.7210 236.5600 driver tip quick release 2mm 389.80 244.13 206.5940 311.8400 drl bit perph reunion 3.1mm 192.00 120.25 101.7600 153.6000 dry suction chest drain #7160 75.55 47.32 40.0415 60.4400 dtrax spinal system 2675.40 1675.60 1417.9620 2140.3200 dynanite nitinol staple w/ins 3110.00 1947.79 1648.3000 2488.0000 dynanite staple w/instr 18x18 4774.20 2990.08 2530.3260 3819.3600 dynanite staple w/instrument 2990.40 1872.89 1584.9120 2392.3200 ebb postpartum balloon 765.45 479.40 405.6885 612.3600 eclipse cage screw sizer 292.85 183.41 155.2105 234.2800 eclipse stimulated dilator set 704.05 440.95 373.1465 563.2400 ns vis adpt guide kit r side 720.50 451.25 381.8650 576.4000 novocut suture manager 230.40 144.30 122.1120 184.3200 novostitch plus 2-0 cartridge 600.50 376.09 318.2650 480.4000 octylseal 0.76 35.50 22.23 18.8150 28.4000 ocutome probe 278.25 174.27 147.4725 222.6000 nuxlif kit disposable #010943 1176.55 736.87 623.5715 941.2400 nvm5 needle module emg 1061.30 664.69 562.4890 849.0400 nvm5 xlif dilator kit 1061.30 664.69 562.4890 849.0400 nvm5 xlif disposable kit 1345.80 842.87 713.2740 1076.6400 drill bit fluted qc/145mm 480.50 300.94 254.6650 384.4000 drill bit graduated 2.5mm 324.80 203.42 172.1440 259.8400 drill bit long 4.0mm 292.75 183.35 155.1575 234.2000 drill bit long 4.7 mm 509.50 319.10 270.0350 407.6000 drill bit mini profile 403.20 252.52 213.6960 322.5600 drill bit qc/110mm 316.88 198.46 167.9464 253.5040 drill bit qc/145mm 480.50 300.94 254.6650 384.4000 drill bit qc/300mm/200mm cal. 460.50 288.41 244.0650 368.4000 drill bit qc/330mm 515.85 323.08 273.4005 412.6800 drill bit qc/330mm/100mm 567.85 355.64 300.9605 454.2800 drill bit three-fluted 2.7mm 361.40 226.34 191.5420 289.1200 drill bit twist j-latch 1.5mm 289.65 181.41 153.5145 231.7200 drill bit/qc/125mm 199.10 124.70 105.5230 159.2800 drill bit/qc/145mm 242.30 151.75 128.4190 193.8400 drill bit/qc/165mm 281.20 176.12 149.0360 224.9600 drill bit/qc/170mm 742.10 464.78 393.3130 593.6800 drill bit/qc/200mm 638.70 400.02 338.5110 510.9600 drill bit/qt/145mm 211.65 132.56 112.1745 169.3200 drill bits not implant 318.00 199.16 168.5400 254.4000 drill bits pass #3320 39.15 24.52 20.7495 31.3200 drill cannulated 3.8mm 444.15 278.17 235.3995 355.3200 drill fixed 2.3x12mm 268.80 168.35 142.4640 215.0400 drill fixed 2.3x14mm 268.80 168.35 142.4640 215.0400 drill for fibertal 1.6mm 384.00 240.50 203.5200 307.2000 drill hand m8g 7.75 300.80 188.39 159.4240 240.6400 drill long 430.55 269.65 228.1915 344.4400 drill long mini 487.60 305.38 258.4280 390.0800 drill micro 2r ext long 428.00 268.06 226.8400 342.4000 drill polarius 2.8mm 247.60 155.07 131.2280 198.0800 drill quick release 2.0 x 5 155.95 97.67 82.6535 124.7600 drill quick release 2.3mm 262.80 164.59 139.2840 210.2400 drill short 4.5mm 420.55 263.39 222.8915 336.4400 drill short sa 3.0mm 430.55 269.65 228.1915 344.4400 nav balloon sinuplasty system 3931.20 2462.11 2083.5360 3144.9600 navigatr accss shth11/13 #9423 304.60 190.77 161.4380 243.6800 ndl anes stim shot 21ga x 90mm 442.95 277.42 234.7635 354.3600 ndl biopsy polished 18gax25cm 68.38 42.83 36.2414 54.7040 ndlbiopsy bonedevicesz2 010817 345.30 216.26 183.0090 276.2400 ndle nerve blck set 18gax100mm 91.20 57.12 48.3360 72.9600 myra collar tubes 25.10 15.72 13.3030 20.0800 myringotomy disp blade 10.80 6.76 5.7240 8.6400 myringotomy tubes/each 16.70 10.46 8.8510 13.3600 nail cann. tibial 345mm-s 2601.85 1629.54 1378.9805 2081.4800 nasal dressing/packing 83.45 52.26 44.2285 66.7600 needle 10g verteport long 131.15 82.14 69.5095 104.9200 needle 4 inch 283.85 177.78 150.4405 227.0800 needle 8g dbl diamond tip 461.80 289.23 244.7540 369.4400 needle and suture capture firs 704.05 440.95 373.1465 563.2400 needle aspir bone 8ga x 6in 260.95 163.43 138.3035 208.7600 needle aspiration slimline 19 3478.90 2178.84 1843.8170 2783.1200 needle aspiration slimline 22 525.70 329.25 278.6210 420.5600 needle aspiration slimline 25 1645.50 1030.58 872.1150 1316.4000 needle biopsy bone marrow 8ga 325.50 203.86 172.5150 260.4000 needle conf intro 13g 6 239.25 149.84 126.8025 191.4000 needle echolong 18gax 100mm 81.70 51.17 43.3010 65.3600 needle endoscopic slimline 19 746.55 467.56 395.6715 597.2400 needle endoscopic slimline 22 1711.30 1071.79 906.9890 1369.0400 needle endoscopic slimline 25 525.70 329.25 278.6210 420.5600 needle endoscopic slimline 9ga 1711.30 1071.79 906.9890 1369.0400 needle endoscopic ultra 19ga 505.50 316.59 267.9150 404.4000 needle insertion 6.5 275.55 172.58 146.0415 220.4400 needle ipas iii #010946 520.10 325.74 275.6530 416.0800 needle jamshidi 10g 5#010866 201.60 126.26 106.8480 161.2800 needle jamshidi 11g # 010882 201.60 126.26 106.8480 161.2800 needle localizer kopan5.0#1764 60.70 38.02 32.1710 48.5600 needle localizer kopan7.0#9196 58.35 36.54 30.9255 46.6800 needle localizer kopan9.0#2814 60.70 38.02 32.1710 48.5600 needle localzer kpn 15.0#10219 58.35 36.54 30.9255 46.6800 needle nerve stimulator #5673 22.83 14.30 12.0999 18.2640 needle nv electrode disposable 1261.18 789.87 668.4254 1008.9440 needle scorpion #7793 391.40 245.13 207.4420 313.1200 needle sheath set 210.90 132.09 111.7770 168.7200 needle suture passer 482.05 301.91 255.4865 385.6400 needle,sclerotherapy 391.80 245.38 207.6540 313.4400 needle-jamshidi biopsy 41.75 26.15 22.1275 33.4000 needle-rotator cuff surfire 358.40 224.47 189.9520 286.7200 needle/clip diamond tip 467.55 292.83 247.8015 374.0400 needles 5 inch 283.85 177.78 150.4405 227.0800 neurostimulator wireless 426.90 267.37 226.2570 341.5200 neurovision kit disposable 1176.55 736.87 623.5715 941.2400 novastitch plus menis rpr sys 719.00 450.31 381.0700 575.2000 nicroknife xl needle 357.45 223.87 189.4485 285.9600 non heat cutter/coagulator 419.00 262.42 222.0700 335.2000 non-ionic kit 175.45 109.88 92.9885 140.3600 non-ionic procedure kit 110.40 69.14 58.5120 88.3200 needle bone marrow 8gax15cm 284.70 178.31 150.8910 227.7600 needle bone marrow apir kit 192.00 120.25 101.7600 153.6000 needle bone marrow bx 8gx6in 93.10 58.31 49.3430 74.4800 nerve block set continuous 164.15 102.81 86.9995 131.3200 nerve locator 515.30 322.73 273.1090 412.2400 nerve stimulator needle 67.45 42.24 35.7485 53.9600 ligasure 18.8cm inst divid/sea 688.50 431.21 364.9050 550.8000 ligasure atlas 30cmd 630.15 394.66 333.9795 504.1200 ligasure atlas20cm ls1020#7068 620.35 388.53 328.7855 496.2800 ligasure laporsc slr/div #7122 612.55 383.64 324.6515 490.0400 ligasure max (cord) 511.70 320.48 271.2010 409.3600 ligasure precise 557.55 349.19 295.5015 446.0400 ligasure v 5mm 729.35 456.79 386.5555 583.4800 introducer lead 10fr #3126 29.65 18.57 15.7145 23.7200 introducer lead 11fr #2729 29.65 18.57 15.7145 23.7200 introducer lead 7fr #6552 29.65 18.57 15.7145 23.7200 introducer lead 8fr #5209 29.65 18.57 15.7145 23.7200 lead temp pace w/intro 240.85 150.84 127.6505 192.6800 legato probe 761.50 476.93 403.5950 609.2000 intermittent caps 2.80 1.75 1.4840 2.2400 interceed 280.90 175.93 148.8770 224.7200 introducer 117.75 73.75 62.4075 94.2000 light source 367.95 230.45 195.0135 294.3600 lithotriptor #7714 559.06 350.14 296.3018 447.2480 loop ostomy starter 30.80 19.29 16.3240 24.6400 low profile g tube 244.95 153.41 129.8235 195.9600 low profile gastrostomy set 479.45 300.28 254.1085 383.5600 low profile gastrostomy tube 385.50 241.44 204.3150 308.4000 ligator band six shooter 446.15 279.42 236.4595 356.9200 light cord disposable #010868 651.55 408.07 345.3215 521.2400 light illuminator blunt 720.50 451.25 381.8650 576.4000 linear cutter ec60 849.30 531.92 450.1290 679.4400 linear cutter reload ec60 546.20 342.09 289.4860 436.9600 guidewire 3.2x300mm 329.05 206.08 174.3965 263.2400 guidewire bio compression scre 27.95 17.51 14.8135 22.3600 guidewire blint tip 268.80 168.35 142.4640 215.0400 guidewire cann non-thrd 1.25mm 68.43 42.85 36.2679 54.7440 guidewire mini 1.1mm threaded 78.00 48.85 41.3400 62.4000 guidewire mini acutrak 035x6 28.20 17.66 14.9460 22.5600 guidewire nitinol 495x1.4mm 146.65 91.85 77.7245 117.3200 guidewire ortho 1.4x50mm 94.30 59.06 49.9790 75.4400 guidewire orthopedic 0.062in d 39.95 25.02 21.1735 31.9600 guidewire orthopedic 2.8mm d 106.40 66.64 56.3920 85.1200 guidewire orthopedic 2mm 42.65 26.71 22.6045 34.1200 guidewire orthopedic 3.2x290mm 217.05 135.94 115.0365 173.6400 guidewire pleuristik nanofx 440.45 275.85 233.4385 352.3600 guidewire threaded 1.1x150mm 73.95 46.31 39.1935 59.1600 guidewire tip 0.094in 57.25 35.86 30.3425 45.8000 guidewire w/trocar tip 2x200mm 95.85 60.03 50.8005 76.6800 gwire pilot reunion 15.5in 76.80 48.10 40.7040 61.4400 hand control pencil 56.70 35.51 30.0510 45.3600 harmonic scalpel ace23e #7694 659.90 413.30 349.7470 527.9200 harmonic scalpel ace36e #7403 757.95 474.70 401.7135 606.3600 harmonic scalpel long 751.10 470.41 398.0830 600.8800 harmonic scalpel short 692.20 433.52 366.8660 553.7600 harris uterine injector 98.10 61.44 51.9930 78.4800 guide pins mgs 114.50 71.71 60.6850 91.6000 guide rod 3mm od x 950mm len 275.80 172.73 146.1740 220.6400 guide rod w/stop 2.5mm 66.35 41.56 35.1655 53.0800 guide sizing implant 99.85 62.54 52.9205 79.8800 guide wire 2.0 x 230mm 128.00 80.17 67.8400 102.4000 guidewire .86 88.10 55.18 46.6930 70.4800 guidewire 1.1mm 88.10 55.18 46.6930 70.4800 guidewire 1.25x150mm 81.35 50.95 43.1155 65.0800 hawkins cn set 209.05 130.93 110.7965 167.2400 filter,redi flow 68.50 42.90 36.3050 54.8000 infusion set w/ y 20 x 0.75 19.15 11.99 10.1495 15.3200 infusion set w/ y 20 x 1in 19.15 11.99 10.1495 15.3200 injection cannula for tfna 618.70 387.49 327.9110 494.9600 injector disposable 25ga 7fr 74.55 46.69 39.5115 59.6400 inserter tip f/large-long 293.55 183.85 155.5815 234.8400 inst stapler endowrist 45mm 372.75 233.45 197.5575 298.2000 insta-trak aspirator 190.05 119.03 100.7265 152.0400 instra-mag-drape 16x20 37.75 23.64 20.0075 30.2000 instrument bb-tak 189.02 118.38 100.1806 151.2160 mouthpiece (niox) 18.70 11.71 9.9110 14.9600 mpfl impant system 3123.75 1956.40 1655.5875 2499.0000 msg 3.0 drill bit sterile 515.50 322.86 273.2150 412.4000 multilead accessory kit 441.55 276.54 234.0215 353.2400 multilead trial cable 441.55 276.54 234.0215 353.2400 multi band mucsoectomy kit 450.50 282.15 238.7650 360.4000 midas rex 3mmx14cm bur 311.20 194.90 164.9360 248.9600 midas rex drill 316.60 198.29 167.7980 253.2800 midas rex irrigation set 531.45 332.85 281.6685 425.1600 midas rex mr8-2.5mm 302.85 189.67 160.5105 242.2800 midas rex mr8-3.0mm 302.85 189.67 160.5105 242.2800 midas rex screw 2.1cn 382.65 239.65 202.8045 306.1200 milling bit disposable 510.00 319.41 270.3000 408.0000 milling bit/s 2.0mm disposable 510.00 319.41 270.3000 408.0000 mini-acutrak 2 drill 436.60 273.44 231.3980 349.2800 minimally invasive disposable 2066.50 1294.25 1095.2450 1653.2000 micro-acutrak 2 drill 436.60 273.44 231.3980 349.2800 micro-acutrak 2 drill,long 461.40 288.97 244.5420 369.1200 microknife xl needle knife dis 393.45 246.42 208.5285 314.7600 mix bowl&spatula, ster, dis 23.40 14.66 12.4020 18.7200 mixer, vaccuum mix w/syrn 398.10 249.33 210.9930 318.4800 mod knee compress dress 41.60 26.05 22.0480 33.2800 molded perfect scalpel 441.55 276.54 234.0215 353.2400 monitoring kit-sorenson 49.75 31.16 26.3675 39.8000 monolith lithotriptor 624.25 390.97 330.8525 499.4000 montgomery strap-ea 4.80 3.01 2.5440 3.8400 maxcess 4 kit 1820.00 1139.87 964.6000 1456.0000 maxcess iv shim kit disposable 1946.90 1219.34 1031.8570 1557.5200 measuring probe 60 degrees 526.80 329.93 279.2040 421.4400 lsc electrode 108.80 68.14 57.6640 87.0400 lsr fiber flexiva trac tip 200 673.90 422.06 357.1670 539.1200 lumbar puncture adult/ped 74.30 46.53 39.3790 59.4400 lumbar puncture kit adult/ped 92.55 57.96 49.0515 74.0400 maternity care kit 56.60 35.45 29.9980 45.2800 matrix hemostatic floseal 5ml 449.50 281.52 238.2350 359.6000 matrix hemostatic surgiflo 8mm 299.60 187.64 158.7880 239.6800 meniscal dart shth w/can #8871 239.25 149.84 126.8025 191.4000 meniscal dartstick 10mm #9597 335.40 210.06 177.7620 268.3200 meniscal dartstick 12mm #9596 352.20 220.58 186.6660 281.7600 meniscal mender #8893 373.30 233.80 197.8490 298.6400 meniscus blade 9.75 6.11 5.1675 7.8000 mep electrode stimulator kit 588.75 368.73 312.0375 471.0000 merogel nasal packing 167.10 104.65 88.5630 133.6800 medullary vent tubing 16.20 10.15 8.5860 12.9600 membrane sheet amniotic 590.50 369.83 312.9650 472.4000 mesh teflon sterile 6x9 214.80 134.53 113.8440 171.8400 bit drill cann dhs/dcs 16mm 895.90 561.10 474.8270 716.7200 bit drill cann flex 13mm 825.85 517.23 437.7005 660.6800 bit drill cann quickfix 1.7mm 395.50 247.70 209.6150 316.4000 bit drill cannulated 2.5mm 411.30 257.60 217.9890 329.0400 bit drill coupling 161.90 101.40 85.8070 129.5200 bit drill coupling 2.4x100mm 332.30 208.12 176.1190 265.8400 bit drill coupling 5mmd 356mml 430.30 269.50 228.0590 344.2400 bit drill coupling 5mmd/330mml 482.30 302.06 255.6190 385.8400 bit drill dist screw 2.7mm 384.00 240.50 203.5200 307.2000 bit drill fixed 12mm 128.00 80.17 67.8400 102.4000 bit drill fixed 14mm 128.00 80.17 67.8400 102.4000 bit drill flex 16mm 1024.40 641.58 542.9320 819.5200 bit drill flipcutter 10mm 545.50 341.65 289.1150 436.4000 bit drill fluted 4.22d 145mm l 441.50 276.51 233.9950 353.2000 bit drill glenoid w/stop bigli 295.70 185.20 156.7210 236.5600 bit drill jacobs 165mm length 527.75 330.53 279.7075 422.2000 bit drill lag 2.7mm 276.90 173.42 146.7570 221.5200 bit drill locking 2.5x216mm 431.50 270.25 228.6950 345.2000 bit drill locking 3.1x216mm 428.40 268.31 227.0520 342.7200 bit drill long 7.5mm 509.50 319.10 270.0350 407.6000 bit drill mini 14 0.76x44.5 331.20 207.43 175.5360 264.9600 bit drill mini 1x50mm 166.15 104.06 88.0595 132.9200 bit drill non-sterile 95mm 389.80 244.13 206.5940 311.8400 bit drill overdrill 3.5x122mm 352.90 221.02 187.0370 282.3200 bit drill quick coupling 2.4mm 415.85 260.45 220.4005 332.6800 bit drill quick coupling 4.5mm 222.10 139.10 117.7130 177.6800 bit drill quick mini 1.5x65mm 166.35 104.19 88.1655 133.0800 blunt guidewire 201.60 126.26 106.8480 161.2800 blunt kwire 143.60 89.94 76.1080 114.8800 blunt tip balloon trocar 341.45 213.85 180.9685 273.1600 bobbin tubes 16.15 10.11 8.5595 12.9200 alcohol preps med/box 10.35 6.48 5.4855 8.2800 alcohol swab/pk 2.35 1.47 1.2455 1.8800 anchor sut reload no2 38in 496.50 310.96 263.1450 397.2000 amniocentesis tray young 88.55 55.46 46.9315 70.8400 amniograft 600.90 376.34 318.4770 480.7200 alveograf durapatite 86.70 54.30 45.9510 69.3600 5-10mm single site cann seal 39.95 25.02 21.1735 31.9600 5.0 aggressive plus 282.80 177.12 149.8840 226.2400 5.0 round barrel bur 12fl 483.40 302.75 256.2020 386.7200 5.0 round bur 12fl 130.10 81.48 68.9530 104.0800 5.0x19cm burr 135.20 84.68 71.6560 108.1600 5.5 barrel bur 12fl 297.45 186.29 157.6485 237.9600 5.5 full radius resector 123.15 77.13 65.2695 98.5200 5.5 full-radious resector 451.75 282.93 239.4275 361.4000 5.5 round bur 12fl 297.45 186.29 157.6485 237.9600 5.5 round bur 6fl 483.40 302.75 256.2020 386.7200 50-s 315.80 197.79 167.3740 252.6400 50-s probe artho 328.10 205.49 173.8930 262.4800 4.2mmx19cm curved shaver 169.00 105.84 89.5700 135.2000 4.3mm drill bit 693.00 434.03 367.2900 554.4000 4.5 angled aggressive plus 304.83 190.91 161.5599 243.8640 4.5 angled resector 304.18 190.50 161.2154 243.3440 4.5mm cannulated drill 358.40 224.47 189.9520 286.7200 4.0 barrel bur 12fl 297.45 186.29 157.6485 237.9600 4.0 cannulated bit drill 379.20 237.49 200.9760 303.3600 4.0 round bur 12fl 464.80 291.10 246.3440 371.8400 4.0mm three-fluted drill bits 384.95 241.09 204.0235 307.9600 5mm sing site cadiere grasper 346.10 216.76 183.4330 276.8800 5mm sing site fundus grasper 346.10 216.76 183.4330 276.8800 5mm sing site mrylnd dissector 346.10 216.76 183.4330 276.8800 5mm sing site suction irrigat 79.85 50.01 42.3205 63.8800 5mm single site cautery hook 385.30 241.31 204.2090 308.2400 5mm single site clip applicat 53.26 33.36 28.2278 42.6080 5f dual lumen powerpicc 322.60 202.04 170.9780 258.0800 5f triple lumen powerpicc 394.30 246.95 208.9790 315.4400 5mm blunt tip ligasure 37cm l 708.45 443.70 375.4785 566.7600 60cc syringe/gauge assembly 66.15 41.43 35.0595 52.9200 bone bpsy device pcksz3 010816 258.80 162.09 137.1640 207.0400 bit drill 7.5mm 509.50 319.10 270.0350 407.6000 bit drill 7mm stop 278.50 174.42 147.6050 222.8000 bit drill 9.5mm miltiloc 478.10 299.43 253.3930 382.4800 bit drill ankle fracture 2.7mm 226.30 141.73 119.9390 181.0400 bit drill cann 10mm single use 709.30 444.23 375.9290 567.4400 bit drill cann 11mm d/280mm l 645.75 404.43 342.2475 516.6000 bit drill cann 12x270mm 649.05 406.50 343.9965 519.2400 bit drill cann 2.1mm single 400.00 250.52 212.0000 320.0000 bit drill cann 4.5x170mm 600.00 375.78 318.0000 480.0000 bit drill cann 6x15mm 410.50 257.10 217.5650 328.4000 bit drill cann 7.3mm w/2.9mm 599.40 375.40 317.6820 479.5200 bit drill cann ao 2.7mm 470.75 294.83 249.4975 376.6000 bit bne chuck skyline 16mm 128.00 80.17 67.8400 102.4000 bit drill 2.5mm diameter 210.35 131.74 111.4855 168.2800 bit drill 2.5mm trabecular rvr 293.30 183.69 155.4490 234.6400 bit drill 2.7mm d 100mm l 168.40 105.47 89.2520 134.7200 bit drill 2.7x122mm 339.35 212.53 179.8555 271.4800 bit drill 2x135mm 339.35 212.53 179.8555 271.4800 bit drill 3 fluted 4.2mm 425.55 266.52 225.5415 340.4400 bit drill 3.5mm d x 195mm l 182.55 114.33 96.7515 146.0400 bone marrow aspiration needle 1617.15 1012.82 857.0895 1293.7200 bone marrow bx tray 100.90 63.19 53.4770 80.7200 bone marrow kit manual 152.90 95.76 81.0370 122.3200 bone plate eggers 50.85 31.85 26.9505 40.6800 biospy brush kit gill 539.20 337.70 285.7760 431.3600 bipolar bayonet 19mm #010963 750.65 470.13 397.8445 600.5200 bone screws eggers 13.00 8.14 6.8900 10.4000 bottles closed drnge 1 bl 61.00 38.20 32.3300 48.8000 boyle chuck it disp 6.85 4.29 3.6305 5.4800 bonetampone stepkit15/3 010812 5349.60 3350.45 2835.2880 4279.6800 bonetampone stepkit20/3 010811 5349.60 3350.45 2835.2880 4279.6800 breast cavity eval device 226.53 141.87 120.0609 181.2240 clear guide #7180 204.80 128.27 108.5440 163.8400 clamp disposable 2066.50 1294.25 1095.2450 1653.2000 clamp external fixation 1159.35 726.10 614.4555 927.4800 clamp external mr safe large 960.95 601.84 509.3035 768.7600 circular stapler 617.75 386.90 327.4075 494.2000 cath balloon tip 5tr dbl 149.10 93.38 79.0230 119.2800 cath balloon tip 6tr dbl 198.90 124.57 105.4170 159.1200 cath filiform 22.05 13.81 11.6865 17.6400 cartilage biopsy kit 804.28 503.72 426.2684 643.4240 cartilage biopsy transport kit 914.65 572.85 484.7645 731.7200 cartridge suture connector 476.60 298.49 252.5980 381.2800 cannual w/disp obturatr5 #9595 126.40 79.16 66.9920 101.1200 cannualted drill w/stop 554.30 347.16 293.7790 443.4400 cannula 10g access 143.75 90.03 76.1875 115.0000 cannula 10g verteport 154.05 96.48 81.6465 123.2400 cannula 7mm x 7cm #7603 69.90 43.78 37.0470 55.9200 cannula 8g verteport cement 149.05 93.35 78.9965 119.2400 cannula bladder balloon-steril 416.50 260.85 220.7450 333.2000 cannula bone traumacem v plus 618.30 387.24 327.6990 494.6400 cannula contour taper tip 115.00 72.02 60.9500 92.0000 cannula crystl 5.5mmx7cm #7604 69.90 43.78 37.0470 55.9200 cannula crystl sht 5.75mm#7594 69.90 43.78 37.0470 55.9200 cannula ercp standard tip 129.00 80.79 68.3700 103.2000 cannula ercp ultra tapered 124.05 77.69 65.7465 99.2400 cannula expan w/o sqt tp #9452 109.05 68.30 57.7965 87.2400 cannula fast fix 360 kpsc 353.45 221.37 187.3285 282.7600 cannula fast fixation 360 kps 367.60 230.23 194.8280 294.0800 cannula fluoro tip ercp 107.35 67.23 56.8955 85.8800 cannula passport 10mmx3cm 128.60 80.54 68.1580 102.8800 cannula passport 8mm 128.60 80.54 68.1580 102.8800 cannula shldr self retaining 395.70 247.83 209.7210 316.5600 cannula triple lumen 167.35 104.81 88.6955 133.8800 cannula w/disp obturatr7 #9594 126.40 79.16 66.9920 101.1200 cannula w/no squirt cap #6777 69.90 43.78 37.0470 55.9200 cannula wdispobturator8.0#9593 424.50 265.86 224.9850 339.6000 cannulated drill 1.7mm 390.95 244.85 207.2035 312.7600 captiflex polypectomy snare 37.40 23.42 19.8220 29.9200 cap protective for pin 5mm 9.07 5.68 4.8071 7.2560 cystm cannula (knll klmn) 41.25 25.83 21.8625 33.0000 cysto irrigating set 17.45 10.93 9.2485 13.9600 cup plst delineator 3.5cm 505.50 316.59 267.9150 404.4000 cup plst delineator 3cm 505.50 316.59 267.9150 404.4000 cup plst delineator 4cm 505.50 316.59 267.9150 404.4000 cups plastic ster 20s/pk 4.80 3.01 2.5440 3.8400 currette sz 2t tip 010818 513.55 321.64 272.1815 410.8400 curved needle epimed 96.95 60.72 51.3835 77.5600 cut down tray 91.30 57.18 48.3890 73.0400 cuter hoot loop 134.40 84.17 71.2320 107.5200 cutr bne endo 10.55mm sgl use 545.50 341.65 289.1150 436.4000 cutter angled plus 4.5mm 126.30 79.10 66.9390 101.0400 cutter full radius 2.5 120.78 75.64 64.0134 96.6240 cutter full radius 2.5mm 123.15 77.13 65.2695 98.5200 cutter lig knee 9.55mm short 712.90 446.49 377.8370 570.3200 cutter ligament knee 8.5mm 567.30 355.30 300.6690 453.8400 cutter ligament knee 8mm short 567.30 355.30 300.6690 453.8400 cutter resector 3.5mm 123.15 77.13 65.2695 98.5200 cutting block visionary custom 494.05 309.42 261.8465 395.2400 cutting loop electrd 12d #5467 181.95 113.96 96.4335 145.5600 cutting loop turp elec12 #6337 277.00 173.49 146.8100 221.6000 cutting loopelectrode 12d#5467 198.70 124.45 105.3110 158.9600 coil stent 7 fr 343.10 214.88 181.8430 274.4800 coil stent all sizes 417.20 261.29 221.1160 333.7600 colangiocath 8.70 5.45 4.6110 6.9600 collor button drain tube 16.65 10.43 8.8245 13.3200 colonic irrigation 19.95 12.49 10.5735 15.9600 colonic-peds 56.60 35.45 29.9980 45.2800 clip fix device 381.15 238.71 202.0095 304.9200 clip laveen surgical 5.25 3.29 2.7825 4.2000 clip nv dsc & in-lne activator 505.60 316.66 267.9680 404.4800 closed suction-trach 43.70 27.37 23.1610 34.9600 coag suc tube 31.60 19.79 16.7480 25.2800 drill bit 1.7mm cannulated 234.30 146.74 124.1790 187.4400 drill bit 10.0mm cann. 985.66 617.32 522.3998 788.5280 drill bit 10.mm hollow 594.25 372.18 314.9525 475.4000 drill bit 13mm 268.80 168.35 142.4640 215.0400 drill bit 14mm 268.80 168.35 142.4640 215.0400 drill bit 190mm 972.40 609.01 515.3720 777.9200 drill bit 195mm 410.55 257.13 217.5915 328.4400 drill bit 2.0/2.4 494.05 309.42 261.8465 395.2400 drill bit 2.0mm 234.30 146.74 124.1790 187.4400 drill bit 2.0mm cannulated 234.30 146.74 124.1790 187.4400 drill bit 2.0mmx100mm 223.60 140.04 118.5080 178.8800 drill bit 2.0mmx140mm 593.58 371.76 314.5974 474.8640 drill bit 2.2 220.90 138.35 117.0770 176.7200 drill bit 2.2mm cannulated 225.30 141.11 119.4090 180.2400 drill bit 2.4 394.80 247.26 209.2440 315.8400 drill bit 2.4mm 414.55 259.63 219.7115 331.6400 drill bit 2.5 cannulated 225.25 141.07 119.3825 180.2000 drill bit 2.5mm 271.20 169.85 143.7360 216.9600 drill bit 2.5mm laser marked 249.60 156.32 132.2880 199.6800 drill bit 2.6m 321.50 201.36 170.3950 257.2000 drill bit 2.7mm 394.60 247.14 209.1380 315.6800 drill bit 2.7mm x 160mm 858.00 537.37 454.7400 686.4000 drill bit 2.8 162.20 101.59 85.9660 129.7600 drill bit 2.8mm 287.95 180.34 152.6135 230.3600 drill bit 2.8mm 200/100mm 460.90 288.66 244.2770 368.7200 drill bit 2.9mm 383.78 240.36 203.4034 307.0240 drill bit 2mm 265.60 166.35 140.7680 212.4800 drill bit 2mm scrws/1.3mm diam 309.15 193.62 163.8495 247.3200 drill bit 3.0mm 269.05 168.51 142.5965 215.2400 drill bit 3.2 x 300mm 527.30 330.25 279.4690 421.8400 drill bit 3.3mm 316.90 198.47 167.9570 253.5200 drill bit 3.5mm 317.73 198.99 168.3969 254.1840 drill bit 3.5mmx110mm 223.65 140.07 118.5345 178.9200 drill bit 3.8 x 270mm 501.00 313.78 265.5300 400.8000 drill bit 3.8mm 389.35 243.85 206.3555 311.4800 drill bit 4.0 mm 292.75 183.35 155.1575 234.2000 drill bit 4.3 x 180mm 435.80 272.94 230.9740 348.6400 drill bit 4.3 x 300mm 514.80 322.42 272.8440 411.8400 drill bit 4.7 475.20 297.62 251.8560 380.1600 drill bit 4.7 mm 509.50 319.10 270.0350 407.6000 drill bit 5.0 x 200mm 754.00 472.23 399.6200 603.2000 drill bit 5.0 x 30mm 775.00 485.38 410.7500 620.0000 drill bit 5mm 453.00 283.71 240.0900 362.4000 drill bit 6.0mm/10.0mm 882.30 552.58 467.6190 705.8400 drill bit bone graft 8mm ster 596.50 373.59 316.1450 477.2000 drill bit cann 13.0mm x 300mm 940.70 589.16 498.5710 752.5600 drill bit cann 2.0mm 411.30 257.60 217.9890 329.0400 drill bit cann 6/9mm 769.60 482.00 407.8880 615.6800 drill bit cann l-300mm 1143.30 716.05 605.9490 914.6400 drill bit cann. 2.9mm 495.20 310.14 262.4560 396.1600 drill bit cannualted 3.5mm 411.30 257.60 217.9890 329.0400 drill bit cannulated 494.05 309.42 261.8465 395.2400 drill bit cannulated 2.0mm 420.95 263.64 223.1035 336.7600 drill bit clbrtd 2.5qc 250/95 322.80 202.17 171.0840 258.2400 drill bit coupling 2.5mmx180mm 267.70 167.66 141.8810 214.1600 drill bit dia 2.6x135mm 329.85 206.59 174.8205 263.8800 drill bit flex quickset 45 845.80 529.72 448.2740 676.6400 endo sac #5889 80.40 50.35 42.6120 64.3200 endo tube-infant 7.20 4.51 3.8160 5.7600 endo-flo trumpet valve system 310.40 194.40 164.5120 248.3200 endoblade plantar release sys 1559.50 976.71 826.5350 1247.6000 endocatch 10mm instrumnt #6612 197.70 123.82 104.7810 158.1600 endoclinch 191.30 119.81 101.3890 153.0400 endopouch 155.70 97.51 82.5210 124.5600 endoscopic cervical spine tray 3500.00 2192.05 1855.0000 2800.0000 fixator external adjustable lg 6192.95 3878.64 3282.2635 4954.3600 fiber loop 2-0 78.00 48.85 41.3400 62.4000 fiber wire #6259 51.80 32.44 27.4540 41.4400 guardus gastric overtube 433.15 271.28 229.5695 346.5200 guid accu-cut 2mm 173.05 108.38 91.7165 138.4400 guide drill anchore suture 1.8 431.90 270.50 228.9070 345.5200 guide drill and depth guage 383.40 240.12 203.2020 306.7200 guide drill/depth guage 383.40 240.12 203.2020 306.7200 guide pin 266.25 166.75 141.1125 213.0000 guide pin 1.4x461 blunt 256.00 160.33 135.6800 204.8000 guide pin 1.4x610 blint 266.25 166.75 141.1125 213.0000 guide pin 1.4x610 blunt 256.00 160.33 135.6800 204.8000 fiberlink #2 146.40 91.69 77.5920 117.1200 fiberlink 2 #10271 139.80 87.56 74.0940 111.8400 fiberlink w/1.3mm suture tape 324.80 203.42 172.1440 259.8400 fiberstick #2 184.50 115.55 97.7850 147.6000 fiberstitch implant 965.65 604.79 511.7945 772.5200 fibertape 2mm #10273 125.85 78.82 66.7005 100.6800 fibertape blue w/needles 290.20 181.75 153.8060 232.1600 fibertape blue w/needles 17in 290.20 181.75 153.8060 232.1600 fiberwire stick/fiberwr #7196 117.80 73.78 62.4340 94.2400 fiberwire stick/fiberwr #9553 57.20 35.82 30.3160 45.7600 fiberwire w/loop #7195 149.60 93.69 79.2880 119.6800 fiberwire w/loop #9911 125.85 78.82 66.7005 100.6800 fiberwire w/needle #9129 54.55 34.16 28.9115 43.6400 fibrin sealant tisl 2.0 #6165 534.55 334.79 283.3115 427.6400 fibula rod drill 2.8mm 289.10 181.06 153.2230 231.2800 fibula rod intramedullart dril 583.70 365.57 309.3610 466.9600 eye solution bbs 211.65 132.56 112.1745 169.3200 fb retrieval hood 393.00 246.14 208.2900 314.4000 facial nerve stimulator 1287.50 806.36 682.3750 1030.0000 feeding tube 6.20 3.88 3.2860 4.9600 es2 rad rod 5.5x90 411.30 257.60 217.9890 329.0400 escape 1.9fr basket #9413 524.30 328.37 277.8790 419.4400 eye pack (austin) #10025 586.05 367.04 310.6065 468.8400 eye pack (kearney) #3218 398.50 249.58 211.2050 318.8000 eye pack (kwiat/elhosen)#10024 508.45 318.44 269.4785 406.7600 eye pack,custom w/bss 526.55 329.78 279.0715 421.2400 eye plant medium 133.95 83.89 70.9935 107.1600 delivery distal bicep repair 1320.50 827.03 699.8650 1056.4000 drill bit 614.91 385.12 325.9023 491.9280 drill bit cannnu. w/stop 6mm 735.55 460.67 389.8415 588.4400 drill bit 1.7 calibrated 262.10 164.15 138.9130 209.6800 drill bit 1.7mm 288.73 180.83 153.0269 230.9840 endotracheal tube 7mmx9.5mm 543.66 340.49 288.1398 434.9280 endowrist 12-8mm cannula reduc 66.55 41.68 35.2715 53.2400 endowrist stapler 45 reload 3144.95 1969.68 1666.8235 2515.9600 endowrist stapler45 blu rld xi 437.40 273.94 231.8220 349.9200 endowrist stapler45 grn rld xi 437.40 273.94 231.8220 349.9200 endowrist suction irrigator 536.10 335.76 284.1330 428.8800 davinci vessel sealer 905.30 566.99 479.8090 724.2400 davinci xi arm drape 138.40 86.68 73.3520 110.7200 davinci xi column drape 47.95 30.03 25.4135 38.3600 davinci xi vessel sealer 848.10 531.17 449.4930 678.4800 deflector diamond ball 360mm 805.50 504.48 426.9150 644.4000 ent case coverage 1445.50 905.32 766.1150 1156.4000 epidural anesthesia set 48.20 30.19 25.5460 38.5600 epidural anesthesia set #256 53.60 33.57 28.4080 42.8800 epidural cath brevi-xl #5387 167.80 105.09 88.9340 134.2400 epidural cath tun-l-xl #10053 219.35 137.38 116.2555 175.4800 erbelift flexible probe#010709 161.20 100.96 85.4360 128.9600 erbelift syringe contrl#010710 21.40 13.40 11.3420 17.1200 ercp cannula 79.55 49.82 42.1615 63.6400 ercp sphint ultrtome lng #6755 391.15 244.98 207.3095 312.9200 ercp sphnt ultrtome xl20#31433 430.55 269.65 228.1915 344.4400 ercp stent 7x10fr #6234 267.30 167.41 141.6690 213.8400 ercp stent 7x5 fr # 4388 267.30 167.41 141.6690 213.8400 ercp stent 7x7fr #4389 267.30 167.41 141.6690 213.8400 ercp wire guided cyto brush 264.90 165.91 140.3970 211.9200 epidural needle #5845 29.20 18.29 15.4760 23.3600 epidural tray sngle shot #7228 40.00 25.05 21.2000 32.0000 epidural-continuous 99.95 62.60 52.9735 79.9600 epimed coude needle epidural 122.60 76.78 64.9780 98.0800 epistaxis balloon 62.40 39.08 33.0720 49.9200 eon mini charging system 1308.85 819.73 693.6905 1047.0800 cytology brush/sheath 110.80 69.39 58.7240 88.6400 acutrak 2 drill 436.60 273.44 231.3980 349.2800 acutrak 2 drill,long 487.60 305.38 258.4280 390.0800 adapter cement cart thread 28.15 17.63 14.9195 22.5200 adapter ureteroscope 2 way 358.50 224.53 190.0050 286.8000 add a foley kit 33.55 21.01 17.7815 26.8400 adh skin dermabond prineo 22cm 233.10 145.99 123.5430 186.4800 adhesive med. 90.00 56.37 47.7000 72.0000 9.75 medium clip applier 143.15 89.65 75.8695 114.5200 90-s accelerator 377.15 236.21 199.8895 301.7200 9 gage vacuum needle 500.25 313.31 265.1325 400.2000 ablator 60 degree #7051 412.80 258.54 218.7840 330.2400 ablator 90 degree $7156 440.35 275.79 233.3855 352.2800 ablator 9606 #6998 125.85 78.82 66.7005 100.6800 ablator cool cut 90 #6997 412.80 258.54 218.7840 330.2400 ablator endometrial 1493.40 935.32 791.5020 1194.7200 access kit 1 520.30 325.86 275.7590 416.2400 access kit w/reamers 890.55 557.75 471.9915 712.4400 accessory thumble thumb tab 71.85 45.00 38.0805 57.4800 acculif tl tubing set 420.50 263.36 222.8650 336.4000 acd a & blood draw disp. gps 420.50 263.36 222.8650 336.4000 acl disposable kit 569.65 356.77 301.9145 455.7200 acl transtibial kit #4976 386.05 241.78 204.6065 308.8400 acp kit series 1 513.80 321.79 272.3140 411.0400 ahto tube set packaging 337.95 211.66 179.1135 270.3600 adult lumbar puncture tray 22.00 13.78 11.6600 17.6000 adv laparoscopic care kit d-he 106.30 66.58 56.3390 85.0400 lumbar puncture tray adult#450 26.30 16.47 13.9390 21.0400 lumbar puncture tray peds #452 21.15 13.25 11.2095 16.9200 m axcess shim kit disposable 1701.55 1065.68 901.8215 1361.2400 mandible 1.8mm drill bit 364.20 228.10 193.0260 291.3600 mandible drill bit 145mm 364.20 228.10 193.0260 291.3600 mandible drill bit 90mm 364.20 228.10 193.0260 291.3600 mandible latch 8mm stop 50 343.45 215.10 182.0285 274.7600 mandible latch 8mm stop 90 364.20 228.10 193.0260 291.3600 mani uterine cervical cup 248.55 155.67 131.7315 198.8400 manipulator uterine 34mm 248.55 155.67 131.7315 198.8400 manipulator uterine cerv large 248.55 155.67 131.7315 198.8400 marker rod disposable 2890.15 1810.10 1531.7795 2312.1200 maromax bone marrow kit 2904.70 1819.21 1539.4910 2323.7600 marrow cellution introducer 11 2839.20 1778.19 1504.7760 2271.3600 mars 3v disposable kit 3969.00 2485.78 2103.5700 3175.2000 mas blade facial splitter 760.50 476.30 403.0650 608.4000 mask eye bilirubin 8.00 5.01 4.2400 6.4000 mast quadrant illumination 1000.15 626.39 530.0795 800.1200 angel cprp & bma tray 1248.50 781.94 661.7050 998.8000 angel prp kit 545.50 341.65 289.1150 436.4000 angio tray 76.45 47.88 40.5185 61.1600 anospec beveled anoscope 103mm 13.30 8.33 7.0490 10.6400 anospec slotted anoscope 90mmx 13.30 8.33 7.0490 10.6400 * dressing 4x4 st 2's 1.15 0.72 0.6095 0.9200 *sponge 4x4 10's 3.70 2.32 1.9610 2.9600 .054 dia parallel wire guide 394.50 247.08 209.0850 315.6000 .86 threaded guidewire 99.45 62.29 52.7085 79.5600 0.045 dia parallel wire guide 410.30 256.97 217.4590 328.2400 0.90mm k-wire 72.02 45.11 38.1706 57.6160 1.1mm drill bit/j-latch 191.80 120.12 101.6540 153.4400 1.7 drill bit 389.05 243.66 206.1965 311.2400 1.9mm cann drill bit 402.05 251.80 213.0865 321.6400 1.9mm cannulated drill bit 402.05 251.80 213.0865 321.6400 1.9mm twist drill 278.50 174.42 147.6050 222.8000 10g 7.75 hand drill 170.25 106.63 90.2325 136.2000 10g ivas bone biopsy kit 206.40 129.27 109.3920 165.1200 10mm single use instrument set 384.00 240.50 203.5200 307.2000 1.3mm suture tape 166.40 104.22 88.1920 133.1200 11x15 needle 192.00 120.25 101.7600 153.6000 12.0mm outer protection sleeve 217.45 136.19 115.2485 173.9600 12.0mm outer protective sleeve 226.15 141.64 119.8595 180.9200 12.5mm reamer 1412.40 884.59 748.5720 1129.9200 12mm distraction screw 130.45 81.70 69.1385 104.3600 12mm medial insert kit 489.30 306.45 259.3290 391.4400 12mmx5cm passport cannula 228.95 143.39 121.3435 183.1600 2.0 micro k-wire 0.8x100 50.60 31.69 26.8180 40.4800 2.0/2.4mm drill bit 411.30 257.60 217.9890 329.0400 2.0/3.5 drill guide 568.90 356.30 301.5170 455.1200 2.0mm qr drill w/depth marks 319.50 200.10 169.3350 255.6000 2.0mm quick release drill 171.50 107.41 90.8950 137.2000 2.0mm straight cann.drill bit 453.75 284.18 240.4875 363.0000 2.0x2.4 screw driver bit 411.30 257.60 217.9890 329.0400 2.2mm drill bit -not implant 288.15 180.47 152.7195 230.5200 2.5 full radius cutter 451.75 282.93 239.4275 361.4000 16mm perc flex drill bit 971.20 608.26 514.7360 776.9600 2-0 fiberloop suture 64.8mm 190.40 119.25 100.9120 152.3200 2.6mm cann drill bit 417.65 261.57 221.3545 334.1200 2.7mm cannulated drill 484.10 303.19 256.5730 387.2800 2.7mm drill bit 386.50 242.06 204.8450 309.2000 2.8mm qr drill w/depth marks 319.50 200.10 169.3350 255.6000 22 gauge fna needle 505.50 316.59 267.9150 404.4000 2x12mm mica burr 465.40 291.48 246.6620 372.3200 3.0 cannulated screwdriver 423.70 265.36 224.5610 338.9600 3.0 hooded abraison bur 464.80 291.10 246.3440 371.8400 3.0mm mgs drill bit 536.10 335.76 284.1330 428.8800 3.2 drill bit 489.30 306.45 259.3290 391.4400 3.5 cannulated drill 459.95 288.07 243.7735 367.9600 3.5 full radius resector 451.75 282.93 239.4275 361.4000 3.5mm measuring drill guide 464.25 290.76 246.0525 371.4000 dispos-a-bag 14.50 9.08 7.6850 11.6000 disposable bag valve mask-adlt 63.45 39.74 33.6285 50.7600 disposable dilatore kit xlif 1220.50 764.40 646.8650 976.4000 disposable drill guide 519.50 325.36 275.3350 415.6000 disposable kit for 25-2800 322.60 202.04 170.9780 258.0800 disposable kit for swivelock 638.05 399.61 338.1665 510.4400 dissector ultrasonic cordless 683.10 427.83 362.0430 546.4800 disp bag valve mast-infant 34.30 21.48 18.1790 27.4400 disp bag valve mast-peds 36.40 22.80 19.2920 29.1200 disp kit arthro shoulder 668.20 418.49 354.1460 534.5600 disp vein strippers 45.95 28.78 24.3535 36.7600 3.5x46mm hexalobe screw 348.15 218.05 184.5195 278.5200 dome 23.40 14.66 12.4020 18.7200 double syringe (asp) system 384.30 240.69 203.6790 307.4400 drainage bag 23.90 14.97 12.6670 19.1200 drainage tubing 9/52 5.25 3.29 2.7825 4.2000 drape arthroscopy 49.00 30.69 25.9700 39.2000 drape c-arm ioban 3m-6017 110.60 69.27 58.6180 88.4800 drape c-armor 107.55 67.36 57.0015 86.0400 drape ear-poly 15.30 9.58 8.1090 12.2400 drape fem angio 3m-1090 42.65 26.71 22.6045 34.1200 drape fluoro 3m-1012 14.50 9.08 7.6850 11.6000 drape hand 36.35 22.77 19.2655 29.0800 drape hip 56.85 35.61 30.1305 45.4800 drape incise 10x16 jj5206 10.35 6.48 5.4855 8.2800 drape incise 24x30 jj5208 28.10 17.60 14.8930 22.4800 drape ioban antim 3m-6051 54.20 33.95 28.7260 43.3600 drape lap/chole 25.20 15.78 13.3560 20.1600 drape laparotomy 14.10 8.83 7.4730 11.2800 drape large 4.50 2.82 2.3850 3.6000 drape ortho 48x50 3m-1015 31.30 19.60 16.5890 25.0400 drape pacemaker 3m-1013 19.90 12.46 10.5470 15.9200 drape peds lap 15.60 9.77 8.2680 12.4800 drape thyroid 17.85 11.18 9.4605 14.2800 drape vertical isolation 94.10 58.93 49.8730 75.2800 drape vi 16x16 3m-1020 11.55 7.23 6.1215 9.2400 drape vi 42x24 25.60 16.03 13.5680 20.4800 drape, ioban ii 3m-6650 20.15 12.62 10.6795 16.1200 drape, t.u.r. 25.75 16.13 13.6475 20.6000 drape-iobon ii #6640 16.35 10.24 8.6655 13.0800 drape-microscope xomed 28.55 17.88 15.1315 22.8400 drape-z 12.15 7.61 6.4395 9.7200 dressing kit, tegaderm 13.55 8.49 7.1815 10.8400 dressing tray special 6.20 3.88 3.2860 4.9600 dressing-jones compress 35.70 22.36 18.9210 28.5600 drill & ez shuttle 9mm 595.40 372.90 315.5620 476.3200 drill 2.0 x 40mm 266.15 166.69 141.0595 212.9200 drill 2.0x110mm long 393.15 246.23 208.3695 314.5200 drill 2.5 x 40mm 276.80 173.36 146.7040 221.4400 drill 2.5mm 546.55 342.30 289.6715 437.2400 drill 2.8mm 275.05 172.26 145.7765 220.0400 drill 3.5 276.90 173.42 146.7570 221.5200 drill anchor c 12mm 487.65 305.42 258.4545 390.1200 drill and ez shuttle 10mm 595.40 372.90 315.5620 476.3200 drain flat suction pratt 43.25 27.09 22.9225 34.6000 drain lube, bebeled, teflon 50.40 31.57 26.7120 40.3200 drain-biliary set 5.25 3.29 2.7825 4.2000 7fr x 6 (16cm) lumen picc 405.60 254.03 214.9680 324.4800 8 gauge system kit 20mm 2543.60 1593.06 1348.1080 2034.8800 8g 15mm ivas system kit 1378.65 863.45 730.6845 1102.9200 8g access cannual 147.00 92.07 77.9100 117.6000 8g ivas bone biopy kit 187.70 117.56 99.4810 150.1600 8mm bladeless obturator-optic 79.85 50.01 42.3205 63.8800 8mm flexible reamer 720.50 451.25 381.8650 576.4000 universal cannula kt5x45 #4714 110.25 69.05 58.4325 88.2000 ultratome sphinctertome 382.95 239.84 202.9635 306.3600 u/bag/ped spec collector 2.80 1.75 1.4840 2.2400 ureteral drnge set 6251 62.25 38.99 32.9925 49.8000 uromax ultra 12f catheter 445.60 279.08 236.1680 356.4800 urovac bladder evacuator 48.50 30.38 25.7050 38.8000 set tubing irrig hall disp 54.20 33.95 28.7260 43.3600 shaft scrw driver ratch handle 500.80 313.65 265.4240 400.6400 series sagittal blade 55.10 34.51 29.2030 44.0800 twist drill 1.5mm x 105mm 314.50 196.97 166.6850 251.6000 twist drill 1.5x50mm 278.50 174.42 147.6050 222.8000 twist drill 1.9x70mm 402.70 252.21 213.4310 322.1600 twist drill 2.2 x 70mm 351.65 220.24 186.3745 281.3200 twist-in cannula #6328 69.90 43.78 37.0470 55.9200 twist-in cannula 8.25x7 #6383 67.20 42.09 35.6160 53.7600 phillips follower 27.90 17.47 14.7870 22.3200 pin drill-clavicle button 3.7 422.80 264.80 224.0840 338.2400 pin fixation kit 1.2mm 407.80 255.41 216.1340 326.2400 pin guide tip drill 2.4 85.20 53.36 45.1560 68.1600 pin holding plate cerv zevo 141.33 88.51 74.9049 113.0640 pin set ii eclipse 515.30 322.73 273.1090 412.2400 pin set univers ii 515.30 322.73 273.1090 412.2400 plastic stent 8.5x7cm #9441 252.20 157.95 133.6660 201.7600 autoplex system w/vertaplex hv 1067.00 668.26 565.5100 853.6000 autosuture eea inst str 537.30 336.51 284.7690 429.8400 autosuture surgiclip m11.s 191.60 120.00 101.5480 153.2800 autotransfusion system davol 425.10 266.24 225.3030 340.0800 awl starter plate roi-c long 720.50 451.25 381.8650 576.4000 auto suture 55-3.5 229.70 143.86 121.7410 183.7600 auto suture 55-4.8 196.50 123.07 104.1450 157.2000 auto suture 90-3.5 196.50 123.07 104.1450 157.2000 auto suture e.e.a. 349.40 218.83 185.1820 279.5200 auto suture g i a 290.50 181.94 153.9650 232.4000 auto suture lds-15 202.50 126.83 107.3250 162.0000 auto suture lds-l/ea 192.70 120.69 102.1310 154.1600 auto suture sm-12/ea 88.90 55.68 47.1170 71.1200 auto suture sm-25/extract 106.55 66.73 56.4715 85.2400 ball nose guide wire 100cm 400.70 250.96 212.3710 320.5600 ball tip 6mm 252.60 158.20 133.8780 202.0800 ball tip diamond long 3mm 272.60 170.73 144.4780 218.0800 ball tip long 3mm 252.60 158.20 133.8780 202.0800 ball tip long 4mm 256.20 160.46 135.7860 204.9600 balloon dissector 371.50 232.67 196.8950 297.2000 balloon extractor 15mm #2867 267.30 167.41 141.6690 213.8400 balloon extractor11.5mm #2865 280.70 175.80 148.7710 224.5600 balloon extractor12-15cm #9436 418.55 262.14 221.8315 334.8400 balloon extrctr rtrvl9-12#9445 402.45 252.05 213.2985 321.9600 balloon inflation device 205.40 128.64 108.8620 164.3200 balloon new extractor 12-15mm 253.45 158.74 134.3285 202.7600 balloon sinuplasty system 2554.25 1599.73 1353.7525 2043.4000 balloon sinuplasty system fron 2560.75 1603.80 1357.1975 2048.6000 band ligator hemorrhoid w/o an 181.74 113.82 96.3222 145.3920 bar locking modular total knee 234.85 147.09 124.4705 187.8800 applicator hemostatic microfib 261.20 163.59 138.4360 208.9600 anterior vitrectomy pack 422.10 264.36 223.7130 337.6800 any sterile set up 159.85 100.11 84.7205 127.8800 aos nail extraction set 494.05 309.42 261.8465 395.2400 appl endo surgiflo 139.40 87.31 73.8820 111.5200 arch bar erich 31.30 19.60 16.5890 25.0400 aquacel ag surgical 9x25 86.30 54.05 45.7390 69.0400 aquacel ag surgical 9x35 95.70 59.94 50.7210 76.5600 aquilex fluid cont.sys.inflow 307.50 192.59 162.9750 246.0000 aquilex fluid cont.sys.outflow 55.95 35.04 29.6535 44.7600 apron sterile disposable 30.10 18.85 15.9530 24.0800 arthowand turbovac 90#10057 656.85 411.39 348.1305 525.4800 arthroscopic fix drill pin 186.35 116.71 98.7655 149.0800 articularting extra thick relo 602.15 377.13 319.1395 481.7200 articulating stapler ax55b 770.20 482.38 408.2060 616.1600 asperation needle 6-port, 4 263.45 165.00 139.6285 210.7600 aspirator 45d insta-trak #9995 240.25 150.47 127.3325 192.2000 aspirator 7fr insta-trak#10058 209.70 131.34 111.1410 167.7600 aspirator straight #10059 209.70 131.34 111.1410 167.7600 arthro pin fix drill pin 2x100 2548.00 1595.81 1350.4400 2038.4000 bio-suture tak disps kit #9502 415.50 260.23 220.2150 332.4000 bio-tendonesis kit #8569 431.90 270.50 228.9070 345.5200 biliary ballon probe 268.75 168.32 142.4375 215.0000 biliary balloon probe 5fr#4402 153.50 96.14 81.3550 122.8000 biliary balloon probe 6fr#4403 153.50 96.14 81.3550 122.8000 biliary delivery system 329.90 206.62 174.8470 263.9200 biliary lumen needle knife 464.70 291.04 246.2910 371.7600 biliary stent pigtail 227.30 142.36 120.4690 181.8400 biop aspirator bone mrro 15cm 192.00 120.25 101.7600 153.6000 screw zygoma 1.8-3.5mm 305.90 191.59 162.1270 244.7200 screwdriver 6.5 444.00 278.08 235.3200 355.2000 sealer ligasure 14d 973.45 609.67 515.9285 778.7600 sealer/divider lig 37cmx5mm 698.90 437.72 370.4170 559.1200 seeker frontal sinus profess 490.45 307.17 259.9385 392.3600 segura hemisphere basket #3206 426.20 266.93 225.8860 340.9600 selastic sheeting 2x4 37.75 23.64 20.0075 30.2000 self punching suture tape 640.10 400.89 339.2530 512.0800 betadine swab/pk 3.55 2.22 1.8815 2.8400 scs accessory kit s 490.90 307.45 260.1770 392.7200 seal cap dextrus assembly#9079 656.80 411.35 348.1040 525.4400 bed mount kit disposable 2066.50 1294.25 1095.2450 1653.2000 bard button gastro device 291.10 182.32 154.2830 232.8800 bb tak instr.joint repair 199.90 125.20 105.9470 159.9200 bb-tak 190.40 119.25 100.9120 152.3200 bb-tak small joint repair 191.70 120.06 101.6010 153.3600 screw spinal caspar 12mm 133.10 83.36 70.5430 106.4800 registration kit ent profess 443.65 277.86 235.1345 354.9200 rectal tubes-ea 10.35 6.48 5.4855 8.2800 reddick screw save kit #5888 430.00 269.31 227.9000 344.0000 reduction tool polar 3 71.92 45.04 38.1176 57.5360 pwdr srgi absrb gelatin#010785 198.80 124.51 105.3640 159.0400 reamer spherical n/s 782.80 490.27 414.8840 626.2400 reamer usage charge 494.05 309.42 261.8465 395.2400 reaming rod w/ ball tip 650mm 379.60 237.74 201.1880 303.6800 reaming rod w/ ball tip 950mm 386.90 242.32 205.0570 309.5200 reaming rod w/ball tip and ext 396.35 248.23 210.0655 317.0800 reamr head wrst fus non hubca 494.05 309.42 261.8465 395.2400 rad pros suture device 420.00 263.05 222.6000 336.0000 radial jaw biopsy jumbo forcep 89.35 55.96 47.3555 71.4800 radial jaw hot biopsy forcep 111.65 69.93 59.1745 89.3200 rake expandable toothed 824.70 516.51 437.0910 659.7600 rasp large tear cross cut tps 222.55 139.38 117.9515 178.0400 rasp small tear cross cut tps 222.85 139.57 118.1105 178.2800 reamer 3.1mm 494.05 309.42 261.8465 395.2400 reamer 4,metacarpal 4.5x87mm n 319.90 200.35 169.5470 255.9200 reamer 6.5mm 1139.30 713.54 603.8290 911.4400 reamer 7.5mm 1139.30 713.54 603.8290 911.4400 reamer 8.5mm 1139.30 713.54 603.8290 911.4400 reamer bone t-shape 3.7mm 489.30 306.45 259.3290 391.4400 reamer endoscopic 533.95 334.41 282.9935 427.1600 reamer low profile cann 10mm 499.50 312.84 264.7350 399.6000 reamer piloled head 8.5 464.70 291.04 246.2910 371.7600 reload blue 3.5 tr45b #5745 622.35 389.78 329.8455 497.8800 reload crvd blue stapler #7552 562.65 352.39 298.2045 450.1200 reload crvd green stapler#7553 562.65 352.39 298.2045 450.1200 reload green 4.1 tr456 #5746 622.35 389.78 329.8455 497.8800 reload stapel davinic 468.50 293.42 248.3050 374.8000 reload staple 60mm blue 468.50 293.42 248.3050 374.8000 reload ta 90 4.8 #7961 124.50 77.97 65.9850 99.6000 reload ta45 green #6608 145.55 91.16 77.1415 116.4400 reloads 458.70 287.28 243.1110 366.9600 remote control 1265.80 792.77 670.8740 1012.6400 relieva balloon sinus system 3166.80 1983.37 1678.4040 2533.4400 restoration adm dual mob aceta 1269.30 794.96 672.7290 1015.4400 retractable knife 420.50 263.36 222.8650 336.4000 retractor caesaren section ale 234.00 146.55 124.0200 187.2000 retractor everset single use 1220.50 764.40 646.8650 976.4000 retractor extr hnd balln #7361 306.10 191.71 162.2330 244.8800 retractor kit disposable 1619.25 1014.14 858.2025 1295.4000 retractor lap 5mm x 45cm disp 49.25 30.85 26.1025 39.4000 retractor laparoscopic 239.70 150.12 127.0410 191.7600 retractor serngeti 745.70 467.03 395.2210 596.5600 retractor system 192.00 120.25 101.7600 153.6000 retractor system serengeti mi 895.45 560.82 474.5885 716.3600 retractro casarean section ale 184.10 115.30 97.5730 147.2800 retriever suture 1.5mm-single 469.65 294.14 248.9145 375.7200 retrofusion disposable kit 863.50 540.81 457.6550 690.8000 reuter bobbin drain tube 93.30 58.43 49.4490 74.6400 reverse cutting needle w/loop 73.20 45.85 38.7960 58.5600 rf 280mm probe 970.50 607.82 514.3650 776.4000 rep kit tb suct w/o tip 33.30 20.86 17.6490 26.6400 rep tube kit suction 56.35 35.29 29.8655 45.0800 rental fee for endo equipment 1281.55 802.63 679.2215 1025.2400 rescue net 813.25 509.34 431.0225 650.6000 resection electr 14-28fr #7239 189.25 118.53 100.3025 151.4000 resection electrode button 12d 704.90 441.48 373.5970 563.9200 resection electrode loop 24fr 677.60 424.38 359.1280 542.0800 resection loop med 45 angle 677.60 424.38 359.1280 542.0800 reservoir suction j pratt 44.25 27.71 23.4525 35.4000 rod ball 2.5mm tip/1150mm 307.90 192.84 163.1870 246.3200 rod carbon fiber 11x400mm 526.00 329.43 278.7800 420.8000 rod ext fix straight 11x250mm 605.30 379.10 320.8090 484.2400 rod femoral 950mm length 264.05 165.37 139.9465 211.2400 rod reaming ball tip 2.5x950mm 290.15 181.72 153.7795 232.1200 pluer-evac 290.55 181.97 153.9915 232.4400 portal skid 171.70 107.54 91.0010 137.3600 power injector vad 8fr 425.80 266.68 225.6740 340.6400 prem surgiclip large #6591 144.55 90.53 76.6115 115.6400 prem surgiclip medium #6592 150.35 94.16 79.6855 120.2800 prem surgiclip small #7606 131.05 82.08 69.4565 104.8400 premium surgiclip iii appliar 121.90 76.35 64.6070 97.5200 prep kit w/restrictors #9606 495.35 310.24 262.5355 396.2800 press patch sterile 9.10 5.70 4.8230 7.2800 probe argon coag 2.3mm d 6.9fr 492.95 308.73 261.2635 394.3600 probe ball tip 100mm 441.55 276.54 234.0215 353.2400 probe ball tip spine 23cm nim 398.80 249.77 211.3640 319.0400 probe electrosurg 2.3mm d 6.9f 486.70 304.82 257.9510 389.3600 probe electrosurg arthr #3499 134.90 84.49 71.4970 107.9200 probe incrementing prass std 395.55 247.73 209.6415 316.4400 probe temp esophageal700 #2253 6.50 4.07 3.4450 5.2000 probe temperature rectal #550 18.05 11.30 9.5665 14.4400 probe termerature rectal 36.95 23.14 19.5835 29.5600 probe trudi 70 degree angle 1763.30 1104.35 934.5490 1410.6400 plate tap 3.0 screw 413.50 258.98 219.1550 330.8000 pins knowles hip 115.80 72.53 61.3740 92.6400 pins-bohlman 43.25 27.09 22.9225 34.6000 piranha #6335 601.20 376.53 318.6360 480.9600 piston w/armstrong loop 143.50 89.87 76.0550 114.8000 pivot navigation dilation 2320.50 1453.33 1229.8650 1856.4000 plate suprocondgle 397.05 248.67 210.4365 317.6400 polyethelyne dr tubes-ea 12.15 7.61 6.4395 9.7200 polyloop ligating device 222.55 139.38 117.9515 178.0400 polyp retrieval device 209.55 131.24 111.0615 167.6400 pnemoclear high flow tube set 34.50 21.61 18.2850 27.6000 pneumoclear high-flow tube set 331.80 207.81 175.8540 265.4400 pneumoclear smoke evac tubing 616.75 386.27 326.8775 493.4000 pneumothorax kit 8 fr #5500 181.50 113.67 96.1950 145.2000 port acs lp obt bldlss 5x100mm 215.35 134.87 114.1355 172.2800 port acs obt bldless 12x100mm 224.00 140.29 118.7200 179.2000 pump suction irrigation 10in 99.25 62.16 52.6025 79.4000 push lock disp kit #010700 431.90 270.50 228.9070 345.5200 quatico needle set 254.55 159.42 134.9115 203.6400 quick coupling/330 100 cal 486.60 304.76 257.8980 389.2800 quickset 1pc flex drill bit 25 662.40 414.86 351.0720 529.9200 quickset kit 5 cc -not implant 3234.00 2025.45 1714.0200 2587.2000 quickset kit 8cc 3990.00 2498.94 2114.7000 3192.0000 rack screw for 7.3x16/32mm 607.80 380.67 322.1340 486.2400 pros moore 1 1/2-2 13/16 1213.35 759.92 643.0755 970.6800 pros moore 2 1/4-2 1/2 1213.35 759.92 643.0755 970.6800 prostatectomy set up 411.45 257.69 218.0685 329.1600 prostatic biopsy needle 28.00 17.54 14.8400 22.4000 prosth,bi-cent (all szs) 947.85 593.64 502.3605 758.2800 prosthesis clement 1/2 do 96.95 60.72 51.3835 77.5600 prosthesis hd-nk all sz 1480.85 927.46 784.8505 1184.6800 profile drill 7.0mm 420.50 263.36 222.8650 336.4000 prosthesis-cement 307.00 192.27 162.7100 245.6000 skin prep wipes/pkg 4.80 3.01 2.5440 3.8400 skin staple 108.50 67.95 57.5050 86.8000 sleeve guide suprapatellar 226.10 141.61 119.8330 180.8800 small hexagonal screwdriver 526.55 329.78 279.0715 421.2400 small joint full radius blade 469.80 294.24 248.9940 375.8400 smart guard irrigator 23.05 14.44 12.2165 18.4400 smartstitch perfectpasser 524.70 328.62 278.0910 419.7600 snare captiflex oval #10380 41.90 26.24 22.2070 33.5200 snare captivtor micro-hex#9419 41.90 26.24 22.2070 33.5200 snare oval standard #5139 26.45 16.57 14.0185 21.1600 soft tissue graft fixation 411.30 257.60 217.9890 329.0400 single-site 5mm curved scissor 2800.00 1753.64 1484.0000 2240.0000 spade tip drill 5.5mm 362.00 226.72 191.8600 289.6000 spade tip drill for 3.9 swivel 279.55 175.08 148.1615 223.6400 spatula advan quick dis #6618 121.25 75.94 64.2625 97.0000 speed cinch crved needle peek 720.50 451.25 381.8650 576.4000 speed guide drill 2.0 383.40 240.12 203.2020 306.7200 speedband suprview super7#9461 500.00 313.15 265.0000 400.0000 sphincterotome endo 49.035in 794.85 497.81 421.2705 635.8800 sphinctertome (hydratome) 656.00 410.85 347.6800 524.8000 spinal anesthesia tray 75.25 47.13 39.8825 60.2000 special g-wire 79.30 49.67 42.0290 63.4400 specimen cont 8oz sterile 2.35 1.47 1.2455 1.8800 specimen retrieval bag #5344 428.30 268.24 226.9990 342.6400 spinal needle for yess 250mm 104.85 65.67 55.5705 83.8800 spinal/epidural tray combined 94.65 59.28 50.1645 75.7200 stethoscope esoph all 11.20 7.01 5.9360 8.9600 stocking knee lrg long #909 5.90 3.70 3.1270 4.7200 stocking knee lrg reg #908 6.25 3.91 3.3125 5.0000 stocking knee med long #911 5.90 3.70 3.1270 4.7200 stocking knee med reg #910 6.25 3.91 3.3125 5.0000 stocking knee small long #913 5.90 3.70 3.1270 4.7200 stocking knee small reg #912 5.90 3.70 3.1270 4.7200 stocking knee xlg long #1187 5.55 3.48 2.9415 4.4400 stocking knee xlg reg #914 6.25 3.91 3.3125 5.0000 sraight drill mini 2.2mm 453.75 284.18 240.4875 363.0000 srgi absrb gel pwdr kit#010787 376.45 235.77 199.5185 301.1600 stent bilary pgtl push-7 #7983 186.65 116.90 98.9245 149.3200 stent bilary pigtail 7x5 #7981 128.55 80.51 68.1315 102.8400 stent bilry pgtl push-10 #7984 186.65 116.90 98.9245 149.3200 stent blry pgtailpsh 10x5#7982 128.55 80.51 68.1315 102.8400 stent nasal pack 4x4cm 371.80 232.86 197.0540 297.4400 steinman pin 48.70 30.50 25.8110 38.9600 step drill for 2.5mm frag scrw 268.80 168.35 142.4640 215.0400 sterile manometer 10.35 6.48 5.4855 8.2800 sterile set-up 24.20 15.16 12.8260 19.3600 sternal puncture-bone-tra 133.45 83.58 70.7285 106.7600 splitter 1701.55 1065.68 901.8215 1361.2400 spnge srgifm asrb gltin#010786 62.70 39.27 33.2310 50.1600 splint nasal kit 69x43mm 453.45 284.00 240.3285 362.7600 sponge 4 x 4 all purpose 3.55 2.22 1.8815 2.8400 sponge shoulder press id 33 56.30 35.26 29.8390 45.0400 spot tattoo endo marker 600.50 376.09 318.2650 480.4000 spinal pump tubing disposable 237.65 148.84 125.9545 190.1200 spybite biopsy forceps 841.35 526.94 445.9155 673.0800 standard femoral componen 2746.40 1720.07 1455.5920 2197.1200 staple reload contour 2mm 492.55 308.48 261.0515 394.0400 stapler 925.60 579.70 490.5680 740.4800 stapler 12mm cannual seal disp 55.95 35.04 29.6535 44.7600 stapler curved loaded ecs29 1188.98 744.66 630.1594 951.1840 stapler davinci 60 sureform 780.50 488.83 413.6650 624.4000 stapler dst ta ti 90-4.8 507.05 317.57 268.7365 405.6400 stapler endopath ets art 45 769.30 481.81 407.7290 615.4400 stapler extra large 25mm 583.75 365.60 309.3875 467.0000 stapler sheath-disposable 55.95 35.04 29.6535 44.7600 stapler titanium 4.8x80mm 187.55 117.46 99.4015 150.0400 staples reload ti gia 4.8x60mm 134.70 84.36 71.3910 107.7600 staples-barbed-zimmer 20.15 12.62 10.6795 16.1200 star sleeve sterile #4653 195.80 122.63 103.7740 156.6400 starting needle 197.15 123.48 104.4895 157.7200 shoulder cannula #9505 41.95 26.27 22.2335 33.5600 shaver expandable 541.30 339.02 286.8890 433.0400 sheath sterile replace kit 123.00 77.03 65.1900 98.4000 sheath teflon replacement 27.75 17.38 14.7075 22.2000 shrill blade diamond abasor 775.50 485.70 411.0150 620.4000 shrill blades 681.20 426.64 361.0360 544.9600 shrill deflector blade 753.50 471.92 399.3550 602.8000 shrill olive cutter 4.5 791.95 496.00 419.7335 633.5600 shrill shaver blade 720.97 451.54 382.1141 576.7760 shrill shaver blade 4.5 830.45 520.11 440.1385 664.3600 shrill shaver blade olive 720.50 451.25 381.8650 576.4000 sialography catheters 78.90 49.42 41.8170 63.1200 sigmoidoscopic suc inst 10.35 6.48 5.4855 8.2800 simpluse solo #1833 80.10 50.17 42.4530 64.0800 simpluse tip #2238 32.25 20.20 17.0925 25.8000 sinus guide catheter handle 153.80 96.32 81.5140 123.0400 sinus illumination system 709.30 444.23 375.9290 567.4400 sizing template set-dstl rad 620.50 388.62 328.8650 496.4000 scoop kit 1099.05 688.34 582.4965 879.2400 screw retainer disposable 268.80 168.35 142.4640 215.0400 scalpel min invasive 1.6mm 527.30 330.25 279.4690 421.8400 scapel 441.55 276.54 234.0215 353.2400 scapel *do not use* 420.50 263.36 222.8650 336.4000 scapel cann everst 0.63 in 432.65 270.97 229.3045 346.1200 schneider rods 204.55 128.11 108.4115 163.6400 sharp kwire 138.05 86.46 73.1665 110.4400 shen kit 2211.15 1384.84 1171.9095 1768.9200 rod template 200mm 268.80 168.35 142.4640 215.0400 rotatable clip fix device#7202 257.95 161.55 136.7135 206.3600 rotatable snare 77.85 48.76 41.2605 62.2800 roticulator all 446.55 279.67 236.6715 357.2400 roticulator stapler 442.30 277.01 234.4190 353.8400 roticulator stplr 55 4.8 #8882 426.60 267.18 226.0980 341.2800 round bur orthopedic #7592 22.05 13.81 11.6865 17.6400 round bur, medium, carbide 26.45 16.57 14.0185 21.1600 roller bar 345.50 216.39 183.1150 276.4000 rx locking device with cap 29.10 18.23 15.4230 23.2800 rx needle knife 529.35 331.53 280.5555 423.4800 sa reduction tube 261.05 163.50 138.3565 208.8400 saline 1000ml 19.20 12.02 10.1760 15.3600 saline 3000ml 30.95 19.38 16.4035 24.7600 saratoga sump 40.85 25.58 21.6505 32.6800 saw blade osteotomy 157.45 98.61 83.4485 125.9600 saw oscillating large bone 196.25 122.91 104.0125 157.0000 water-ster-irr 500ml/ea 16.20 10.15 8.5860 12.9600 weck shield fascial closure 252.90 158.39 134.0370 202.3200 wet field eraser 16.20 10.15 8.5860 12.9600 xi 5mm-8mm universal seal 437.40 273.94 231.8220 349.9200 xi 8mm bladeless obturator 403.20 252.52 213.6960 322.5600 xi 8mm bladeless obturator, lo 419.30 262.61 222.2290 335.4400 xi cautery hook permanent mono 459.20 287.60 243.3760 367.3600 xi clip applier large 39.15 24.52 20.7495 31.3200 xi clip applier med/lge 39.15 24.52 20.7495 31.3200 xi fenestrated bipolar forcep 535.65 335.48 283.8945 428.5200 xi grasper tip-up fenestrated 529.35 331.53 280.5555 423.4800 xi grasping forcep 553.30 346.53 293.2490 442.6400 xi maryland bipolar forcep 535.65 335.48 283.8945 428.5200 xi monopolar curved scissor 590.25 369.67 312.8325 472.2000 xi needle driver large 481.05 301.28 254.9565 384.8400 xi needle driver mega suturecu 502.90 314.97 266.5370 402.3200 xi prograsp forceps 481.05 301.28 254.9565 384.8400 xi single site port 385.30 241.31 204.2090 308.2400 visionary cutting block l f7t6 861.55 539.59 456.6215 689.2400 visionary left cutting block k 756.55 473.83 400.9715 605.2400 visonary right cutting block k 756.55 473.83 400.9715 605.2400 vistaseal fibrin sealant 697.95 437.13 369.9135 558.3600 vistaseal fibrin sealant 45 149.45 93.60 79.2085 119.5600 vena cava clip 71.70 44.91 38.0010 57.3600 venous pressure 85.65 53.64 45.3945 68.5200 vaporflex probe 857.50 537.05 454.4750 686.0000 vaporflex probe bipolar 320mm 891.80 558.53 472.6540 713.4400 visionart cutting block r 861.55 539.59 456.6215 689.2400 visionary cutting block 756.55 473.83 400.9715 605.2400 vitrector 278.25 174.27 147.4725 222.6000 vortex mixing system #6346 479.45 300.28 254.1085 383.5600 wand bevel 45 deg 3.0mm #6445 448.90 281.15 237.9170 359.1200 wand plasma reflex 45 #6118 453.75 284.18 240.4875 363.0000 wand plasma reflex ultra #6711 486.50 304.69 257.8450 389.2000 wand plasma w/cable 5.5in 468.50 293.42 248.3050 374.8000 washer flat 8.0 322.55 202.01 170.9515 258.0400 wire guide smooth 0.94 34.60 21.67 18.3380 27.6800 wire guide troc 6.5/8.0 187.70 117.56 99.4810 150.1600 wire kirschner blunt nitinol 128.00 80.17 67.8400 102.4000 wire kirschner bone head 2mm 194.30 121.69 102.9790 155.4400 wound protector/retractor 119.60 74.91 63.3880 95.6800 wrist fixation system 3754.91 2351.70 1990.1023 3003.9280 x-stream lap irrig tubing set 530.50 332.25 281.1650 424.4000 zero tip b basket 2.4fr #5809 461.80 289.23 244.7540 369.4400 zero tip nt basket 1.9fr #5810 457.10 286.28 242.2630 365.6800 wire guide 0.62 34.50 21.61 18.2850 27.6000 surgical drainage sys.tls 102.65 64.29 54.4045 82.1200 stomahesive wafer w/flang 8.70 5.45 4.6110 6.9600 stomahesive/duoderm 11.15 6.98 5.9095 8.9200 stone cone #6329 444.05 278.11 235.3465 355.2400 stonetome 712.70 446.36 377.7310 570.1600 stonetome removal device 555.35 347.82 294.3355 444.2800 strap distractor 152.35 95.42 80.7455 121.8800 structural balloon 303.90 190.33 161.0670 243.1200 stylet w/steering cap 50cm 235.20 147.31 124.6560 188.1600 subclavian cathetu tray 132.30 82.86 70.1190 105.8400 submucosal inj eleview 10ml 207.80 130.15 110.1340 166.2400 suction coagulator 10 fr 27.30 17.10 14.4690 21.8400 suction ent curved 70 degrees 471.60 295.36 249.9480 377.2800 suction ent curved 90 degrees 490.45 307.17 259.9385 392.3600 suction ent straight profess 471.60 295.36 249.9480 377.2800 suture fiberware 2.38 in 54.10 33.88 28.6730 43.2800 suture fiberwire 4-0 12.3mm 58.60 36.70 31.0580 46.8800 suture fiberwire 5 38in 12 bx 105.05 65.79 55.6765 84.0400 suture kit micro 513.80 321.79 272.3140 411.0400 suture lasso 45 #6382 321.50 201.36 170.3950 257.2000 suture lasso 90 #6381 391.40 245.13 207.4420 313.1200 suture lasso micro lg cv #8253 391.40 245.13 207.4420 313.1200 suture lasso micro sm cv #8252 376.35 235.71 199.4655 301.0800 suture lasso micro strgt #8254 376.35 235.71 199.4655 301.0800 suture needle expressewiii 426.66 267.22 226.1298 341.3280 suture passing wire 201.60 126.26 106.8480 161.2800 suture retriever #5685 101.30 63.44 53.6890 81.0400 suture sleeve 96.95 60.72 51.3835 77.5600 suture sleeve 1cm 96.95 60.72 51.3835 77.5600 suture sleeve 2.3cm 96.95 60.72 51.3835 77.5600 suprapubic drainage sys 113.00 70.77 59.8900 90.4000 surgeon controlled probe010892 845.25 529.38 447.9825 676.2000 surgflo hemostat matrix 352.40 220.71 186.7720 281.9200 surgical bit solid 3.8mm 177.20 110.98 93.9160 141.7600 surgiclip med 121.15 75.88 64.2095 96.9200 surgiflo #010922 473.80 296.74 251.1140 379.0400 surgiflo hemostatic matrix kit 482.15 301.97 255.5395 385.7200 surgineedle 120mm #7035 41.45 25.96 21.9685 33.1600 surgineedle 150mm long #6594 37.95 23.77 20.1135 30.3600 surgineedle all 61.05 38.24 32.3565 48.8400 surgiport all 170.65 106.88 90.4445 136.5200 surgiseal skin adhesive 35ml 35.50 22.23 18.8150 28.4000 surgn cntrld stim probe kit 845.80 529.72 448.2740 676.6400 tape suture fibertape 279.55 175.08 148.1615 223.6400 tape suture fiberwire 2x36 399.35 250.11 211.6555 319.4800 tape suture w/needle 26.5mm 93.20 58.37 49.3960 74.5600 tape sutured 26.5mm tapered 93.20 58.37 49.3960 74.5600 tb et emg trivant 7x9.5mm 543.66 340.49 288.1398 434.9280 tb evac fltr smoke btfr 203.70 127.58 107.9610 162.9600 teflon-sh 90.65 56.77 48.0445 72.5200 tegaderm iv dressing 6mm 1.80 1.13 0.9540 1.4400 ta 30 466.75 292.33 247.3775 373.4000 ta 45 415.25 260.07 220.0825 332.2000 ta 90 477.15 298.84 252.8895 381.7200 ta reload 45 3.5 126.80 79.41 67.2040 101.4400 ta reload 45 4.8 126.80 79.41 67.2040 101.4400 tablepad&headrest 010801/0108 251.60 157.58 133.3480 201.2800 tack plate thrd 0.062x3in 69.25 43.37 36.7025 55.4000 tenodesis kit 513.80 321.79 272.3140 411.0400 terra nova usage fee 832.00 521.08 440.9600 665.6000 tfn helical blade 80mm 776.50 486.32 411.5450 621.2000 tfn helical blade 90mm 746.65 467.63 395.7245 597.3200 tfn-advanced helical blade 776.50 486.32 411.5450 621.2000 tfna helical blade 11x380mm 3060.40 1916.73 1622.0120 2448.3200 tfna helical blade 95mm 1104.50 691.75 585.3850 883.6000 thoracentesis tray 84.70 53.05 44.8910 67.7600 thoracic procedure case 384.00 240.50 203.5200 307.2000 sut labral tape 1.5mmx36 wht 166.40 104.22 88.1920 133.1200 suture anchor inserter 1.4mm 543.25 340.24 287.9225 434.6000 suture anchor kit 513.80 321.79 272.3140 411.0400 sut ct m conn smartstich ster 138.70 86.87 73.5110 110.9600 suture tak mini kit 494.05 309.42 261.8465 395.2400 suture tigerstick 177.40 111.11 94.0220 141.9200 suturelasso sc 1.88mm diameter 71.70 44.91 38.0010 57.3600 suturelasso suture passer 102.40 64.13 54.2720 81.9200 suturing device fixate band 1806.55 1131.44 957.4715 1445.2400 swan ganz catheter 7.5fr 233.75 146.40 123.8875 187.0000 swan ganz catheter-6f 122.25 76.57 64.7925 97.8000 swan ganz catheter-7f 109.15 68.36 57.8495 87.3200 swan ganz pacing lead 337.95 211.66 179.1135 270.3600 syringe 60cc c.t. 5.25 3.29 2.7825 4.2000 syringe bulb 2oz disp-ea 5.25 3.29 2.7825 4.2000 syringe control with stopcock 53.26 33.36 28.2278 42.6080 syringe infl system 429.50 269.00 227.6350 343.6000 sys endo guidebead 5mm 180ml 106.50 66.70 56.4450 85.2000 sys vac del omni-cup w/pump 69.70 43.65 36.9410 55.7600 system chargeing 2646.00 1657.19 1402.3800 2116.8000 system mixing cement 256.00 160.33 135.6800 204.8000 system mixing cement w/syring 293.70 183.94 155.6610 234.9600 system mixing sterile 3ml 484.10 303.19 256.5730 387.2800 system repair meniscus minder 378.05 236.77 200.3665 302.4400 t tubes 17.70 11.09 9.3810 14.1600 t-fix endoscopic meniscal kit 116.90 73.21 61.9570 93.5200 t-handle coupler 542.25 339.61 287.3925 433.8000 tubes hemlich 18.05 11.30 9.5665 14.4400 tubing arthroscopy pump #7104 117.45 73.56 62.2485 93.9600 tubing closed drnge-ea 47.10 29.50 24.9630 37.6800 tubing core irrigation 117.00 73.28 62.0100 93.6000 tubing disposable 228.50 143.11 121.1050 182.8000 tubing irrigation acessory 154.70 96.89 81.9910 123.7600 tubing urogate 29.70 18.60 15.7410 23.7600 tunnel cannula #6400 53.15 33.29 28.1695 42.5200 tunneler 394.55 247.11 209.1115 315.6400 tur-y set 35.45 22.20 18.7885 28.3600 turbinator coblator ii 475.50 297.81 252.0150 380.4000 turp cutting loop 253.10 158.52 134.1430 202.4800 turp cutting loop elect12 6337 253.65 158.86 134.4345 202.9200 twist drill 00-09 289.65 181.41 153.5145 231.7200 twist drill 07-09 278.50 174.42 147.6050 222.8000 twist drill 1.5 x 50mm 395.15 247.48 209.4295 316.1200 uterine balloon colpo-pneumo 741.95 464.68 393.2335 593.5600 uterine manip rumi sys #8394 122.70 76.85 65.0310 98.1600 uterine manipltr rumi sys#5839 122.70 76.85 65.0310 98.1600 vaginal exan tray 25.60 16.03 13.5680 20.4800 vaginal irrigation tray 10.35 6.48 5.4855 8.2800 vaginal packing tray 18.05 11.30 9.5665 14.4400 versabond #6985 308.85 193.43 163.6905 247.0800 versaport 10mm-15mm #874 130.10 81.48 68.9530 104.0800 versaport 5-12mm w/fixtr #8850 115.25 72.18 61.0825 92.2000 versaport v2 5mm #7232 72.65 45.50 38.5045 58.1200 versaport v2 5mm short #7231 72.65 45.50 38.5045 58.1200 versaport v2 5mm-12mm #7233 86.48 54.16 45.8344 69.1840 versaport5mm lng w/fixtr #8851 103.80 65.01 55.0140 83.0400 versaport5mm shrt w/fixr #8849 103.80 65.01 55.0140 83.0400 versitomic flex reamer system 720.50 451.25 381.8650 576.4000 versitomic sterile pin pack 517.30 323.98 274.1690 413.8400 vertical isolation drape 237.65 148.84 125.9545 190.1200 vi-drape bag 27.90 17.47 14.7870 22.3200 video camera cover 38.40 24.05 20.3520 30.7200 trapezoid retrieval baskt#6098 588.65 368.67 311.9845 470.9200 tray uretheral dilation 294.50 184.45 156.0850 235.6000 tray urethral dilation 421.20 263.80 223.2360 336.9600 tray urethral dilation #7686 469.05 293.77 248.5965 375.2400 trial kit spine stimulator 147.85 92.60 78.3605 118.2800 trigger flex 808.00 506.05 428.2400 646.4000 trigger flex bi-polar 859.45 538.27 455.5085 687.5600 trigger flex bi-polar 35mm 857.50 537.05 454.4750 686.0000 trigger flex bi-polar 39mm 857.50 537.05 454.4750 686.0000 trigger flex bi-polar 40mm 857.50 537.05 454.4750 686.0000 trigger flex-long probe 859.45 538.27 455.5085 687.5600 trim-it drill pin kit 1.5#9604 431.05 269.97 228.4565 344.8400 trimane beach chair kit 209.65 131.30 111.1145 167.7200 triple lumen mahurkar 13fr 441.55 276.54 234.0215 353.2400 triple play device 3.0mm 1019.05 638.23 540.0965 815.2400 triune trumpet, sil 1.27/2.54 40.30 25.24 21.3590 32.2400 trocar & flex cannula 102.45 64.16 54.2985 81.9600 trocar bladed lap cann 5mm 53.26 33.36 28.2278 42.6080 trocar bladed versaone 12x100 404.05 253.06 214.1465 323.2400 trocar bladeless 12mm 393.20 246.26 208.3960 314.5600 trocar cath complete 75.80 47.47 40.1740 60.6400 trocar cath replacement 42.65 26.71 22.6045 34.1200 trocar cath-ingram 78.65 49.26 41.6845 62.9200 trocar endoscopic cannula rt5 66.55 41.68 35.2715 53.2400 trocar lap 5mm w/fxtn cann 319.50 200.10 169.3350 255.6000 tap cort dcp 4.0mm d 5.75in l 616.70 386.24 326.8510 493.3600 trocar versaport v2 5mm not im 99.80 62.50 52.8940 79.8400 trud nav suction 460.20 288.22 243.9060 368.1600 trudi curettes 567.30 355.30 300.6690 453.8400 trudi probe 536.10 335.76 284.1330 428.8800 tube endo nasal soft sz5#10457 11.10 6.95 5.8830 8.8800 tube endo nasal soft sz6 #880 11.10 6.95 5.8830 8.8800 tube endo nasal soft sz7 #9283 11.10 6.95 5.8830 8.8800 tube endotracheal disp 21.30 13.34 11.2890 17.0400 tube feeding special 43.40 27.18 23.0020 34.7200 tube gastric lavage edlic 16.35 10.24 8.6655 13.0800 thorocotomy tray 85.10 53.30 45.1030 68.0800 threaded k-wire-not implant 100.80 63.13 53.4240 80.6400 three fluter drill bit 4.2mm 425.70 266.62 225.6210 340.5600 tiger tape 2mm #10272 121.00 75.78 64.1300 96.8000 tip cover accessory 459.20 287.60 243.3760 367.3600 tip irrigation femoral 17.05 10.68 9.0365 13.6400 tip manipulator 6.7mm d 10cm l 121.42 76.05 64.3526 97.1360 tool cutting legend 16mm 391.55 245.23 207.5215 313.2400 tool cutting legend 3mm 450.85 282.37 238.9505 360.6800 tool dissecting 3mmx14cm burr 213.40 133.65 113.1020 170.7200 tool legend 14cm 3.0mm mh 2flt 318.00 199.16 168.5400 254.4000 tool match head 3mmx15cm 345.30 216.26 183.0090 276.2400 topaz micro debrider 525.60 329.18 278.5680 420.4800 topaz microblator 0.8mm #9466 631.60 395.57 334.7480 505.2800 topaz microblator 1.4mm #9016 637.20 399.08 337.7160 509.7600 torcar lap w/cannula 5mm 50.60 31.69 26.8180 40.4800 tibia bolt 86.30 54.05 45.7390 69.0400 total case outfits 222.60 139.41 117.9780 178.0800 trach tube cuffed sz-8 #826 92.30 57.81 48.9190 73.8400 trach tube fen cfkess-sz6#8607 92.30 57.81 48.9190 73.8400 trach tube fen cfless-sz8#8609 92.30 57.81 48.9190 73.8400 trachea emer tray 78.65 49.26 41.6845 62.9200 tracheostomy tube disp 165.80 103.84 87.8740 132.6400 tracheostomy tube sz-6 #824 92.30 57.81 48.9190 73.8400 total knee patella dome 453.20 283.84 240.1960 362.5600 touhy-borst w/side port 32.50 20.35 17.2250 26.0000 transconnector lock screw 21 133.10 83.36 70.5430 106.4800 transconnector lock screw 22 133.10 83.36 70.5430 106.4800 transfix ii drlpins gr wr#5963 391.15 244.98 207.3095 312.9200 female vest no sleeves w/pouch 119.80 75.03 63.4940 95.8400 carticel 15303.75 9584.74 8110.9875 12243.0000 6mm cage 853.30 534.42 452.2490 682.6400 lead cap kit 63.90 40.02 33.8670 51.1200 pacemaker, misc 21375.00 13387.16 11328.7500 17100.0000 pacemaker,implant misc 6995.00 4380.97 3707.3500 5596.0000 extractor stone basket 9-12 458.20 286.97 242.8460 366.5600 extender fluted 15x150mm 1134.45 710.51 601.2585 907.5600 extender stem press fit 16mm 1104.20 691.56 585.2260 883.3600 exp interbody sys 11x28x7-10mm 5824.00 3647.57 3086.7200 4659.2000 expand device lordotic 28x9x10 5824.00 3647.57 3086.7200 4659.2000 expandable interbody 32x10x10 5824.00 3647.57 3086.7200 4659.2000 patella itotal-29 patella impl 494.15 309.49 261.8995 395.3200 pain rlf sys 100mmx16gx20g-sti 358.40 224.47 189.9520 286.7200 pain relief sys 100mmc16gx20g 395.70 247.83 209.7210 316.5600 foundation 16.5x14x7 cage 700.50 438.72 371.2650 560.4000 pedicle screw 7.5mm x 50mm 1040.90 651.92 551.6770 832.7200 floseal hemosatic sealant 5ml 505.60 316.66 267.9680 404.4800 peek coroent xl 12x22x5mm 7350.00 4603.31 3895.5000 5880.0000 peek coroent xl 12x26x45mm 8085.00 5063.64 4285.0500 6468.0000 peek coroent xl 8x18x45mm 5880.00 3682.64 3116.4000 4704.0000 peek coroent xl 8x18x50mm 5880.00 3682.64 3116.4000 4704.0000 peek coroent xl xw 10x26x55mm 7350.00 4603.31 3895.5000 5880.0000 peek coroent xl xw 8x26x60mm 7350.00 4603.31 3895.5000 5880.0000 peek ring core insert 169.40 106.10 89.7820 135.5200 peek xl(xw) 8 x 26 x 55mm 10 7350.00 4603.31 3895.5000 5880.0000 fixator external low prof 220 1419.40 888.97 752.2820 1135.5200 fixed 4.0mm self drilling 16mm 192.00 120.25 101.7600 153.6000 fixed perc rod 55mm 420.50 263.36 222.8650 336.4000 fixed perc rod 60mm 420.50 263.36 222.8650 336.4000 fixed perc rod 65mm 437.30 273.88 231.7690 349.8400 fixed perc rod 70mm 420.50 263.36 222.8650 336.4000 gft bne lumbar magnifuse 5cm 2402.40 1504.62 1273.2720 1921.9200 gft bone cerv post sub 1165.50 729.95 617.7150 932.4000 gft tendon pat 10mm dia dowel 4224.50 2645.80 2238.9850 3379.6000 gft tendon w/bne block >160mm 2398.20 1501.99 1271.0460 1918.5600 frozen semitendinosus 1979.20 1239.57 1048.9760 1583.3600 gastrostomy tube 22fr 196.30 122.94 104.0390 157.0400 gage lordotic 8x10x32mm 4042.50 2531.82 2142.5250 3234.0000 frozen gracilic tendon 230mm x 1654.40 1036.15 876.8320 1323.5200 frozen graft link 3381.00 2117.52 1791.9300 2704.8000 everest mi screw 6.5x45mm 1223.60 766.34 648.5080 978.8800 everest mi screw 6.5x50mm 1223.60 766.34 648.5080 978.8800 everest mi screw 7.5x40mm 1176.55 736.87 623.5715 941.2400 everest mi screw 7.5x45mm 1223.60 766.34 648.5080 978.8800 end cap 8x10mm 520.50 325.99 275.8650 416.4000 end cap standard 520.50 325.99 275.8650 416.4000 olive wire 1.4mm 282.25 176.77 149.5925 225.8000 omega lif (cage) 4900.00 3068.87 2597.0000 3920.0000 peg non-locking 2.7 30mm 239.55 150.03 126.9615 191.6400 peg non-locking 2.7 x 18mm 239.55 150.03 126.9615 191.6400 peg non-locking 2.7 x 20mm 239.55 150.03 126.9615 191.6400 peg non-locking 2.7 x 26mm 239.55 150.03 126.9615 191.6400 peg non-locking 2.7 x 28mm 239.55 150.03 126.9615 191.6400 peg part.thread 2.5x10mm 217.75 136.38 115.4075 174.2000 peg partial thread 2.5x30mm 217.80 136.41 115.4340 174.2400 peg partial thread 30 324.20 203.05 171.8260 259.3600 peg partial thread 35 324.20 203.05 171.8260 259.3600 peg partial thread 37.5 324.20 203.05 171.8260 259.3600 peg partial thread 40 324.20 203.05 171.8260 259.3600 peg partial thread 45 324.20 203.05 171.8260 259.3600 peg screw 2.5 x 18mm 290.35 181.85 153.8855 232.2800 peg smooth 37.5 266.15 166.69 141.0595 212.9200 peg smooth locking 2.0 x 10mm 239.55 150.03 126.9615 191.6400 peg smooth locking 2.0 x 12mm 266.15 166.69 141.0595 212.9200 peg smooth locking 2.0 x 14mm 239.55 150.03 126.9615 191.6400 peg smooth locking 2.0 x 21mm 266.15 166.69 141.0595 212.9200 peg smooth locking 2.0 x 22m 266.15 166.69 141.0595 212.9200 peg smooth locking 2.0 x 23mm 266.15 166.69 141.0595 212.9200 peg smooth locking 2.0 x 24mm 266.15 166.69 141.0595 212.9200 peg smooth locking 2.0 x 26mm 266.15 166.69 141.0595 212.9200 peg smooth locking 2.0 x 28mm 266.15 166.69 141.0595 212.9200 peg smooth locking 2.0 x 30mm 266.15 166.69 141.0595 212.9200 peg smooth locking 2.0x16mm 239.55 150.03 126.9615 191.6400 peg smooth locking 2.0x18mm 239.55 150.03 126.9615 191.6400 peg smooth locking 2.0x19mm 239.55 150.03 126.9615 191.6400 peg smooth locking 2.0x20mm 239.55 150.03 126.9615 191.6400 peg threaded 2.3 x 10mm 239.55 150.03 126.9615 191.6400 peg threaded 2.3 x 12mm 266.15 166.69 141.0595 212.9200 peg threaded 2.3 x 14mm 239.55 150.03 126.9615 191.6400 peg threaded 2.3 x 16mm 239.55 150.03 126.9615 191.6400 peg threaded 2.3 x 18mm 239.55 150.03 126.9615 191.6400 grafton orhtoblend 5cc 1162.20 727.89 615.9660 929.7600 grafton orthoblend 10cc 1508.85 944.99 799.6905 1207.0800 grafton orthoblend 15cc 1730.15 1083.59 916.9795 1384.1200 grafton orthoblend 5cc lg 1117.50 699.89 592.2750 894.0000 grafton putty 5cc 556.20 348.35 294.7860 444.9600 grafton strip matrix 8x1x20cm 3148.75 1972.06 1668.8375 2519.0000 graft rope ac 1273.85 797.81 675.1405 1019.0800 graft rope tendon 1235.35 773.70 654.7355 988.2800 grafton 10cc putty #010962 1339.90 839.18 710.1470 1071.9200 grafton 1cc plus paste 401.65 251.55 212.8745 321.3200 grafton 1cc putty #010856 417.70 261.61 221.3810 334.1600 grafton 5cc crunch 1164.40 729.26 617.1320 931.5200 grafton 5cc putty #010899 949.26 594.52 503.1078 759.4080 grafton dbm gel 0.5cc 228.50 143.11 121.1050 182.8000 grafton dbm gel 1cc 401.65 251.55 212.8745 321.3200 grafton dbm gel 5cc 912.75 571.66 483.7575 730.2000 grafton dbm matrix strips 1x10 1740.90 1090.33 922.6770 1392.7200 goldenberg malleable (proth) 768.55 481.34 407.3315 614.8400 goldenberg malleable torp 753.90 472.17 399.5670 603.1200 genesis pin and drill set 308.62 193.29 163.5686 246.8960 peg dvr thrd 2.5x28mm ti 217.80 136.41 115.4340 174.2400 peg full thrd 2.5x14mm 164.00 102.71 86.9200 131.2000 peg full thrd 2.5x18mm 164.00 102.71 86.9200 131.2000 peg hich comp.locking 2.7x18mm 239.55 150.03 126.9615 191.6400 peg high comp locking 2.7x16mm 266.15 166.69 141.0595 212.9200 peg high comp locking 2.7x19mm 266.15 166.69 141.0595 212.9200 peg high comp locking 2.7x20mm 266.15 166.69 141.0595 212.9200 peg high comp locking 2.7x21mm 266.15 166.69 141.0595 212.9200 peg high comp locking 2.7x22mm 266.15 166.69 141.0595 212.9200 peg high comp locking 2.7x23mm 266.15 166.69 141.0595 212.9200 peg high comp locking 2.7x24mm 266.15 166.69 141.0595 212.9200 peg high comp locking 2.7x26mm 266.15 166.69 141.0595 212.9200 peg high comp locking 2.7x28mm 266.15 166.69 141.0595 212.9200 peg high comp locking 2.7x30mm 266.15 166.69 141.0595 212.9200 peg 2.5 x 14mm 290.35 181.85 153.8855 232.2800 peg 2.5 x 16mm 290.35 181.85 153.8855 232.2800 peg 2.5 x 18mm 290.35 181.85 153.8855 232.2800 peg 2.5 x 20mm 290.35 181.85 153.8855 232.2800 peg 2.5 x 22mm 290.35 181.85 153.8855 232.2800 peg 2.5 x 24mm 290.35 181.85 153.8855 232.2800 peg 2.5 x 26mm 290.35 181.85 153.8855 232.2800 peg 2.5x12mm 217.75 136.38 115.4075 174.2000 grft bone cell matrix frzn 1ml 651.55 408.07 345.3215 521.2400 head standard m.i.s. 861.55 539.59 456.6215 689.2400 gold markers 370.00 231.73 196.1000 296.0000 hex rad rod 5.5x50mm 568.40 355.99 301.2520 454.7200 blade spiral hum nail 44mm 708.45 443.70 375.4785 566.7600 inerbody coroent xl 8x18x50 5880.00 3682.64 3116.4000 4704.0000 implant bone 15x15x15mm 1455.50 911.58 771.4150 1164.4000 implant lumbar 11x24x9-12mm 5824.00 3647.57 3086.7200 4659.2000 implant lumbar 11x28x9-12 5824.00 3647.57 3086.7200 4659.2000 implant nail,metacarpal stand. 992.80 621.79 526.1840 794.2400 implant system bridge repair 2588.30 1621.05 1371.7990 2070.6400 implant tissue biocart 1ml 1248.50 781.94 661.7050 998.8000 humeral nail/left/cann 8x160mm 3040.00 1903.95 1611.2000 2432.0000 hook extended body 8.0 #010901 992.80 621.79 526.1840 794.2400 hoop shim mas tlif #010947 893.05 559.32 473.3165 714.4400 jrf speed graft 3385.20 2120.15 1794.1560 2708.1600 jrny pfj implant x-sm lt 3969.00 2485.78 2103.5700 3175.2000 cath power picc t-lumen 5fr 412.70 258.47 218.7310 330.1600 catheter trocar 20fr 26.70 16.72 14.1510 21.3600 catheter ivad 8.5fr tray 666.10 417.18 353.0330 532.8800 cath tray triple lumen 352.65 220.86 186.9045 282.1200 catheter trocar 10fr 26.70 16.72 14.1510 21.3600 cable with crimp 1.7mm x 750mm 817.90 512.25 433.4870 654.3200 cancellous bone screw 6.5x35mm 128.00 80.17 67.8400 102.4000 cancellous chips 15cc #8929 574.95 360.09 304.7235 459.9600 cable and ext 2ft 1x16 spectra 441.55 276.54 234.0215 353.2400 cage anchor 10x33x4deg. 4042.50 2531.82 2142.5250 3234.0000 cage anchor c 6x14x16x4deg 4042.50 2531.82 2142.5250 3234.0000 cage anchor c 7x14x16x4deg 3822.00 2393.72 2025.6600 3057.6000 cage anchor c 7x24x16 8d 3675.00 2301.65 1947.7500 2940.0000 cage cambria lord 17x13x6mm 920.50 576.51 487.8650 736.4000 cage cerv lordotic roi-c 14x15 1837.50 1150.83 973.8750 1470.0000 cage cervical 28mm 3730.90 2336.66 1977.3770 2984.7200 cage cervical 4mm 1176.55 736.87 623.5715 941.2400 cage cervical 5mm 1176.55 736.87 623.5715 941.2400 cage cervical 5x14x11mm 1176.55 736.87 623.5715 941.2400 cage cervical 6mm 1176.55 736.87 623.5715 941.2400 cage cervical 6x14x11mm 1176.55 736.87 623.5715 941.2400 cage cervical 7mm 1176.55 736.87 623.5715 941.2400 cage cervical 9x14x11mm 1176.55 736.87 623.5715 941.2400 cage cervical hijak 9x15x17 1373.30 860.10 727.8490 1098.6400 cage clydesdale 14x55mm 6860.00 4296.42 3635.8000 5488.0000 cage clydesdale 6 deg 10x50mm 6860.00 4296.42 3635.8000 5488.0000 cage clydesdale 6 deg 8x45mm 6860.00 4296.42 3635.8000 5488.0000 cage clydesdale 6 deg 8x55x22 6860.00 4296.42 3635.8000 5488.0000 cage llordotic 24mm 3880.15 2430.14 2056.4795 3104.1200 cage lordotic 10x10x32mm 4042.50 2531.82 2142.5250 3234.0000 cage lordotic 10x32x13mm 4042.50 2531.82 2142.5250 3234.0000 cage lordotic 10x32x9mm 4042.50 2531.82 2142.5250 3234.0000 cage lordotic 11x10x32mm 4042.50 2531.82 2142.5250 3234.0000 cage lordotic 12x10x32mm 4042.50 2531.82 2142.5250 3234.0000 cage lordotic 14x10x32mm tlif 4042.50 2531.82 2142.5250 3234.0000 cage lordotic 18mm 3730.90 2336.66 1977.3770 2984.7200 cage lordotic 20mm #011102 3730.90 2336.66 1977.3770 2984.7200 cage lordotic 22mm #010910 3730.90 2336.66 1977.3770 2984.7200 cage lordotic 26mm 3730.90 2336.66 1977.3770 2984.7200 cage lordotic 34mm 3730.90 2336.66 1977.3770 2984.7200 cage lordotic 42mm 3942.55 2469.22 2089.5515 3154.0400 cage lordotic 8x10x32mm 4042.50 2531.82 2142.5250 3234.0000 cage lordotic x-large 12x22x45 5605.60 3510.79 2970.9680 4484.4800 cage lorodotic cor 8x22x45mm 5390.00 3375.76 2856.7000 4312.0000 cage spacer peek 5x14x11mm 1365.55 855.24 723.7415 1092.4400 cage spinal 10 deg 14x22x60mm 4900.00 3068.87 2597.0000 3920.0000 cage spinal 11x24x12-15mm 4659.20 2918.06 2469.3760 3727.3600 cage spinal 11x28x12-15mm 5241.60 3282.81 2778.0480 4193.2800 cage spinal 14x22x55mm 10 deg 4900.00 3068.87 2597.0000 3920.0000 cage spinal 16x14x6mm 870.50 545.19 461.3650 696.4000 cage spinal 16x14x7mm 870.50 545.19 461.3650 696.4000 cage spinal 16x22x50mm 4900.00 3068.87 2597.0000 3920.0000 cage spinal 22x12x45mm 4900.00 3068.87 2597.0000 3920.0000 cage spinal cervical 6x12x14 853.30 534.42 452.2490 682.6400 cage spinal ptc 16x14x5mm 905.30 566.99 479.8090 724.2400 cage spinal stackable 22mm 4200.00 2630.46 2226.0000 3360.0000 cage tlif device9x9x23mm 50d 4410.00 2761.98 2337.3000 3528.0000 cage unilif 10x30x40 4042.50 2531.82 2142.5250 3234.0000 cage xlifw lordotic 10x22x55mm 7350.00 4603.31 3895.5000 5880.0000 caheter trocar 28fr 26.70 16.72 14.1510 21.3600 blade titanium humeral 42mm 708.45 443.70 375.4785 566.7600 blade intermed nail-ex 38mm 708.45 443.70 375.4785 566.7600 peg threaded 2.3 x 19mm 239.55 150.03 126.9615 191.6400 peg threaded 2.3 x 20mm 239.55 150.03 126.9615 191.6400 peg threaded 2.3 x 21mm 266.15 166.69 141.0595 212.9200 peg threaded 2.3 x 22m 266.15 166.69 141.0595 212.9200 peg threaded 2.3 x 23mm 266.15 166.69 141.0595 212.9200 peg threaded 2.3 x 24mm 266.15 166.69 141.0595 212.9200 peg threaded 2.3 x 26mm 266.15 166.69 141.0595 212.9200 peg threaded 2.3 x 28mm 266.15 166.69 141.0595 212.9200 peg threaded 2.3 x 30mm 239.55 150.03 126.9615 191.6400 peg threaded 2.7 x 10mm 920.50 576.51 487.8650 736.4000 peg threaded 2.7 x 12mm 266.15 166.69 141.0595 212.9200 peg threaded 2.7 x 14mm 266.15 166.69 141.0595 212.9200 peg threaded 2.7 x 16mm 239.55 150.03 126.9615 191.6400 peg threaded 2.7 x 20mm 239.55 150.03 126.9615 191.6400 peg threaded 2.7 x 22mm 276.80 173.36 146.7040 221.4400 peg threaded 2.7 x 24mm 266.15 166.69 141.0595 212.9200 peg ulnar shortening reduc 247.30 154.88 131.0690 197.8400 bucket handle 4.0mm (proth) 485.00 303.76 257.0500 388.0000 bucket handle 4.25mm (proth) 485.00 303.76 257.0500 388.0000 kt perc insr suturetak 3mm 432.10 270.62 229.0130 345.6800 kit catheter iv periph 18x8cm 115.20 72.15 61.0560 92.1600 kit catheter iv periph 20x8cm 115.20 72.15 61.0560 92.1600 kit central venous arrow 311.00 194.78 164.8300 248.8000 kit syringe aug 4x1ml 368.05 230.51 195.0665 294.4400 kit spinal locking cap w/screw 133.10 83.36 70.5430 106.4800 latera implant 1423.25 891.38 754.3225 1138.6000 lateral fibula plate 6-hl 959.40 600.87 508.4820 767.5200 connector side-to-ide #010904 1615.95 1012.07 856.4535 1292.7600 key stoma meas device 113.15 70.87 59.9695 90.5200 centralizer stem invis 12mm 106.50 66.70 56.4450 85.2000 cerclage wire 175mm 201.30 126.07 106.6890 161.0400 cervical cage/fusion device 970.50 607.82 514.3650 776.4000 cementralizer 13.0 279.85 175.27 148.3205 223.8800 cge lordtic coront xlg18x55x10 6615.00 4142.97 3505.9500 5292.0000 catheter trocar 36fr 27.80 17.41 14.7340 22.2400 catheter trocar 32 fr 26.70 16.72 14.1510 21.3600 catheter trocar 32fr 27.80 17.41 14.7340 22.2400 dev spinal cerv interbody fus 920.50 576.51 487.8650 736.4000 devex ti cage 10mm 5d 4410.00 2761.98 2337.3000 3528.0000 devex ti cage 8mm 5d 4410.00 2761.98 2337.3000 3528.0000 device fusion interbod 12x14x5 870.50 545.19 461.3650 696.4000 device fusion poly 12x22x50 6260.80 3921.14 3318.2240 5008.6400 device fusion tetra 14.5x17x7 870.50 545.19 461.3650 696.4000 device interbody 14.5x17x5 853.30 534.42 452.2490 682.6400 disc shim-ss 704.05 440.95 373.1465 563.2400 cuff neuroflex 3mm d 2.5mm l 1446.10 905.69 766.4330 1156.8800 demineralized bone matrix 2cc 549.90 344.40 291.4470 439.9200 device spinal 10x22x55 6260.80 3921.14 3318.2240 5008.6400 device spinal 12x22x60 6260.80 3921.14 3318.2240 5008.6400 device spinal 12x22x60mm 5600.00 3507.28 2968.0000 4480.0000 device spinal 3d 10x18x50 6260.80 3921.14 3318.2240 5008.6400 device spinal 3d 8x18x50 6260.80 3921.14 3318.2240 5008.6400 device spinal 8x22x50 polyaxia 6260.80 3921.14 3318.2240 5008.6400 device spinal cerv 10x22x50 6552.00 4103.52 3472.5600 5241.6000 device spinal cerv 12x22x50 6552.00 4103.52 3472.5600 5241.6000 device spinal cerv 15x13x6mm 920.50 576.51 487.8650 736.4000 device spinal fusion 10 deg 6260.80 3921.14 3318.2240 5008.6400 device spinal fusion 10x22x45 6260.80 3921.14 3318.2240 5008.6400 device spinal fusion 10x22x50 6260.80 3921.14 3318.2240 5008.6400 device spinal ketone 10x22x40 5096.00 3191.62 2700.8800 4076.8000 device spinal ketone 8x22x40mm 4900.00 3068.87 2597.0000 3920.0000 device spinal peek 12x26x60 5600.00 3507.28 2968.0000 4480.0000 device spinal polyaxial 10deg 6260.80 3921.14 3318.2240 5008.6400 coupler stem knee legion 4mm 1064.50 666.70 564.1850 851.6000 cover screw hub cap 266.15 166.69 141.0595 212.9200 connector transverse medium 470.50 294.67 249.3650 376.4000 connectors implant 2x15mm 599.05 375.19 317.4965 479.2400 contol cable & sleeve 1.8mm x 602.70 377.47 319.4310 482.1600 corkscrew sutr lasso lt #6384 376.35 235.71 199.4655 301.0800 corkscrew sutr lasso rt #6385 391.40 245.13 207.4420 313.1200 coroent xl 10-10x18x50mm 5880.00 3682.64 3116.4000 4704.0000 coroent xl 10x22x55mm 8085.00 5063.64 4285.0500 6468.0000 coroent xl 12x22x50 10 deg. 7350.00 4603.31 3895.5000 5880.0000 coroent xl 12x22x60mm 8085.00 5063.64 4285.0500 6468.0000 coroent xl 8x22x45mm 7350.00 4603.31 3895.5000 5880.0000 coroent xl 8x22x50mm 7717.50 4833.47 4090.2750 6174.0000 coroent xl wide 10x22x45mm 8408.40 5266.18 4456.4520 6726.7200 coroent xl wide 10x22x50mm 8085.00 5063.64 4285.0500 6468.0000 coroent xl wide 10x22x55mm 8085.00 5063.64 4285.0500 6468.0000 coroent xl wide 10x22x60mm 8085.00 5063.64 4285.0500 6468.0000 coroent xl wide 12x22x50 7350.00 4603.31 3895.5000 5880.0000 coroent xl wide 12x22x55 6615.00 4142.97 3505.9500 5292.0000 coroent xl wide 8x22x55mm 8085.00 5063.64 4285.0500 6468.0000 coroent xl wide 8x22x60mm 8085.00 5063.64 4285.0500 6468.0000 coroent xlfw 10x22x60mm 7350.00 4603.31 3895.5000 5880.0000 coroent xlxw 8x26x55mm 7350.00 4603.31 3895.5000 5880.0000 coroent xlxw 10x26x50mm 7350.00 4603.31 3895.5000 5880.0000 coroent xlxw 10x26x55mm 7350.00 4603.31 3895.5000 5880.0000 coroent xlxw 10x26x60mm 7350.00 4603.31 3895.5000 5880.0000 coroent xlxw 12x26x50mm 7350.00 4603.31 3895.5000 5880.0000 coroent xlxw 8x26x55mm 7350.00 4603.31 3895.5000 5880.0000 coroent xlxw 8x26x60mm 7350.00 4603.31 3895.5000 5880.0000 coroentxlfw lordotic 10x22x55 7350.00 4603.31 3895.5000 5880.0000 introducer diamond tip 8gax6in 199.70 125.07 105.8410 159.7600 intro pn dmd 11ga x 15cm ster 199.70 125.07 105.8410 159.7600 introbody coroent xl 8x22x60mm 8085.00 5063.64 4285.0500 6468.0000 introbody coroent xl10x22x55mm 8085.00 5063.64 4285.0500 6468.0000 internal brace ligament 3110.00 1947.79 1648.3000 2488.0000 liner acetabular 32 x 48mm 2511.10 1572.70 1330.8830 2008.8800 lite blocker 139.80 87.56 74.0940 111.8400 fast-fix 360 kpsc slotted cann 385.85 241.66 204.5005 308.6800 low profile screw 2.4x12mm 445.65 279.11 236.1945 356.5200 lgn xlpe cr insert sz 3-4 9mm 1019.05 638.23 540.0965 815.2400 locking collar 128.00 80.17 67.8400 102.4000 locking screw 2.7 x 11mm 370.85 232.26 196.5505 296.6800 locking third tubular plate 5h 578.80 362.50 306.7640 463.0400 interbody cerv 7deg 13x16x6 870.50 545.19 461.3650 696.4000 interbody coroent xl 10x18x55 5880.00 3682.64 3116.4000 4704.0000 interbody coroent xl 10x18x60 5880.00 3682.64 3116.4000 4704.0000 interbody coroent xl 10x22x60m 8085.00 5063.64 4285.0500 6468.0000 interbody coroent xl 12x18x55 5880.00 3682.64 3116.4000 4704.0000 interbody coroent xl 8x18x55 5880.00 3682.64 3116.4000 4704.0000 interbody coroent xl 8x18x60mm 5880.00 3682.64 3116.4000 4704.0000 interbody coroent xxl 10x18x50 5880.00 3682.64 3116.4000 4704.0000 interbody coronet xl 10x18x45 5880.00 3682.64 3116.4000 4704.0000 interbody coronet xl 8x18x45 5880.00 3682.64 3116.4000 4704.0000 interbody fsn lord 6x12.5x15mm 1100.50 689.24 583.2650 880.4000 inserter tip md\md 5mm 293.50 183.82 155.5550 234.8000 insert tibial lateral 770.10 482.31 408.1530 616.0800 inserter tip deep implant 6mm 293.55 183.85 155.5815 234.8400 infuse medium bone graft kit 7480.45 4685.01 3964.6385 5984.3600 infuse small bone graft kit 5275.90 3304.30 2796.2270 4220.7200 guidewire 2.8x300mm implant 280.65 175.77 148.7445 224.5200 guides alming 1.5mm 75.50 47.29 40.0150 60.4000 guidewire 0.44in diameter 419.30 262.61 222.2290 335.4400 hat trick mtp unilat proc pak 1040.05 651.38 551.2265 832.0400 meniscal cinch 509.80 319.29 270.1940 407.8400 meniscal cinch ii 816.90 511.62 432.9570 653.5200 mesh spinal fusion 27x20mm 3348.80 2097.35 1774.8640 2679.0400 med top load transconnector 489.30 306.45 259.3290 391.4400 matrix bone sub grafton 5ml 715.10 447.87 379.0030 572.0800 matrix graft bone putty 1ml 345.10 216.14 182.9030 276.0800 lordotic rod 5.5x35mm 411.30 257.60 217.9890 329.0400 lumbar interbody 11x24x7-10mm 5824.00 3647.57 3086.7200 4659.2000 mobi-c cervical disc prosthesi 620.50 388.62 328.8650 496.4000 mobi-c implant 15x17hs 6552.00 4103.52 3472.5600 5241.6000 modified t-tube silicone 92.30 57.81 48.9190 73.8400 modulus cage xlw 8x22x55 6260.80 3921.14 3318.2240 5008.6400 modulus xl, 10x18x55mm 6260.80 3921.14 3318.2240 5008.6400 modulus xlw 8x22x60 6260.80 3921.14 3318.2240 5008.6400 mlx 10x38x28mm 12 6552.00 4103.52 3472.5600 5241.6000 mlx 8x34x24mm 4 6552.00 4103.52 3472.5600 5241.6000 mis reduction head 704.05 440.95 373.1465 563.2400 micro profile drill bit 403.20 252.52 213.6960 322.5600 multi-lumen w/biopatch 314.00 196.66 166.4200 251.2000 nail distal radius short,ti 992.80 621.79 526.1840 794.2400 nail ex spiral blade 407.15 255.00 215.7895 325.7200 nail ex/150mm-sterile 3023.90 1893.87 1602.6670 2419.1200 nail ex/220mm-s 7mm 3175.05 1988.53 1682.7765 2540.0400 nail fixation 360mm/right-s 2905.20 1819.53 1539.7560 2324.1600 nail humeral can ti ex 9x230mm 2823.30 1768.23 1496.3490 2258.6400 nail prox.humeral cann ex 9x22 2643.40 1655.56 1401.0020 2114.7200 nail standard 4.0mm,ti 992.80 621.79 526.1840 794.2400 nail tfn 10 x 320mm r 3049.00 1909.59 1615.9700 2439.2000 nail ti humeral 9.5mm 3192.00 1999.15 1691.7600 2553.6000 nail tibial cannulatged 9mm 2601.85 1629.54 1378.9805 2081.4800 nail titanium cann 10mm 360/13 3050.50 1910.53 1616.7650 2440.4000 nail titanium cann 11mm 380/13 3172.50 1986.94 1681.4250 2538.0000 nail troch 11mm/125 320mm/r-s 3050.50 1910.53 1616.7650 2440.4000 nail troch 340mm/left-s 3050.50 1910.53 1616.7650 2440.4000 nail troch 340mm/right 2905.20 1819.53 1539.7560 2324.1600 nail troch 400mm/right-s 3050.50 1910.53 1616.7650 2440.4000 nail troch 420mm/right-s 3050.50 1910.53 1616.7650 2440.4000 nail-ex/210mm-s 3175.05 1988.53 1682.7765 2540.0400 nail-ex/360mm/lt-s 2744.50 1718.88 1454.5850 2195.6000 nailcann dist fem 11mmx320mm 2805.50 1757.08 1486.9150 2244.4000 naill cann distal femoral 320 2805.50 1757.08 1486.9150 2244.4000 narrow head 3 hole-r 1077.30 674.71 570.9690 861.8400 narrow head 4 hole-r 1077.30 674.71 570.9690 861.8400 novel cerv spacer 7mm l 7 deg 920.50 576.51 487.8650 736.4000 novel cervical spacer 6mm lrg 920.50 576.51 487.8650 736.4000 novi-c cervical disc prosth 6552.00 4103.52 3472.5600 5241.6000 nm implant 17x13 6mm flat lord 920.50 576.51 487.8650 736.4000 nm implant 17x13 7mm flat lord 920.50 576.51 487.8650 736.4000 nail cannnulated 9mm 260mm st 2446.00 1531.93 1296.3800 1956.8000 nail 340mm/left-s 2905.20 1819.53 1539.7560 2324.1600 nail 360mm/left-s 2836.03 1776.20 1503.0959 2268.8240 nail 380mm/left-s 2905.20 1819.53 1539.7560 2324.1600 nail 380mm/right-sterile 2905.20 1819.53 1539.7560 2324.1600 nail 7mm humeral ex-240mm ster 2422.60 1517.27 1283.9780 1938.0800 nail cann distal femoral 360mm 2805.50 1757.08 1486.9150 2244.4000 drill sleeve 1.7mm nubbun 173.40 108.60 91.9020 138.7200 drill kit continuous.comp impl 646.30 404.78 342.5390 517.0400 drill cannulated 07mm 499.30 312.71 264.6290 399.4400 nextra hammertoe sterile kit 1381.30 865.11 732.0890 1105.0400 nut transconnector 7.5mm 128.00 80.17 67.8400 102.4000 dvr plate template set sterile 72.60 45.47 38.4780 58.0800 dtrax cervical cage b 2470.50 1547.27 1309.3650 1976.4000 dtrax graft allograft implant 1749.18 1095.51 927.0654 1399.3440 driver cannulated hex 2.5mm 389.80 244.13 206.5940 311.8400 allgrft tendon ach w/bone 160 1769.80 1108.43 937.9940 1415.8400 allograft bone 1.7-10mm 390.78 244.75 207.1134 312.6240 allograft bone g2 tiss divert 510.10 319.48 270.3530 408.0800 allograft medium trinity eiite 4454.10 2789.60 2360.6730 3563.2800 allograft spacer 14x16x7 970.50 607.82 514.3650 776.4000 allograft spacer 16mml 6mm h 870.50 545.19 461.3650 696.4000 allograft spacer 5x16x14 970.50 607.82 514.3650 776.4000 allograft tendon gracilis 1622.80 1016.36 860.0840 1298.2400 60mm synapse rod 320.00 200.42 169.6000 256.0000 6.5mm flat washer 217.75 136.38 115.4075 174.2000 5mm cage large 853.30 534.42 452.2490 682.6400 5x14x17 ant crevical cage 853.30 534.42 452.2490 682.6400 all-inside double tendon 3234.00 2025.45 1714.0200 2587.2000 4.0mm x 70mm rod 320.00 200.42 169.6000 256.0000 4.0x36mm cannulated screw 327.50 205.11 173.5750 262.0000 4.0x48mm cann screw long thrd 330.15 206.77 174.9795 264.1200 420mm 3.5 to 5.5 rod 411.30 257.60 217.9890 329.0400 4.5mm occipital bone screw 9mm 1176.55 736.87 623.5715 941.2400 40mm mis contoured rod 520.50 325.99 275.8650 416.4000 40mm rod 489.30 306.45 259.3290 391.4400 50mm contoured rod 520.50 325.99 275.8650 416.4000 50mm mis rod 395.50 247.70 209.6150 316.4000 50mm rod 411.30 257.60 217.9890 329.0400 48mm 3 level xtend plate 1260.00 789.14 667.8000 1008.0000 55mm mis rod 395.50 247.70 209.6150 316.4000 5.5x35mm rod 411.30 257.60 217.9890 329.0400 cath billn bakri 24frx54cm 437.50 274.01 231.8750 350.0000 click anchor 428.40 268.31 227.0520 342.7200 cap revolve locking 134.40 84.17 71.2320 107.5200 cap screw spinal sterile 128.00 80.17 67.8400 102.4000 capston l xlif 10x44mm #010968 4200.00 2630.46 2226.0000 3360.0000 cap end t40 stardrive 416.60 260.92 220.7980 333.2800 bone void filler 974.95 610.61 516.7235 779.9600 bone screw fa-sd 4.0x14mm 403.20 252.52 213.6960 322.5600 bone screw non ster acutrak 30 619.50 387.99 328.3350 495.6000 bone screw va-sd 4.0x12mm 403.20 252.52 213.6960 322.5600 bone graft 5x14x11mm #010857 1159.75 726.35 614.6675 927.8000 bone graft 6x14x11mm #010858 1159.75 726.35 614.6675 927.8000 bone graft 7mm 508.75 318.63 269.6375 407.0000 bold lkng 3.5mm 4.9mm d 46mm l 378.00 236.74 200.3400 302.4000 bolt lkng 3.5mm 4.9mm d 50mm l 378.00 236.74 200.3400 302.4000 bolt locking 38mm 444.30 278.27 235.4790 355.4400 bolt locking 4.9mmx30mm 444.30 278.27 235.4790 355.4400 bolt locking 4.9mmx36mm 444.30 278.27 235.4790 355.4400 bolt locking hex recess titani 444.30 278.27 235.4790 355.4400 bone screw va-sd 4.0x14mm 403.20 252.52 213.6960 322.5600 femoral adapter 5 degree 2595.30 1625.44 1375.5090 2076.2400 femoral adapter bolt +2/-2mm s 491.40 307.76 260.4420 393.1200 femoral rod 2.5mm x 950mm 287.65 180.16 152.4545 230.1200 femoral stem hip 12mm 11/13 18 2352.00 1473.06 1246.5600 1881.6000 f3d cage 16.5x14x6x7 700.50 438.72 371.2650 560.4000 f3d cage 16.5x14x8x7 700.50 438.72 371.2650 560.4000 guide pin threaded 90.60 56.74 48.0180 72.4800 guide pin threaded 3.2mmx9in 58.60 36.70 31.0580 46.8800 es2 rad rod 5.5x55mm 411.30 257.60 217.9890 329.0400 dbm putty 1cc 403.20 252.52 213.6960 322.5600 dbm putty 5cc 924.55 579.05 490.0115 739.6400 dbx putty 10cc 2227.05 1394.80 1180.3365 1781.6400 endoskele implant lord 10x26mm 2572.50 1611.16 1363.4250 2058.0000 endoskeleton tt implant large 4042.50 2531.82 2142.5250 3234.0000 endoskeleton tt implant xl 10m 4042.50 2531.82 2142.5250 3234.0000 endoskeleton tt implant xl 12m 4042.50 2531.82 2142.5250 3234.0000 endoskeleton tt implant xl 9mm 4042.50 2531.82 2142.5250 3234.0000 endoskeleton tt large 4042.50 2531.82 2142.5250 3234.0000 drill bit 1.7mm 403.20 252.52 213.6960 322.5600 clydesdale 10 x 60 cage 6860.00 4296.42 3635.8000 5488.0000 clydesdale 12 x 55 cage 6860.00 4296.42 3635.8000 5488.0000 clydesdale 8 x 50mm 7203.00 4511.24 3817.5900 5762.4000 clydesdale ptc 10x55 6860.00 4296.42 3635.8000 5488.0000 clydesdale ptc 12x50x6 deg 6860.00 4296.42 3635.8000 5488.0000 clydesdale xlif device 10x45mm 6835.50 4281.07 3622.8150 5468.4000 clydesdale xlif device 10x50mm 6835.50 4281.07 3622.8150 5468.4000 clydesdale xlif device 8x50mm 6835.50 4281.07 3622.8150 5468.4000 collar locking ext 134.40 84.17 71.2320 107.5200 tibial wedge step m.b.t 4 5 mm 2296.15 1438.08 1216.9595 1836.9200 tightrope abs 14mm button 551.80 345.59 292.4540 441.4400 tightrope abs button 14mm 446.80 279.83 236.8040 357.4400 tightrope abs implant 515.58 322.90 273.2574 412.4640 ti end cap 5mm ext-ster 540.75 338.67 286.5975 432.6000 ti rod 5.5x40 lordotic 411.30 257.60 217.9890 329.0400 ti rod 5.5x45 lordotic 411.30 257.60 217.9890 329.0400 tlif cage 10mm, 12x32mm 4042.50 2531.82 2142.5250 3234.0000 tlif cage 10x28mm 4410.00 2761.98 2337.3000 3528.0000 tlif cage 22x9mm aleutian 4410.00 2761.98 2337.3000 3528.0000 tlif cage 7x28x10mm 4410.00 2761.98 2337.3000 3528.0000 tlif cage 8mm*do not use* 4410.00 2761.98 2337.3000 3528.0000 tlif cage 8x28mm 4410.00 2761.98 2337.3000 3528.0000 tlif cage 9x28mm 4410.00 2761.98 2337.3000 3528.0000 tlif device 11mm10x28interbody 4410.00 2761.98 2337.3000 3528.0000 tlif device 11mm12x36interbody 4410.00 2761.98 2337.3000 3528.0000 tlif device aleut 11mm 11x22mm 4410.00 2761.98 2337.3000 3528.0000 tlif device aleut 12mm8.5x22mm 4410.00 2761.98 2337.3000 3528.0000 tlif device aleutian 7mm8.5x22 4410.00 2761.98 2337.3000 3528.0000 tlif device aleutian 8x8.5x22 4410.00 2761.98 2337.3000 3528.0000 tlif device aleutian8.5x10x22 4410.00 2761.98 2337.3000 3528.0000 tlif device spacer 8x22 9ht 4410.00 2761.98 2337.3000 3528.0000 tlil cage 11x33x40-11 4042.50 2531.82 2142.5250 3234.0000 tlx20 9x11x26 cage 7280.00 4559.46 3858.4000 5824.0000 tube mic jejunostomy feeding 446.90 279.89 236.8570 357.5200 tube myringotomy sil 1.35x5mm 49.60 31.06 26.2880 39.6800 tube sheehy #5618 29.00 18.16 15.3700 23.2000 tube armstrong #5619 62.10 38.89 32.9130 49.6800 tube armstrong #6094 58.45 36.61 30.9785 46.7600 trapezoid ret basket 3.0 cm 536.65 336.10 284.4245 429.3200 trocar sz 2 jamshidi needle-on 630.55 394.91 334.1915 504.4400 triple play device 2.0/2.4mm 1019.05 638.23 540.0965 815.2400 val screw 2.4x22mm 437.30 273.88 231.7690 349.8400 t-plate low prof 3.0mm 4 hole 1431.70 896.67 758.8010 1145.3600 t-tube goode #4843 58.05 36.36 30.7665 46.4400 t-tube modified silicone #6564 90.25 56.52 47.8325 72.2000 system implant del bicep rpr 1373.30 860.10 727.8490 1098.6400 taper post 9.5mm 675.70 423.19 358.1210 540.5600 suture tak 2.4mm percutaneous 453.75 284.18 240.4875 363.0000 wire guide blunt 21in 128.00 80.17 67.8400 102.4000 wire guide sharp 21in 1.57mm 128.00 80.17 67.8400 102.4000 xtab mis cannulated 6x40mm 1281.55 802.63 679.2215 1025.2400 xtab mis cannulated 6x45mm 1281.55 802.63 679.2215 1025.2400 xtend anterior cerv plate 30mm 1020.50 639.14 540.8650 816.4000 xtend cervical plate 3-level-3 1176.55 736.87 623.5715 941.2400 x-tab mis cannulated 5x30mm 1281.55 802.63 679.2215 1025.2400 x-tab mis deformity 6x45mm 1281.55 802.63 679.2215 1025.2400 washer headless 3.5 186.30 116.68 98.7390 149.0400 washer inside 2.7mm 121.00 75.78 64.1300 96.8000 washer orth titan nonstrl 13mm 70.05 43.87 37.1265 56.0400 washer ortho cann screw 4.5x10 69.30 43.40 36.7290 55.4400 washer orthopedic 13mm diam 61.10 38.27 32.3830 48.8800 washer orthopedic for t8 & t10 84.35 52.83 44.7055 67.4800 washer screw bone 3.5x7 61.25 38.36 32.4625 49.0000 washer screw bone 3.6x7 61.35 38.42 32.5155 49.0800 washers flat 97.90 61.31 51.8870 78.3200 visionary cutting block 494.05 309.42 261.8465 395.2400 var 4.0mm self drilling 16mm 192.00 120.25 101.7600 153.6000 xia 3 ti blocker #010837 134.40 84.17 71.2320 107.5200 xia 3 ti pa screw dia 6.5x45mm 1281.55 802.63 679.2215 1025.2400 xia 3 ti pa screw dia 7.5x50mm 1281.55 802.63 679.2215 1025.2400 xia 3 ti rad rod diam 6mml70mm 403.20 252.52 213.6960 322.5600 xia ii blocker #010863 134.40 84.17 71.2320 107.5200 xlif decade plate 2-hole 4522.35 2832.35 2396.8455 3617.8800 wire 2.8mm 20mm length 137.45 86.08 72.8485 109.9600 wire guide 0.035x6in 27.00 16.91 14.3100 21.6000 tube ear flora #6139 52.10 32.63 27.6130 41.6800 wedge femoral rev 5-6 5mm 920.50 576.51 487.8650 736.4000 washer 13mm 85.30 53.42 45.2090 68.2400 washer 7mm 83.68 52.41 44.3504 66.9440 washer bone grft titanium 17mm 396.30 248.20 210.0390 317.0400 washer flat 4.0 310.50 194.47 164.5650 248.4000 washer flat 7.0 310.75 194.62 164.6975 248.6000 s-rom sleeve prx ztt,16f-sml 546.55 342.30 289.6715 437.2400 s-rom sleeve prx ztt,18f-sml 568.40 355.99 301.2520 454.7200 s-rom*head femoral cocr 32+0 756.55 473.83 400.9715 605.2400 s-rom*sleeve prx ztt, 16b-sml 546.55 342.30 289.6715 437.2400 s-rom*sleeve prx ztt,16d-sml 546.55 342.30 289.6715 437.2400 s-rom*sleeve prx ztt,18d-sml 546.55 342.30 289.6715 437.2400 s-rom*sleeve prx ztt,20d-sml 546.55 342.30 289.6715 437.2400 s-rom*slve zttovsz 22f-sml20id 546.55 342.30 289.6715 437.2400 s-rom*stm sleeve prx ztt,20f-s 546.55 342.30 289.6715 437.2400 rx pigtail naviflex 10fr 229.20 143.55 121.4760 183.3600 roi-c lordotic cervical cage 1 1837.50 1150.83 973.8750 1470.0000 screw 2.3x9mm 267.10 167.28 141.5630 213.6800 screw 3.5mm hex 6mm diameter 387.50 242.69 205.3750 310.0000 screw ant cerv var ang slf drl 256.00 160.33 135.6800 204.8000 screw bone 7.5x55mm 957.30 599.56 507.3690 765.8400 screw bone spinal 4x17mm 192.00 120.25 101.7600 153.6000 screw bone spinal 7.5x50mm 1061.30 664.69 562.4890 849.0400 screw bone variable 4x15mm 192.00 120.25 101.7600 153.6000 screw can inv/rev 4.5x48 256.00 160.33 135.6800 204.8000 screw can pinnacle 6.5x15mm 720.50 451.25 381.8650 576.4000 screw can pinnacle 6.5x20mm 128.00 80.17 67.8400 102.4000 screw cancellous fix 6.5x25mm 66.55 41.68 35.2715 53.2400 screw cann 16mm thrd 2.9x7.3mm 472.80 296.11 250.5840 378.2400 screw cann 6mm d 40mm l 957.30 599.56 507.3690 765.8400 screw cann ext tab 6.5x45mm 1061.30 664.69 562.4890 849.0400 screw cann fixation 6.5x30 66.55 41.68 35.2715 53.2400 screw cann mod 7.5x45mm 645.50 404.28 342.1150 516.4000 screw cann modular self tap 645.50 404.28 342.1150 516.4000 screw cann plyaz 7.5x60mm 1113.30 697.26 590.0490 890.6400 screw cann protasul 4.5x33mm 128.00 80.17 67.8400 102.4000 screw cann solera 6.5x55mm 1061.30 664.69 562.4890 849.0400 screw cann solera 7.5x40 1061.30 664.69 562.4890 849.0400 screw cerv pyrenees 4x16mm 192.00 120.25 101.7600 153.6000 screw cerv self tap 4x14mm 192.00 120.25 101.7600 153.6000 screw cervical fixed 4x16mm 192.00 120.25 101.7600 153.6000 screw cervical va 4x16mm 192.00 120.25 101.7600 153.6000 screw compress non-ster 36mm l 106.05 66.42 56.2065 84.8400 screw dist quick start 14mm 645.30 404.15 342.0090 516.2400 screw distraction 12mm #010860 107.55 67.36 57.0015 86.0400 screw distraction 14mm #010861 102.40 64.13 54.2720 81.9200 screw distraction 16mm #010862 107.55 67.36 57.0015 86.0400 screw drill free titan 1.5mm 123.15 77.13 65.2695 98.5200 screw for rod 3.5/5mm 133.10 83.36 70.5430 106.4800 screw for rod 3.5/5mm diam 133.10 83.36 70.5430 106.4800 screw fxtn cerv 4.5x14mm 184.35 115.46 97.7055 147.4800 screw fxtn cerv 4.5x16mm 184.35 115.46 97.7055 147.4800 screw head spherical 6.5x15mm 66.55 41.68 35.2715 53.2400 screw head spherical 6.5x20mm 66.55 41.68 35.2715 53.2400 screw hex non loc st 3x22mm 181.05 113.39 95.9565 144.8400 screw hexalobe var angle 4x14 184.35 115.46 97.7055 147.4800 screw interfer biocomp 8x23mm 556.50 348.54 294.9450 445.2000 screw lcking mid foot ss 3.5mm 342.15 214.29 181.3395 273.7200 screw lcking ss sufix 3.5x22 520.20 325.80 275.7060 416.1600 screw lcking ss surfix 3.5x20 520.20 325.80 275.7060 416.1600 screw lcking ss uni-cp 3.5x16 520.20 325.80 275.7060 416.1600 screw lkng maxdrive 2.3x11m 267.10 167.28 141.5630 213.6800 screw locking 3.5mm/6mmd/80mml 393.40 246.39 208.5020 314.7200 screw low pro va 2.4x28.0mm 420.50 263.36 222.8650 336.4000 screw mi ped phoenixt open 645.50 404.28 342.1150 516.4000 screw min invasive *do not use 1220.50 764.40 646.8650 976.4000 screw multiaxial 7.5mm od 55mm 820.50 513.88 434.8650 656.4000 screw nonlocking 3.5mmx18mm 133.10 83.36 70.5430 106.4800 screw on femoral wedge 957.30 599.56 507.3690 765.8400 screw ped 6.5x45mm 2c 1020.50 639.14 540.8650 816.4000 screw pedicle 6.5x50 957.30 599.56 507.3690 765.8400 screw pedicle 7.5x50 957.30 599.56 507.3690 765.8400 screw polyaxial 9.5x80mm 957.30 599.56 507.3690 765.8400 screw precept lock 128.00 80.17 67.8400 102.4000 shim 12mm x 30mm 6 degrees 2912.00 1823.79 1543.3600 2329.6000 shim implant 3567.20 2234.14 1890.6160 2853.7600 shim implant 10mm 3567.20 2234.14 1890.6160 2853.7600 shim implant 12mm 6 degree 3567.20 2234.14 1890.6160 2853.7600 shim implant 9mm 3567.20 2234.14 1890.6160 2853.7600 shim implant spinal 3567.20 2234.14 1890.6160 2853.7600 screw self tap fixed 4.3mm 192.00 120.25 101.7600 153.6000 screw self tap variable 4.3mm 192.00 120.25 101.7600 153.6000 screw set firebird 128.00 80.17 67.8400 102.4000 screw spinal 3.5x10mm lgth 820.50 513.88 434.8650 656.4000 screw spinal 3.5x12mm 820.50 513.88 434.8650 656.4000 screw spinal 3.5x12mm lgth 820.50 513.88 434.8650 656.4000 screw spinal 3.5x14mm lgth 820.50 513.88 434.8650 656.4000 screw spinal 3.5x16 853.30 534.42 452.2490 682.6400 screw spinal 3.5x16mm 853.30 534.42 452.2490 682.6400 screw spinal 3.5x18 853.30 534.42 452.2490 682.6400 sharp fixation pin 174.20 109.10 92.3260 139.3600 sheath ureteral 12/14fx36cm 302.20 189.27 160.1660 241.7600 shel acet plasma plrcup sz55ti 1281.55 802.63 679.2215 1025.2400 shell implant spine 3567.20 2234.14 1890.6160 2853.7600 short blade screw 6.5x50mm` 1176.55 736.87 623.5715 941.2400 spyscope deiliver & catheter 3858.40 2416.52 2044.9520 3086.7200 spnl cerv lord 13x16x7mm 870.50 545.19 461.3650 696.4000 stem centralized 12.0mm 279.85 175.27 148.3205 223.8800 stem fluted triathlon 13x150 1134.45 710.51 601.2585 907.5600 stent polaris ultra 5fr 24cm 349.00 218.58 184.9700 279.2000 spine cerv fusion 17x13x12 920.50 576.51 487.8650 736.4000 spine cervical fusion 15x13x5 920.50 576.51 487.8650 736.4000 spinal spacer modulus 12x18x55 6260.80 3921.14 3318.2240 5008.6400 spinal spacer modulus 8x22x45 6260.80 3921.14 3318.2240 5008.6400 spinal titanium 10x18x50 6260.80 3921.14 3318.2240 5008.6400 spinal titanium 12x18x50 6260.80 3921.14 3318.2240 5008.6400 spinal polyaxial 10x18x45 6260.80 3921.14 3318.2240 5008.6400 spinal polyaxial 8x18x50 6260.80 3921.14 3318.2240 5008.6400 spectra patient trial kit 161.30 101.02 85.4890 129.0400 spinal anterior cervical 6mm 1009.30 632.12 534.9290 807.4400 spinal cerv fus nanometalene 920.50 576.51 487.8650 736.4000 spinal fusion 3d mod 12x22x45 6260.80 3921.14 3318.2240 5008.6400 spinal fusion poly 10x22x60 6260.80 3921.14 3318.2240 5008.6400 spinal fusion titan 12x22x55 6260.80 3921.14 3318.2240 5008.6400 spinal interbody 10x22x55 6552.00 4103.52 3472.5600 5241.6000 spinal lordotic 7deg 13x16x6mm 870.50 545.19 461.3650 696.4000 spcr avs unlif4degree 13x30x11 4042.50 2531.82 2142.5250 3234.0000 spacer ant cerv 5x12.5x15mm 1100.50 689.24 583.2650 880.4000 spacer ant cerv 7x12.5x15 1100.50 689.24 583.2650 880.4000 spacer cerv 7 deg lrg 8mm 920.50 576.51 487.8650 736.4000 spacer colonial xxl lor 5mm 970.50 607.82 514.3650 776.4000 spacer crescent ti 3220.00 2016.69 1706.6000 2576.0000 spacer distal ring 12mm 102.40 64.13 54.2720 81.9200 spacer distal ring 15mm od 102.40 64.13 54.2720 81.9200 spacer distal ring sz 2 102.40 64.13 54.2720 81.9200 spacer elevate 23x10mm 3640.00 2279.73 1929.2000 2912.0000 spacer humeral size 36 738.90 462.77 391.6170 591.1200 spacer lordotic elev 28x8mm 5824.00 3647.57 3086.7200 4659.2000 spacer lordotic elevate 28x8 3640.00 2279.73 1929.2000 2912.0000 spacer lordotic tcif 27x11mm 3850.00 2411.26 2040.5000 3080.0000 spacer lordotic tcif 27x9mm 3850.00 2411.26 2040.5000 3080.0000 spacer spinal 14x13x6 non-ster 905.30 566.99 479.8090 724.2400 spacer spinal 14x13x7 non-ster 905.30 566.99 479.8090 724.2400 spacer spinal 16x15x6 853.30 534.42 452.2490 682.6400 spacer spinal 16x15x8mm 905.30 566.99 479.8090 724.2400 spacer spinal 16x15x9mm 870.50 545.19 461.3650 696.4000 spacer spinal 32x9 2548.00 1595.81 1350.4400 2038.4000 spacer spinal 360 large 905.30 566.99 479.8090 724.2400 spacer spinal cage 28x7mm 5824.00 3647.57 3086.7200 4659.2000 spacer spinal cerv 17x14x6mm 920.50 576.51 487.8650 736.4000 spacer spinal cerv 17x14x7mm 920.50 576.51 487.8650 736.4000 spacer spinal cerv 5mm 17x14mm 920.50 576.51 487.8650 736.4000 spacer spinal cervical 16x15x7 905.30 566.99 479.8090 724.2400 spacer spinal lordotic 16x15x5 905.30 566.99 479.8090 724.2400 spacer spinal x-lor 32x11mm 4900.00 3068.87 2597.0000 3920.0000 slv fem prox s-rom ztt sm 18f 541.30 339.02 286.8890 433.0400 slv fem prox s-rom ztt sm 20f 520.50 325.99 275.8650 416.4000 sleeve prox femoral 20 od 541.30 339.02 286.8890 433.0400 sleeve proximal 16 d sml 3089.25 1934.80 1637.3025 2471.4000 sleeve resorbable 465.15 291.32 246.5295 372.1200 sleeve s-romoverszd ztt 2bf-sm 546.55 342.30 289.6715 437.2400 sleeve srom overszd ztt 20f-sm 546.55 342.30 289.6715 437.2400 sleeve srom ovrszd 20f 520.50 325.99 275.8650 416.4000 sleeve centering prox fem 20f 520.50 325.99 275.8650 416.4000 sleeve fem prox sm 16mm 520.50 325.99 275.8650 416.4000 sleeve femoral proximal ztt sm 546.55 342.30 289.6715 437.2400 propel mometasone implant 999.75 626.14 529.8675 799.8000 prosthesis ossicular 0.8x8mm 623.25 390.34 330.3225 498.6000 proximal sleeve 18d 2942.10 1842.64 1559.3130 2353.6800 prost ossic 3x5.5mm 620.10 388.37 328.6530 496.0800 prodisc-c implant lg/5mm 7432.65 4655.07 3939.3045 5946.1200 prodisc-c-implant lg 5mm 7432.65 4655.07 3939.3045 5946.1200 prodisc-c-implant med.deep 5mm 7432.65 4655.07 3939.3045 5946.1200 prodisc-cimplant 6mm s 7432.65 4655.07 3939.3045 5946.1200 pusher stent rx 4/5fr 146.40 91.69 77.5920 117.1200 putty allograft bone 3ml 550.50 344.78 291.7650 440.4000 putty allograft bone fiber 1ml 385.50 241.44 204.3150 308.4000 putty allograft bone mat 6ml 880.50 551.46 466.6650 704.4000 putty bio dbm 10cc #010916 1514.50 948.53 802.6850 1211.6000 putty bio dbm 2cc # 010880 546.60 342.34 289.6980 437.2800 putty bio mastercraft 10ml 577.50 361.69 306.0750 462.0000 putty conduct marix 2 cc 403.20 252.52 213.6960 322.5600 pump pain kit on-q 515.30 322.73 273.1090 412.2400 pump pain q 339.45 212.60 179.9085 271.5600 port implantable infus 9.5fr 712.90 446.49 377.8370 570.3200 podiatric implant/fixation sys 6064.80 3798.38 3214.3440 4851.8400 plate t comp s 4 h 2438.10 1526.98 1292.1930 1950.4800 pin 2.4 148.20 92.82 78.5460 118.5600 pin 3.0 123.65 77.44 65.5345 98.9200 plate tib prox 4.5mmd 118mml 1495.30 936.51 792.5090 1196.2400 plate tublar lcking 3rd ss 6h 478.90 299.94 253.8170 383.1200 plate two level 36mm 1020.50 639.14 540.8650 816.4000 plate xtend 10mm 1 level 1071.55 671.11 567.9215 857.2400 pmt cervical cage implant 3439.80 2154.35 1823.0940 2751.8400 pn gwire spnl blunt 2.4x50mm 133.10 83.36 70.5430 106.4800 pn intro placement 11 ga 15cm 192.00 120.25 101.7600 153.6000 powerport mri implant port 496.50 310.96 263.1450 397.2000 pouch mesh conform porous 3644.15 2282.33 1931.3995 2915.3200 precut cerlcage wire 175mm 201.30 126.07 106.6890 161.0400 post fixation 90 degree 330.70 207.12 175.2710 264.5600 post hub cap 0.152'x0.148'x0.2 96.80 60.63 51.3040 77.4400 post int brace lig aug plate 1613.50 1010.54 855.1550 1290.8000 plt bn radial head lkng std 5 1268.95 794.74 672.5435 1015.1600 post pin clamp 30 degree 11mmn 349.35 218.80 185.1555 279.4800 rod spinal 2.5x90mm 411.30 257.60 217.9890 329.0400 rod spinal 3.5x60mm 320.00 200.42 169.6000 256.0000 rod spinal 3.5x70mm 340.80 213.44 180.6240 272.6400 rod spinal 4x120mm 320.00 200.42 169.6000 256.0000 rod spinal 5.5x120mm 437.30 273.88 231.7690 349.8400 rod spinal 5.5x45mm 411.30 257.60 217.9890 329.0400 rod spinal 5.5x500 411.30 257.60 217.9890 329.0400 rod spinal 55x130mm 437.30 273.88 231.7690 349.8400 rod spinal 60x4.75mm 437.30 273.88 231.7690 349.8400 rod spinal 65x4.75mm 437.30 273.88 231.7690 349.8400 rod spinal cobalt 4.75x35mm 437.30 273.88 231.7690 349.8400 rod spinal cortical 4.75x60 411.30 257.60 217.9890 329.0400 rod spinal curved 45mm ster 420.50 263.36 222.8650 336.4000 rod spinal curved 4x70mm 332.80 208.43 176.3840 266.2400 rod spinal curved titan 4x45mm 320.00 200.42 169.6000 256.0000 rod spinal fix w/hex 70mm 384.00 240.50 203.5200 307.2000 rod spinal fixation system 377.25 236.27 199.9425 301.8000 rod spinal fixed 40mm 420.50 263.36 222.8650 336.4000 rod spinal fixed 50mm sterile 420.50 263.36 222.8650 336.4000 rod spinal fixed curved 35mm 437.30 273.88 231.7690 349.8400 rod spinal fixed curved 40mm 437.30 273.88 231.7690 349.8400 rod spinal hex end 5.5x110 437.30 273.88 231.7690 349.8400 rod spinal hex end 5.5x120 420.50 263.36 222.8650 336.4000 rod spinal lord viper 2 55mm 420.50 263.36 222.8650 336.4000 rod spinal min lordotic 5.5x55 437.30 273.88 231.7690 349.8400 rod spinal phoenix relordosed 339.00 212.32 179.6700 271.2000 rod spinal pre-bent 3.5x70 332.80 208.43 176.3840 266.2400 rod spinal prebent 5.5x35 411.30 257.60 217.9890 329.0400 rod spinal prebent 5.5x40mm 411.30 257.60 217.9890 329.0400 rod spinal rad 5.5x120mm 411.30 257.60 217.9890 329.0400 rod spinal reline 5.5x40 411.30 257.60 217.9890 329.0400 rod spinal reline 5.5x45 411.30 257.60 217.9890 329.0400 rod spinal solera 30mm 411.30 257.60 217.9890 329.0400 rod spinal solera 4.75x30mm 437.30 273.88 231.7690 349.8400 rod spinal solera 4.75x50mm 470.50 294.67 249.3650 376.4000 rod spinal solera 90x4.75 411.30 257.60 217.9890 329.0400 rod spinal straight 100x4.75 411.30 257.60 217.9890 329.0400 rod spinal straight 200mm 420.50 263.36 222.8650 336.4000 rod spinal viper 120mm 411.30 257.60 217.9890 329.0400 rod spinal w/line 5.5x35mm 320.00 200.42 169.6000 256.0000 rod fiber ster 3.5x110mm 1331.70 834.04 705.8010 1065.3600 rod mi pre lordosed w/hex 339.00 212.32 179.6700 271.2000 rod percutaneous 4.75x40 437.30 273.88 231.7690 349.8400 rod prbnt lordotic 70 470.50 294.67 249.3650 376.4000 rod connector parallel 5.5mm 520.50 325.99 275.8650 416.4000 rod curved solera 35mm 395.50 247.70 209.6150 316.4000 rise 12x26 6300.00 3945.69 3339.0000 5040.0000 rise spacer cage 10x8x14mm 10d 6300.00 3945.69 3339.0000 5040.0000 rod 4.75ccm ns curv 40mm 395.50 247.70 209.6150 316.4000 rod 75mm 470.50 294.67 249.3650 376.4000 rasp 2.1mm elite helicoidal 290.35 181.85 153.8855 232.2800 reline mas rod 4x50 lordotic 411.30 257.60 217.9890 329.0400 reline mas rod 5.5x100mm 411.30 257.60 217.9890 329.0400 reline mas rod 5.5x110mm 411.30 257.60 217.9890 329.0400 reline mas ti rod 5.5x35 411.30 257.60 217.9890 329.0400 reline mas ti rod 5.5x70 411.30 257.60 217.9890 329.0400 reamer sod ball tip 3.0x950mm 288.50 180.69 152.9050 230.8000 rad rod 5.5x30mm 411.30 257.60 217.9890 329.0400 rad rod 5.5x65mm 411.30 257.60 217.9890 329.0400 rebar servical spacer 5mm 970.50 607.82 514.3650 776.4000 reamer surg sod ball 3.0x950mm 288.50 180.69 152.9050 230.8000 q-fix implant 2.8mm 520.30 325.86 275.7590 416.2400 reg full thrd 2.5 x 16mm 290.35 181.85 153.8855 232.2800 screw spinal everest 7.5x45 957.30 599.56 507.3690 765.8400 screw spinal everest 7.5x50 957.30 599.56 507.3690 765.8400 screw spinal for 5.5 rod 7x55 820.50 513.88 434.8650 656.4000 screw spinal plyax 5.5x8x50mm 820.50 513.88 434.8650 656.4000 screw spinal polyaxial 3.5x22 820.50 513.88 434.8650 656.4000 screw spinal polyaxial 4x14 820.50 513.88 434.8650 656.4000 screw spinal polyaxial 4x16 820.50 513.88 434.8650 656.4000 screw spinal polyaxial 6.5x35 1020.50 639.14 540.8650 816.4000 screw spinal polyaxial 6.5x55 1061.30 664.69 562.4890 849.0400 screw spinal self tap 4x14 159.75 100.05 84.6675 127.8000 screw spinal solera 7.5x40 820.50 513.88 434.8650 656.4000 screw spinal solera 7.5x50 820.50 513.88 434.8650 656.4000 screw spinal titanium 3.5x14 853.30 534.42 452.2490 682.6400 screw tlcking ss surfix 3.5x18 620.20 388.43 328.7060 496.1600 screw trajectory 4.2 x 16mm 256.00 160.33 135.6800 204.8000 screw trajectory 4.6 x 16mm 256.00 160.33 135.6800 204.8000 screw transconnector 3.5-4mm 128.00 80.17 67.8400 102.4000 screw var self tap 18mm 192.00 120.25 101.7600 153.6000 screw variable 4x18 199.70 125.07 105.8410 159.7600 screw variable 5.5x55mm 437.30 273.88 231.7690 349.8400 screw voyage 7.5x55 1113.30 697.26 590.0490 890.6400 bearing tibial anterior stab.a 966.55 605.35 512.2715 773.2400 scrw bne hum 6.5x32mm 192.00 120.25 101.7600 153.6000 scrw bone var slf drill 4.2x1 256.00 160.33 135.6800 204.8000 scrw hum perph 4.5x32mm 192.00 120.25 101.7600 153.6000 scrw hum perph 4.5x40mm 192.00 120.25 101.7600 153.6000 screw spinal 3.5x18mm 853.30 534.42 452.2490 682.6400 screw spinal 3.5x20 853.30 534.42 452.2490 682.6400 screw spinal 3.5x20mm 853.30 534.42 452.2490 682.6400 screw spinal 6x35 957.30 599.56 507.3690 765.8400 screw spinal anterior 4.5x17mm 159.75 100.05 84.6675 127.8000 arthroeresis implant 10 x 14mm 1769.80 1108.43 937.9940 1415.8400 anchr sut tigertail 3x14mm 567.30 355.30 300.6690 453.8400 applebaum, large (prothesis) 687.15 430.36 364.1895 549.7200 applebaum, small (prothesis) 687.15 430.36 364.1895 549.7200 ankle external fixation-steril 5395.60 3379.26 2859.6680 4316.4800 ankle transfer pin kit 3651.85 2287.15 1935.4805 2921.4800 bar locking tibial-knee 332.80 208.43 176.3840 266.2400 augment femoral dist l sz 6 1031.90 646.28 546.9070 825.5200 augment tibial half block l 963.50 603.44 510.6550 770.8000 augment tibial r med sz 7 963.50 603.44 510.6550 770.8000 avs interbody 8x30x11 4deg. l 4042.50 2531.82 2142.5250 3234.0000 plate sss non strl 8/h 93mm 434.20 271.94 230.1260 347.3600 plate ant cerv 2-level 37mm 892.50 558.97 473.0250 714.0000 plate ant cerv 3-level 42mm 1020.50 639.14 540.8650 816.4000 plate ant cerv 3lvl 45mm 988.50 619.10 523.9050 790.8000 plate ant cervical 26mm 957.30 599.56 507.3690 765.8400 plate anterior cerv 1lvl 12mm 920.50 576.51 487.8650 736.4000 plate assembly ant cerv 24mm 920.50 576.51 487.8650 736.4000 plate bone ant cerv 17mm 920.50 576.51 487.8650 736.4000 plate bone ant cerv 19mm 920.50 576.51 487.8650 736.4000 plate bone ant cerv 55mm 1020.50 639.14 540.8650 816.4000 plate bone ant zevo 31mm 920.50 576.51 487.8650 736.4000 plate bone comp. 30mm 2 h 2160.30 1353.00 1144.9590 1728.2400 plate bone luxe 3lvl 51mm 988.50 619.10 523.9050 790.8000 plate bone tub 9 hile 105mm 389.60 244.01 206.4880 311.6800 plate calcaneal mini lt 822.40 515.07 435.8720 657.9200 plate cerv ant 3lvl 45mm 1020.50 639.14 540.8650 816.4000 plate cerv anterior xtend 10mm 1020.50 639.14 540.8650 816.4000 plate cerv level 1 xtend 12 1020.00 638.83 540.6000 816.0000 plate cervalign 26mm 905.30 566.99 479.8090 724.2400 plate cervical 10mm 1 level 928.20 581.33 491.9460 742.5600 plate cervical 2 level 36mm 920.50 576.51 487.8650 736.4000 plate cervical ant 14mm l 920.50 576.51 487.8650 736.4000 plate cervical ant 34mm 957.30 599.56 507.3690 765.8400 plate cervical anterior 12mm 957.30 599.56 507.3690 765.8400 plate cervical anterior 24mm 957.30 599.56 507.3690 765.8400 plate cl midshaft rt 8 hole lg 1109.50 694.88 588.0350 887.6000 plate compress uni-cp h 20mm 2160.30 1353.00 1144.9590 1728.2400 plate condylar lcp 6h r 170mm 1522.90 953.79 807.1370 1218.3200 plate elbow locking 12 hole 1123.70 703.77 595.5610 898.9600 plate fem lcp 4.5x211 6h l 1640.18 1027.24 869.2954 1312.1440 plate humerus 7 hole 70-0376 1190.50 745.61 630.9650 952.4000 plate lcp 4.5mm 8/hole/152mm 814.00 509.81 431.4200 651.2000 plate locking delt avul 5h 1045.50 654.80 554.1150 836.4000 plate locking r 26hole, 3.0 2761.85 1729.75 1463.7805 2209.4800 plate modulus xlif 10mm 2912.00 1823.79 1543.3600 2329.6000 plate orbital 3d xsm;0.4mmthic 878.30 550.08 465.4990 702.6400 plate pyrenees 38mm 920.50 576.51 487.8650 736.4000 plate reconstruction 3.5x98mm 663.80 415.74 351.8140 531.0400 plate sky level 3 39mm 1442.00 903.12 764.2600 1153.6000 plate spinal 1-level 12mm 920.50 576.51 487.8650 736.4000 plate spinal 1-level 16mm 920.50 576.51 487.8650 736.4000 plate spinal 2 level 2mm 920.50 576.51 487.8650 736.4000 plate spinal 2 level 34mm 920.50 576.51 487.8650 736.4000 plate spinal 2-level 28mm 920.50 576.51 487.8650 736.4000 plate spinal 3-level 39mm 1020.50 639.14 540.8650 816.4000 plate spinal 3-level 42mm 1020.50 639.14 540.8650 816.4000 plate spinal anterior cerv 19 905.30 566.99 479.8090 724.2400 plate str mtp lng ti lp 1020.00 638.83 540.6000 816.0000 pin threaded temp fix #010915 326.60 204.55 173.0980 261.2800 pin trocar guide 2.4x508mm 128.00 80.17 67.8400 102.4000 pin-sterile 4.5mm thread 434.25 271.97 230.1525 347.4000 pin kit 436.30 273.25 231.2390 349.0400 pin kit universal 645.30 404.15 342.0090 516.2400 pin lrg extern fixator 5x225mm 377.95 236.71 200.3135 302.3600 pin set glenoid system 645.30 404.15 342.0090 516.2400 set screw reline 5.5mm 133.10 83.36 70.5430 106.4800 set screw stainless 130.00 81.42 68.9000 104.0000 set screws 139.80 87.56 74.0940 111.8400 semitendinosus tendon 2241.75 1404.01 1188.1275 1793.4000 uromax ultra 12f diltr bln kit 628.25 393.47 332.9725 502.6000 unicortical screw 2.8x10.0mm 319.90 200.35 169.5470 255.9200 unicortical screw 2.8x5.0mm 319.90 200.35 169.5470 255.9200 uncortical screw 2.8x12.0mm,ti 319.90 200.35 169.5470 255.9200 uncortical screw 2.8x7mm,ti 319.90 200.35 169.5470 255.9200 uncortical screw 2.8x8mm,ti 319.90 200.35 169.5470 255.9200 universal spacer 738.90 462.77 391.6170 591.1200 8mm xxl coal 15x18 spacer cerv 2870.00 1797.48 1521.1000 2296.0000 8x12x14mm fortilink spacer 870.50 545.19 461.3650 696.4000 8x22mm endo to plif lordotic i 3150.00 1972.85 1669.5000 2520.0000 8x26mm endo to plif lordotic i 3150.00 1972.85 1669.5000 2520.0000 8x28 elevate cage expandable 5600.00 3507.28 2968.0000 4480.0000 8x32 elevator cage 5824.00 3647.57 3086.7200 4659.2000 7x32 elevator cage 5824.00 3647.57 3086.7200 4659.2000 7.0x55 spinal implant 3500.00 2192.05 1855.0000 2800.0000 7.5 x 45 voyager screw 1165.30 729.83 617.6090 932.2400 7.5mm x 45mm cannulated ped sc 704.05 440.95 373.1465 563.2400 7.5mm x 50mm cannulated ped sc 704.05 440.95 373.1465 563.2400 7.5mmx55mm cann ped screw 670.50 419.93 355.3650 536.4000 7.5x50 solera voyager screw 1113.30 697.26 590.0490 890.6400 7.5x60mm screw poly cannulated 1120.50 701.77 593.8650 896.4000 70mm curved rod 520.50 325.99 275.8650 416.4000 70mm rod 332.80 208.43 176.3840 266.2400 75 mm rod 470.50 294.67 249.3650 376.4000 3.5x40mm rod 332.80 208.43 176.3840 266.2400 3.0 cannulated drill 2.1 438.70 274.76 232.5110 350.9600 disc cervical mobi-c 15x15mm 6300.00 3945.69 3339.0000 5040.0000 28x10 elevate cage 5600.00 3507.28 2968.0000 4480.0000 2.7x12mm non-locking hex screw 181.05 113.39 95.9565 144.8400 2.7x14mm non-locking hex screw 174.10 109.04 92.2730 139.2800 12-15mm rx balloon 492.95 308.73 261.2635 394.3600 2.5x3cm testicular prosthesis 2520.00 1578.28 1335.6000 2016.0000 12x22x55 cage 6020.00 3770.33 3190.6000 4816.0000 12x55mm clydesdale ptc 5880.00 3682.64 3116.4000 4704.0000 13mm titan cann nail 2154.05 1349.08 1141.6465 1723.2400 14.5x17.5mm fortilink-c spacer 905.30 566.99 479.8090 724.2400 14.5x17.6 mm spacer 905.30 566.99 479.8090 724.2400 14mm self drilling f/a screw 192.00 120.25 101.7600 153.6000 14mm self drilling v/a screw 192.00 120.25 101.7600 153.6000 15-18mm rx balloon 492.95 308.73 261.2635 394.3600 11x28 elevate (spacer) 3640.00 2279.73 1929.2000 2912.0000 1.6mm threaded k-wire 114.50 71.71 60.6850 91.6000 10x22mm endo to plif lordotic 3150.00 1972.85 1669.5000 2520.0000 10x28 elevated cage 5824.00 3647.57 3086.7200 4659.2000 10x32 elevate cage 5824.00 3647.57 3086.7200 4659.2000 10x45 clydesdale ptc 7203.00 4511.24 3817.5900 5762.4000 10x50mm clydesdale ptc 5880.00 3682.64 3116.4000 4704.0000 11mm xlrg implant lordotic 4410.00 2761.98 2337.3000 3528.0000 10mm medial insert kit 770.10 482.31 408.1530 616.0800 1.1mm k-wire 77.22 48.36 40.9266 61.7760 anterior cervical screw 256.00 160.33 135.6800 204.8000 anterior tibials tendon 3223.75 2019.03 1708.5875 2579.0000 mas ti rod 5.5x75 411.30 257.60 217.9890 329.0400 acute ac repair system 1902.20 1191.35 1008.1660 1521.7600 acute triple lumen cath 12fr 296.80 185.89 157.3040 237.4400 acis prots lor/m 5mm 905.30 566.99 479.8090 724.2400 acculiftl 6-9x11x34x0mm (cage) 5320.00 3331.92 2819.6000 4256.0000 acculif tl 10-16x11x34x0mm 5320.00 3331.92 2819.6000 4256.0000 acculif tl 8-12mmx11mmx34mm 5460.00 3419.60 2893.8000 4368.0000 ac 2 level plate-24mm lordotic 1020.50 639.14 540.8650 816.4000 9-12mm rx balloon 492.95 308.73 261.2635 394.3600 80 mm rod 470.50 294.67 249.3650 376.4000 9mm rise 8x26 implant 6615.00 4142.97 3505.9500 5292.0000 9x23 mm elevated cage 5600.00 3507.28 2968.0000 4480.0000 9x28 elevate cage 5600.00 3507.28 2968.0000 4480.0000 9x28x11 omegalif (11-4) 4900.00 3068.87 2597.0000 3920.0000 adapter cobalt chrome 6mm 1050.45 657.90 556.7385 840.3600 adapter offset cobalt chrome 4 1050.45 657.90 556.7385 840.3600 air cast,complete 113.65 71.18 60.2345 90.9200 *tape ashesive all-size 5.25 3.29 2.7825 4.2000 *tape micropore all-size 10.35 6.48 5.4855 8.2800 * dressing 4x4 unst-200pk 35.70 22.36 18.9210 28.5600 24 hr specimen cont-disp 3.55 2.22 1.8815 2.8400 underpads 17x24 pk 5.25 3.29 2.7825 4.2000 uni-derm 3oz tube 11.75 7.36 6.2275 9.4000 uni-wash 8oz bottle 12.40 7.77 6.5720 9.9200 shampoo drain 5.25 3.29 2.7825 4.2000 aqua k pad 31.00 19.42 16.4300 24.8000 belt-sanitary 5.25 3.29 2.7825 4.2000 bag-stoma drain-ea 3.55 2.22 1.8815 2.8400 plastic shoe horn 11.15 6.98 5.9095 8.9200 polaroid 8.95 5.61 4.7435 7.1600 splint cock-up depuy 53.40 33.44 28.3020 42.7200 stoma irr drn-7724-comb 3.55 2.22 1.8815 2.8400 stoma pouch/drn-w/micropr 4.80 3.01 2.5440 3.8400 sitz bath-ea 28.85 18.07 15.2905 23.0800 shoe horn no stoop 9.05 5.67 4.7965 7.2400 shoe lace elastic 6.35 3.98 3.3655 5.0800 viroter deodorant 15.00 9.39 7.9500 12.0000 water pik 18.05 11.30 9.5665 14.4400 sur-fit pouch 4.80 3.01 2.5440 3.8400 thermometer kit isol 7.20 4.51 3.8160 5.7600 toothettes 2.35 1.47 1.2455 1.8800 traction bucks extension 176.75 110.70 93.6775 141.4000 traction cervical 161.05 100.87 85.3565 128.8400 traction pelvic 236.95 148.40 125.5835 189.5600 traction thomas 185.65 116.27 98.3945 148.5200 traction trapeze w/balk 102.15 63.98 54.1395 81.7200 enemas-all 5.25 3.29 2.7825 4.2000 face masks/box 33.90 21.23 17.9670 27.1200 bot-o-jet 18.05 11.30 9.5665 14.4400 chux-small pk 3.55 2.22 1.8815 2.8400 ear irrigation tray 19.95 12.49 10.5735 15.9600 elastic shoe laces 8.70 5.45 4.6110 6.9600 nipple nuk 4.05 2.54 2.1465 3.2400 loop ostomy bridge 5.25 3.29 2.7825 4.2000 mattress pad sof-care 98.75 61.85 52.3375 79.0000 mattress, eggcrate 78.50 49.16 41.6050 62.8000 * elastoplast-rl-all 13.00 8.14 6.8900 10.4000 *bandage gauze unster/rl 3.55 2.22 1.8815 2.8400 bubble tubing 3.55 2.22 1.8815 2.8400 peri bottle-ea 5.25 3.29 2.7825 4.2000 peri pads-pk 5.25 3.29 2.7825 4.2000 isolation-daily 54.20 33.95 28.7260 43.3600 invalid ring disp-ea 10.35 6.48 5.4855 8.2800 gloves-exam latex unst/bx 28.85 18.07 15.2905 23.0800 one time irrig set 27.65 17.32 14.6545 22.1200 output pan disp-ea 5.25 3.29 2.7825 4.2000 pad wheelchair 15.55 9.74 8.2415 12.4400 pavlik harness 164.15 102.81 86.9995 131.3200 external catheter 3.30 2.07 1.7490 2.6400 gd1a ab (igg,igm) 261.27 163.63 138.4731 209.0160 gd1b ab (igg,igm) 236.27 147.97 125.2231 189.0160 gliadin ab (igg,a) 145.13 90.89 76.9189 116.1040 gliadin antibodies iga and igg 118.55 74.25 62.8315 94.8400 overflow/t-bed maria 1872.00 1172.43 992.1600 1497.6000 overflow/transitional bed ac 1428.95 894.95 757.3435 1143.1600 overflow/transitional bed er 1872.00 1172.43 992.1600 1497.6000 overflow/transitional maria 1338.50 838.30 709.4050 1070.8000 glucose tolerance test 2 hr 343.20 214.95 181.8960 274.5600 glucose tolerance test 3 hr 374.40 234.49 198.4320 299.5200 glucose tolerance test 4 hr 405.60 254.03 214.9680 324.4800 glucose tolerance test 5 hr 435.80 272.94 230.9740 348.6400 glucose tolerance test 6 hr 465.90 291.79 246.9270 372.7200 gluten sensitivity panel 191.35 119.84 101.4155 153.0800 gm1 ab (igg,igm) 212.65 133.18 112.7045 170.1200 gm1 antibody panel 228.80 143.30 121.2640 183.0400 hepatitus b genotype 666.00 417.12 352.9800 532.8000 hepatitis a antibody panel 116.50 72.96 61.7450 93.2000 hemochromatosis gene anal(dna) 330.86 207.22 175.3558 264.6880 heavy metals eval (u) 218.00 136.53 115.5400 174.4000 heavy metals panel 4, blood 212.15 132.87 112.4395 169.7200 hepatitis c by rna 670.75 420.09 355.4975 536.6000 hdlg frozen specimen-c 47.00 29.44 24.9100 37.6000 hdlg frozen specimen-jrhc 49.85 31.22 26.4205 39.8800 hpv dna assay 127.00 79.54 67.3100 101.6000 huntingtons d 1360.00 851.77 720.8000 1088.0000 igg subclasses 507.00 317.53 268.7100 405.6000 igg subclasses profile 183.05 114.64 97.0165 146.4400 imipramine 121.18 75.89 64.2254 96.9440 imipramine & desipramine-073 230.90 144.61 122.3770 184.7200 imipramine/desipramine frac 53.05 33.23 28.1165 42.4400 immonofixation serum quant 235.05 147.21 124.5765 188.0400 inactive 08/31/99 18.00 11.27 9.5400 14.4000 cadasil/notch3mutation(athena) 1084.30 679.10 574.6790 867.4400 jak2 gene 960.00 601.25 508.8000 768.0000 kappa/lambda free light s 79.05 49.51 41.8965 63.2400 c-cyp2c9 by pcr 966.00 605.01 511.9800 772.8000 c-ugt1a1 molecular assay 1710.00 1070.97 906.3000 1368.0000 cortisol stimulation test 202.70 126.95 107.4310 162.1600 cortisol stimulation test-r 158.60 99.33 84.0580 126.8800 csf protein electrophoresis 85.30 53.42 45.2090 68.2400 csf, immunoglobulins a,g,m 293.30 183.69 155.4490 234.6400 csf,myasthenia gravis panel 374.40 234.49 198.4320 299.5200 cfs oligoclonal bands 134.40 84.17 71.2320 107.5200 chromosome anal(frag-x,carrier 407.05 254.94 215.7365 325.6400 cholinesterase & dibucaine # 187.20 117.24 99.2160 149.7600 ldh isoenzymes 191.35 119.84 101.4155 153.0800 lactate & pyruvate (blood) 312.00 195.41 165.3600 249.6000 lactose tolerance test 3 hr 374.40 234.49 198.4320 299.5200 mat4 (maternal screen 4 tests) 159.00 99.58 84.2700 127.2000 mat4 (maternal screen-4 tests) 449.30 281.40 238.1290 359.4400 maternal marker(triple test) 327.60 205.18 173.6280 262.0800 mecp2 gene analysis-retts 2380.00 1490.59 1261.4000 1904.0000 med surg daily care-semi 250.00 156.58 132.5000 200.0000 med surg semi private 250.00 156.58 132.5000 200.0000 med surg- semi private 250.00 156.58 132.5000 200.0000 med surg-private 268.00 167.85 142.0400 214.4000 med surg-semi private 250.00 156.58 132.5000 200.0000 med-surg daily care-private 268.00 167.85 142.0400 214.4000 med-surg daily care-semi3 250.00 156.58 132.5000 200.0000 med-surg private 268.00 167.85 142.0400 214.4000 med-surg semi private 250.00 156.58 132.5000 200.0000 med-surg daily care-semi 250.00 156.58 132.5000 200.0000 motorneuro 1401.90 878.01 743.0070 1121.5200 myasthenia gravis panel,serum 374.40 234.49 198.4320 299.5200 mthfr 270.00 169.10 143.1000 216.0000 monoclonal prot (spep-ife)-exp 382.70 239.69 202.8310 306.1600 insulin abs w/titer 312.00 195.41 165.3600 249.6000 insulin free 81.10 50.79 42.9830 64.8800 insulin-ft 443.05 277.48 234.8165 354.4400 leave of absence 250.00 156.58 132.5000 200.0000 e.chaffeenis (igg,m) 112.30 70.33 59.5190 89.8400 drug abuse evaluation 495.75 310.49 262.7475 396.6000 chromosome analysis 1224.95 767.19 649.2235 979.9600 chromosome analysis cf gene 580.00 363.25 307.4000 464.0000 chromosome fragile x 682.00 427.14 361.4600 545.6000 carisoprodol & meprobamate 118.55 74.25 62.8315 94.8400 carisoprodol & meprobamate - 2 59.30 37.14 31.4290 47.4400 ancaint-anca- 114.40 71.65 60.6320 91.5200 breast tumor profile-t84-r 440.75 276.04 233.5975 352.6000 alpha-1-antitrypsin&phenotype 403.50 252.71 213.8550 322.8000 alk phos isoenzymes 100.20 62.76 53.1060 80.1600 amitriptylene/nortriptylene 95.70 59.94 50.7210 76.5600 amoxapine & metabolite 249.60 156.32 132.2880 199.6800 amylase isoenzymes 272.50 170.67 144.4250 218.0000 factor v (leiden) mutation 268.50 168.16 142.3050 214.8000 cyp2d6 812.00 508.56 430.3600 649.6000 co-oximetry 187.20 117.24 99.2160 149.7600 thyroglobulin profile 291.20 182.38 154.3360 232.9600 vap cholesterol 478.40 299.62 253.5520 382.7200 transglutaminase ab (iga) 141.80 88.81 75.1540 113.4400 thiopurine metabolites 636.50 398.64 337.3450 509.2000 testerone free & weakly bound 455.50 285.28 241.4150 364.4000 testosterone tot&bioavail male 151.85 95.10 80.4805 121.4800 testosterone tot&bioavl female 235.05 147.21 124.5765 188.0400 testosterone tot&fred pro male 137.30 85.99 72.7690 109.8400 testosterone,tot&free 293.30 183.69 155.4490 234.6400 testosterone,total&free female 235.05 147.21 124.5765 188.0400 t3,free(dialysis)-pregnancy 224.65 140.70 119.0645 179.7200 t-3,ria-jrhc 81.45 51.01 43.1685 65.1600 syncann b 42172094 116.50 72.96 61.7450 93.2000 synthetic cannabinoid metabol 219.45 137.44 116.3085 175.5600 stool starch 70.70 44.28 37.4710 56.5600 sulfatide abs(igg,m) 249.20 156.07 132.0760 199.3600 vitamin b12 & folate 206.15 129.11 109.2595 164.9200 vitamin d 323.60 202.67 171.5080 258.8800 vitamin d, 25-oh 313.20 196.16 165.9960 250.5600 room rate 2007.20 1257.11 1063.8160 1605.7600 roto virus 64.30 40.27 34.0790 51.4400 private room 1497.82 938.08 793.8446 1198.2560 protein electrophoresis 75.90 47.54 40.2270 60.7200 prothrm gene analysis 42171675 38.10 23.86 20.1930 30.4800 prothrombin gene analysis 448.50 280.90 237.7050 358.8000 prothrombin gene analysis prof 157.25 98.49 83.3425 125.8000 pt req - priv room 172.63 108.12 91.4939 138.1040 pt request - priv room 100.90 63.19 53.4770 80.7200 pth intact 174.70 109.41 92.5910 139.7600 pth intact with ca 199.70 125.07 105.8410 159.7600 pth,intact w/ca 216.60 135.66 114.7980 173.2800 pth,n-terminal w/ca 216.70 135.72 114.8510 173.3600 private room-patient request 2230.80 1397.15 1182.3240 1784.6400 private room-pt request 383.00 239.87 202.9900 306.4000 private room - patient request 2014.50 1261.68 1067.6850 1611.6000 private room - pt request 2171.50 1360.01 1150.8950 1737.2000 psa free and total-explosion 344.25 215.60 182.4525 275.4000 psa,total,free & %free 217.35 136.13 115.1955 173.8800 bcrt922pcr 1335.78 836.60 707.9634 1068.6240 semi private room 1550.94 971.35 821.9982 1240.7520 arthritis profile iii 154.50 96.76 81.8850 123.6000 asialogm1 ab 167.55 104.94 88.8015 134.0400 asialogm1 ab (igg,igm) 335.10 209.87 177.6030 268.0800 semi-private room 1739.51 1089.46 921.9403 1391.6080 urine drug screen pm-non mct 349.90 219.14 185.4470 279.9200 urine drug screen,ql stat 38.10 23.86 20.1930 30.4800 urine immunofix quant 24 hr 201.80 126.39 106.9540 161.4400 urine,amitriptyline ql(random) 1.85 1.16 0.9805 1.4800 urine,drug comp(50drgs) 163.80 102.59 86.8140 131.0400 urine,methylmalonic acid 272.50 170.67 144.4250 218.0000 urine,porphyrins(fract) 24hr 230.90 144.61 122.3770 184.7200 urine,protein electro,random 100.20 62.76 53.1060 80.1600 phenytoin, free profile 106.10 66.45 56.2330 84.8800 phenytoin-free & tot 312.00 195.41 165.3600 249.6000 urine17ketosteroids(fract)24hr 440.95 276.17 233.7035 352.7600 draw fee-jrhc 7.35 4.60 3.8955 5.8800 afp,maternal,initial profile 99.85 62.54 52.9205 79.8800 lymphocyte subset panel 5 230.90 144.61 122.3770 184.7200 lymphocyte subset panel 3 418.10 261.86 221.5930 334.4800 lymphocyte subset panel 3 (p) 197.60 123.76 104.7280 158.0800 lymphocyte subset panel 4 222.60 139.41 117.9780 178.0800 lupus comprehensive panel 114.40 71.65 60.6320 91.5200 lupus comprehensive profile 355.15 222.43 188.2295 284.1200 lupus profile 1 128.95 80.76 68.3435 103.1600 lupus profile ii(serum&plasma) 380.65 238.40 201.7445 304.5200 lyme-ab(igg,m)wb 260.00 162.84 137.8000 208.0000 lyme-ab(igg,m)wb (2nd test) 260.00 162.84 137.8000 208.0000 lymphocyte subset panel 1 445.25 278.86 235.9825 356.2000 adenovirus ab 99.85 62.54 52.9205 79.8800 urine, immunofixation, random 121.70 76.22 64.5010 97.3600 typhus ab(igg,m) rflx titer 272.50 170.67 144.4250 218.0000 arthritis profile iii 445.10 278.77 235.9030 356.0800 beta 2 glycoprotein 1 abs agm 258.95 162.18 137.2435 207.1600 protein c&s panel 244.64 153.22 129.6592 195.7120 polio ab(type 1,2,3)infect. 249.60 156.32 132.2880 199.6800 rocky mtn spotted fever igg,m 126.90 79.48 67.2570 101.5200 rocky mtn spotted fever/typhus 126.90 79.48 67.2570 101.5200 s cerebisiae (asca) iga,igg 46.92 29.39 24.8676 37.5360 s cerevisiae ab(asca) iga,igg 222.55 139.38 117.9515 178.0400 sjogren's abs,ss-a&ss-b-c 45.00 28.18 23.8500 36.0000 sjogren's abs,ss-a&ss-b-j 45.00 28.18 23.8500 36.0000 sjogren's abs,ss-a&ss-b-r 47.70 29.87 25.2810 38.1600 ss-a & ss-b (sjogren's) 260.00 162.84 137.8000 208.0000 ss-a & ss-b (sjogren's)-2nd 260.00 162.84 137.8000 208.0000 ssa/b reflex-explosion 197.35 123.60 104.5955 157.8800 sm & rnp antibodies 30.60 19.16 16.2180 24.4800 vldl and coronary eval 113.54 71.11 60.1762 90.8320 west nile virus abs(igg,m) 272.50 170.67 144.4250 218.0000 strep pneumonia abs igg 611.50 382.98 324.0950 489.2000 thyroid antibodies (ata,tpo) 260.00 162.84 137.8000 208.0000 toxoplasma ab igg 152.90 95.76 81.0370 122.3200 torch profile (igg) 162.25 101.62 85.9925 129.8000 torch profile (igm) 259.42 162.47 137.4926 207.5360 culherptyp rflx$ 42.70 26.74 22.6310 34.1600 epidermal abs w/rfx to titer 230.90 144.61 122.3770 184.7200 allergan,anim,epi,dan,feather 85.30 53.42 45.2090 68.2400 allergen bee profile 78.00 48.85 41.3400 62.4000 allergen food comp 1 profile 405.60 254.03 214.9680 324.4800 allergen foods profile 13 202.80 127.01 107.4840 162.2400 allergen nut profile 124.80 78.16 66.1440 99.8400 allergen pediatric foods prof1 98.80 61.88 52.3640 79.0400 allergen seafood profile 78.00 48.85 41.3400 62.4000 allergen, animal profile 149.80 93.82 79.3940 119.8400 allergen, common adult foods 219.45 137.44 116.3085 175.5600 allergen, dust profile 153.90 96.39 81.5670 123.1200 allergen, food profile 228.80 143.30 121.2640 183.0400 allergen, grass profile 228.80 143.30 121.2640 183.0400 allergen, mold profile 153.90 96.39 81.5670 123.1200 allergen, perennial profile 228.80 143.30 121.2640 183.0400 allergen, resp reg 1 profile 452.40 283.34 239.7720 361.9200 allergen, shellfish prof food 268.30 168.04 142.1990 214.6400 allergen, southeastern profile 228.80 143.30 121.2640 183.0400 allergen, tree profile 149.80 93.82 79.3940 119.8400 allergen, weed profile 228.80 143.30 121.2640 183.0400 cat scratch antibodies 106.10 66.45 56.2330 84.8800 cat scratch dis abs quint 210.10 131.59 111.3530 168.0800 cardiolipin ab (igg,a,m) 418.10 261.86 221.5930 334.4800 cardiolipin ab (igg,m) 374.40 234.49 198.4320 299.5200 cardiolipin iga,g,m 221.50 138.73 117.3950 177.2000 e.chaffeensis ab (igg,m) 334.90 209.75 177.4970 267.9200 ebv(epstein-barr virus)ab prof 436.80 273.57 231.5040 349.4400 echovirus antibodies 296.40 185.64 157.0920 237.1200 ena ab (sm/rnp) 272.50 170.67 144.4250 218.0000 northeast inhl profile 358.80 224.72 190.1640 287.0400 monoclonal prot w/flc.pep,ife 276.65 173.27 146.6245 221.3200 mmr/vzv profile,eia 291.20 182.38 154.3360 232.9600 mitochon&smooth muscle ab/rfx 210.10 131.59 111.3530 168.0800 mpopr3abs rflx$ 50.83 31.83 26.9399 40.6640 med-surg daily care-semi 250.00 156.58 132.5000 200.0000 med-surg daily care-private 226.33 141.75 119.9549 181.0640 med- surg daily care - semi 250.00 156.58 132.5000 200.0000 med- surg daily care- private 268.00 167.85 142.0400 214.4000 med- surg daily care- semi 250.00 156.58 132.5000 200.0000 med- surg daily crae - semi 250.00 156.58 132.5000 200.0000 med-surg daily care- private 268.00 167.85 142.0400 214.4000 med-surg daily care- semi 250.00 156.58 132.5000 200.0000 chlamydia pheumoniae 327.60 205.18 173.6280 262.0800 chlamydia trach. group ab 115.45 72.31 61.1885 92.3600 chlamydia trach.ab profile-ser 212.15 132.87 112.4395 169.7200 csf,polio ab(type 1,2,3)infect 282.60 176.99 149.7780 226.0800 coxsackie b1-b6 ab serum 262.10 164.15 138.9130 209.6800 influenza a&b,igg,igm 108.15 67.73 57.3195 86.5200 hypersensitivity pneumonitis 330.73 207.13 175.2869 264.5840 inflammatory bowel disease 156.00 97.70 82.6800 124.8000 hiv 1,2 ab/ag exp screen 111.30 69.71 58.9890 89.0400 hiv 1,2 suplm w/rflx 64.50 40.40 34.1850 51.6000 hiv-1 dna by pcr&hiv-1 ab scr 358.75 224.69 190.1375 287.0000 hiv-1 p24 ag qual&hiv-1 ab scr 249.60 156.32 132.2880 199.6800 hiv1&2 supp w/rflx 222.55 139.38 117.9515 178.0400 hepatitis panel 177.85 111.39 94.2605 142.2800 hepatitus b acute profile 336.95 211.03 178.5835 269.5600 hepatitus panel(a/r,b/r,bcore) 145.60 91.19 77.1680 116.4800 herpes simplex ab 1,2 igg igm 120.65 75.56 63.9445 96.5200 herpes simplex ab 1,2 igg,igm 253.80 158.95 134.5140 203.0400 herpes simplex ab type 1,2 igg 210.10 131.59 111.3530 168.0800 herpes simplex igm with reflex 312.00 195.41 165.3600 249.6000 hge abs (human g ehrlichiosis) 312.00 195.41 165.3600 249.6000 hge igg,m anaplas phagocytop 185.10 115.93 98.1030 148.0800 hypercoaguable state profile 873.60 547.14 463.0080 698.8800 folate,rbc & hct 272.50 170.67 144.4250 218.0000 von willebrand fact.(multim) 424.30 265.74 224.8790 339.4400 special stain - group ii 171.75 107.57 91.0275 137.4000 lupus/phospholipid ab panel 640.65 401.24 339.5445 512.5200 lupus 390.00 244.26 206.7000 312.0000 lupus anticoagulant 316.15 198.00 167.5595 252.9200 lupus anticoagulant eval prof 116.50 72.96 61.7450 93.2000 virus culture profile 132.75 83.14 70.3575 106.2000 tick disease panel pcr 686.40 429.89 363.7920 549.1200 std panel 1 - aptima 669.80 419.50 354.9940 535.8400 ova & parasite smear & stain 94.65 59.28 50.1645 75.7200 hpv,dna profile 203.85 127.67 108.0405 163.0800 influenza a & b dir antigen 118.55 74.25 62.8315 94.8400 herpes typing reflex 174.70 109.41 92.5910 139.7600 herpes simplex culture w/typ 158.10 99.02 83.7930 126.4800 hepatitis b acute profile 159.10 99.64 84.3230 127.2800 influenza a/b dfa 218.40 136.78 115.7520 174.7200 c-virus culture1 42171627 26.55 16.63 14.0715 21.2400 c-virus culture2 42171627 26.55 16.63 14.0715 21.2400 c-virus culture3 42171627 26.55 16.63 14.0715 21.2400 c-virus culture4 42171627 26.55 16.63 14.0715 21.2400 c-virus culture5 42171627 26.55 16.63 14.0715 21.2400 crypto/giardia rapid assay 274.55 171.95 145.5115 219.6400 chlamydia trach/gc (dna-probe) 187.20 117.24 99.2160 149.7600 measles culture 153.90 96.39 81.5670 123.1200 mycobacterium stain 93.60 58.62 49.6080 74.8800 mumps virus culture 153.90 96.39 81.5670 123.1200 environmental culture svcs 15.45 9.68 8.1885 12.3600 culture influenza a/b ag 302.65 189.55 160.4045 242.1200 culture, afb (bronch washing) 187.20 117.24 99.2160 149.7600 culture,afb (body fluid) 201.80 126.39 106.9540 161.4400 culture,afb (gastric) 187.20 117.24 99.2160 149.7600 culture,afb (sputum) 194.50 121.82 103.0850 155.6000 culture,afb sputum (pcr) 374.40 234.49 198.4320 299.5200 culture,afb(csf) 187.20 117.24 99.2160 149.7600 culture,afb(stool/tissue) 187.20 117.24 99.2160 149.7600 culture,afb(urine) 187.20 117.24 99.2160 149.7600 culture,varicella 42171697 73.33 45.92 38.8649 58.6640 clostridium diff txn test kit 217.35 136.13 115.1955 173.8800 leukolyte, ur 12.85 8.05 6.8105 10.2800 nitrite-c 12.85 8.05 6.8105 10.2800 respiratory virus profile 174.70 109.41 92.5910 139.7600 rho-gam w processing 275.95 172.83 146.2535 220.7600 potassium- vet 6.15 3.85 3.2595 4.9200 sodium- vet 6.15 3.85 3.2595 4.9200 sterility indicator processing 15.45 9.68 8.1885 12.3600 albumin- vet 6.15 3.85 3.2595 4.9200 abd & rho grouping 119.60 74.91 63.3880 95.6800 abo-rho grouping 59.70 37.39 31.6410 47.7600 type and screen 221.50 138.73 117.3950 177.2000 sgot (ast)- vet 6.15 3.85 3.2595 4.9200 sgpt (alt)- vet 6.15 3.85 3.2595 4.9200 sensitivity- vet 6.50 4.07 3.4450 5.2000 urine/fluid culture-vet 12.95 8.11 6.8635 10.3600 urine monoclonal protein study 324.60 203.30 172.0380 259.6800 urine free light chains 687.50 430.58 364.3750 550.0000 urine free light chains w/ife 562.70 352.42 298.2310 450.1600 urine immunofix qnt rflx lc 112.50 70.46 59.6250 90.0000 phenobarbital- vet 12.30 7.70 6.5190 9.8400 phenytoin- vet 12.30 7.70 6.5190 9.8400 phosphorous- vet 6.15 3.85 3.2595 4.9200 total cholesterol- vet 6.15 3.85 3.2595 4.9200 total bilirubin- vet 6.15 3.85 3.2595 4.9200 total protein- vet 6.15 3.85 3.2595 4.9200 thyroxine (t4)- vet 12.30 7.70 6.5190 9.8400 thyroglobulin qnt&ata qual 312.00 195.41 165.3600 249.6000 wbc differential-vet 6.50 4.07 3.4450 5.2000 ecoli shiga toxin stx 1 & 2 68.65 43.00 36.3845 54.9200 initial crossmatch/immed 271.30 169.92 143.7890 217.0400 co2- vet 6.15 3.85 3.2595 4.9200 cmplx culture (wounds,ect)-vet 25.80 16.16 13.6740 20.6400 collection,lab,mro, spec drug 141.95 88.90 75.2335 113.5600 breast tumor profile -t84 415.80 260.42 220.3740 332.6400 breast tumor profile t84 1868.90 1170.49 990.5170 1495.1200 breast tumor profile-t84 415.80 260.42 220.3740 332.6400 amylase- vet 6.15 3.85 3.2595 4.9200 alkaline phosphatase- vet 6.15 3.85 3.2595 4.9200 choloride- vet 6.15 3.85 3.2595 4.9200 chromosome anal(carrier status 1243.85 779.02 659.2405 995.0800 chromosome anal(cyst fib gene) 299.25 187.42 158.6025 239.4000 chem 18- vet (contino) 29.40 18.41 15.5820 23.5200 cbc-vet 9.85 6.17 5.2205 7.8800 cpk- vet 6.15 3.85 3.2595 4.9200 crossmatch 270.40 169.35 143.3120 216.3200 creatinine- vet 6.15 3.85 3.2595 4.9200 cortisol stimulation test-c 149.60 93.69 79.2880 119.6800 cortisol stimulation test-jrhc 149.60 93.69 79.2880 119.6800 bun- vet 6.15 3.85 3.2595 4.9200 calcium- vet 6.15 3.85 3.2595 4.9200 glucose- vet 6.15 3.85 3.2595 4.9200 hdlg frozen spec-jrhc 47.00 29.44 24.9100 37.6000 hdlg frozen spec-r 49.85 31.22 26.4205 39.8800 hdlg frozen specimen 98.80 61.88 52.3640 79.0400 imipramine & desipramine-073-r 86.85 54.39 46.0305 69.4800 immunofluorescent study 6557.20 4106.77 3475.3160 5245.7600 csctcb cell search 1522.55 953.57 806.9515 1218.0400 celiac disease genotyping 509.60 319.16 270.0880 407.6800 chromosome anal.,pha stim.,bld 1329.10 832.42 704.4230 1063.2800 bone marrow aspirate/biopsy 407.70 255.34 216.0810 326.1600 renal pathology 2641.60 1654.43 1400.0480 2113.2800 lymphocyte subset panel 2 162.25 101.62 85.9925 129.8000 lymphocyte subset panel 4 prof 249.60 156.32 132.2880 199.6800 lymphocyte subset panel 5 422.25 264.46 223.7925 337.8000 chromosome analys bone marrow 1679.60 1051.93 890.1880 1343.6800 chromosome analysis (fish) 690.55 432.49 365.9915 552.4400 chromosome analysis blood 1268.80 794.65 672.4640 1015.0400 leuk/lymp bone marrow - flow 1098.25 687.83 582.0725 878.6000 leuk/lymph comp prof(quest) 1826.25 1143.78 967.9125 1461.0000 leuk/lymph flow bone marrow 1048.30 656.55 555.5990 838.6400 leuk/lymph flow whole blood 1154.40 723.00 611.8320 923.5200 leuk/lymph phemo flow misc 1164.80 729.51 617.3440 931.8400 chromosome anal.,tissue 1872.00 1172.43 992.1600 1497.6000 chromosome analy prod concept 1566.25 980.94 830.1125 1253.0000 chromosome anal(leuk w/interp) 1872.00 1172.43 992.1600 1497.6000 chromosome anal leuk 1439.35 901.46 762.8555 1151.4800 chromosome anal leuk w/interp 1437.30 900.18 761.7690 1149.8400 chromosome anal(15q,22q) 1872.00 1172.43 992.1600 1497.6000 fna-cytology tech services 127.90 80.10 67.7870 102.3200 peds charge diff 25.00 15.66 13.2500 20.0000 pediatric/private 268.00 167.85 142.0400 214.4000 pediatric/semi-private 250.00 156.58 132.5000 200.0000 pediatric/war 245.00 153.44 129.8500 196.0000 pediatric/ward 245.00 153.44 129.8500 196.0000 pediatrics daily care-private 268.00 167.85 142.0400 214.4000 pediatrics daily care-semi 250.00 156.58 132.5000 200.0000 pediatrics daily care-ward 245.00 153.44 129.8500 196.0000 pediatrics-semi private 250.00 156.58 132.5000 200.0000 pediatrics-ward 245.00 153.44 129.8500 196.0000 charge explosion-peds priv rm 325.00 203.55 172.2500 260.0000 alternate level care 358.00 224.22 189.7400 286.4000 semi private room 358.00 224.22 189.7400 286.4000 private room 383.00 239.87 202.9900 306.4000 private room patient request 383.00 239.87 202.9900 306.4000 ward 352.00 220.46 186.5600 281.6000 tunneled cath insertion 4426.25 2772.16 2345.9125 3541.0000 port insertion radiology 823.30 515.63 436.3490 658.6400 removal tunneled cv cath 977.60 612.27 518.1280 782.0800 shoulder pain management right 746.25 467.38 395.5125 597.0000 upper gi sing contr w/sm bowel 1267.80 794.02 671.9340 1014.2400 non-tunneled cath-radiology 766.50 480.06 406.2450 613.2000 knee 2 view left portable 177.00 110.86 93.8100 141.6000 knee 2 view rt portable 177.00 110.86 93.8100 141.6000 ct bone density 291.10 182.32 154.2830 232.8800 dexa axial skeleton 283.05 177.27 150.0165 226.4400 dexa vertebral fx assessment 53.75 33.66 28.4875 43.0000 perq verte/sacroplsty fluor 747.80 468.35 396.3340 598.2400 pain management 1183.50 741.23 627.2550 946.8000 pain management bil 1155.45 723.66 612.3885 924.3600 esi/facet rad dept 1155.45 723.66 612.3885 924.3600 hysterosalpingogram/rad inj 635.78 398.19 336.9634 508.6240 hip pain management left 746.70 467.66 395.7510 597.3600 hip 1 view left 177.00 110.86 93.8100 141.6000 hip 1 view right 177.00 110.86 93.8100 141.6000 charge explosion mh priv rm 350.00 219.21 185.5000 280.0000 mh private room 1182.13 740.37 626.5289 945.7040 mh semi private 1144.00 716.49 606.3200 915.2000 mh semi private rrom 1019.20 638.32 540.1760 815.3600 alternate level of care 383.00 239.87 202.9900 306.4000 semi-private room 385.00 241.13 204.0500 308.0000 semi-private room 385.00 241.13 204.0500 308.0000 semi private room 385.00 241.13 204.0500 308.0000 semi private 385.00 241.13 204.0500 308.0000 private room 410.00 256.78 217.3000 328.0000 private rm differential 25.00 15.66 13.2500 20.0000 private room patient request 410.00 256.78 217.3000 328.0000 private room- patient request 410.00 256.78 217.3000 328.0000 psychiatric care-care 250.00 156.58 132.5000 200.0000 psychiatric care-private 268.00 167.85 142.0400 214.4000 psychiatric care-semi 250.00 156.58 132.5000 200.0000 psychiatric care-semiinactive 250.00 156.58 132.5000 200.0000 psychiatric/private 268.00 167.85 142.0400 214.4000 psychiatric/semi-private 250.00 156.58 132.5000 200.0000 hip arthrography/inj 1800.25 1127.50 954.1325 1440.2000 hip arthrography/inj bilateral 1848.10 1157.47 979.4930 1478.4800 hip inj right ops 786.25 492.43 416.7125 629.0000 hip injection left ops 786.25 492.43 416.7125 629.0000 fluor ivad/chest ins/exp expl 723.85 453.35 383.6405 579.0800 chest 1 view portable 169.00 105.84 89.5700 135.2000 cxr1 line placement 2 707.20 442.92 374.8160 565.7600 cxr1 line placement 3 1060.80 664.38 562.2240 848.6400 ob/maternity room 1872.00 1172.43 992.1600 1497.6000 obstetrical daily care-private 293.00 183.51 155.2900 234.4000 obstetrical daily care-semi 275.00 172.23 145.7500 220.0000 obstetrical/private 293.00 183.51 155.2900 234.4000 obstetrical/semi-private 275.00 172.23 145.7500 220.0000 charge explosion ob priv room 350.00 219.21 185.5000 280.0000 private room-patient request 405.00 253.65 214.6500 324.0000 private room 405.00 253.65 214.6500 324.0000 semi private room 385.00 241.13 204.0500 308.0000 mat charge diff 31.00 19.42 16.4300 24.8000 mammo/sterotactic breast bx 584.35 365.98 309.7055 467.4800 add set-spec plus base 165.45 103.62 87.6885 132.3600 add view plus base 39.43 24.69 20.8979 31.5440 bae. prep kit-jrhc 14.35 8.99 7.6055 11.4800 uper gi w/air & sm bowel 1142.95 715.83 605.7635 914.3600 stereotactic breast biopsy 1840.65 1152.80 975.5445 1472.5200 stereotactic breast localizat 724.65 453.85 384.0645 579.7200 spot view plus base 54.05 33.85 28.6465 43.2400 specimen 100.60 63.01 53.3180 80.4800 surgical lumbar spine 757.10 474.17 401.2630 605.6800 surgical thorasic spine 548.10 343.28 290.4930 438.4800 surgical cervical spine 561.60 351.73 297.6480 449.2800 fluoro over 1hr 380.65 238.40 201.7445 304.5200 pacemaker/chest 1view inactive 648.90 406.41 343.9170 519.1200 pacemaker/chest 2 views 477.35 298.96 252.9955 381.8800 fba tract > 17 inches 765.45 479.40 405.6885 612.3600 43280024 replaced as 01/01/14 10671.90 6683.81 5656.1070 8537.5200 43280025 replaced as 01/01/14 10671.90 6683.81 5656.1070 8537.5200 brst local/mammo w/o cad rt 1556.90 975.09 825.1570 1245.5200 brst local/mammo w/o cad rt s 1766.40 1106.30 936.1920 1413.1200 breast cyst aspiration 271.40 169.98 143.8420 217.1200 brst bx/mammo w/o cad/spec lt 6743.83 4223.66 3574.2299 5395.0640 brst bx/mammo w/o cad/spec rt 6743.83 4223.66 3574.2299 5395.0640 brst lcl/mammo w/o cad/spec lt 1542.70 966.19 817.6310 1234.1600 brst lcl/mammo w/o cad/spec rt 1602.40 1003.58 849.2720 1281.9200 brst local/mammo w/o cad lt 1556.90 975.09 825.1570 1245.5200 intensive care unit 501.87 314.32 265.9911 401.4960 overflow/t-bed icu 2974.40 1862.87 1576.4320 2379.5200 imrt mlc 1562.10 978.34 827.9130 1249.6800 imrt plan 5579.60 3494.50 2957.1880 4463.6800 coronary care unit 3328.00 2084.33 1763.8400 2662.4000 isod complex 793.50 496.97 420.5550 634.8000 isod simple 483.60 302.88 256.3080 386.8800 elect, neutron 1300.00 814.19 689.0000 1040.0000 cardiac care unit 300.00 187.89 159.0000 240.0000 special tx procedure 1851.20 1159.41 981.1360 1480.9600 special dosimetry 471.10 295.05 249.6830 376.8800 sim 3d 4431.45 2775.42 2348.6685 3545.1600 sim complex 1480.95 927.52 784.9035 1184.7600 sim intermediate 1197.05 749.71 634.4365 957.6400 sim simple 788.30 493.71 417.7990 630.6400 rpm scan in ct 1250.10 782.94 662.5530 1000.0800 tx devices complex 825.80 517.20 437.6740 660.6400 tx devices intermediate 746.70 467.66 395.7510 597.3600 tx devices simple 729.05 456.60 386.3965 583.2400 basic dos 436.80 273.57 231.5040 349.4400 chemo iv push same drug 301.60 188.89 159.8480 241.2800 chemo-add'l 15 min-jrhc 12.45 7.80 6.5985 9.9600 chemo-add'l 30 min-jrhc 24.90 15.59 13.1970 19.9200 chemo-add'l 45 min-jrhc 37.30 23.36 19.7690 29.8400 chemo-add'l 60 min-jrhc 49.70 31.13 26.3410 39.7600 chemotherapy-jrhc 55.90 35.01 29.6270 44.7200 complex analysis w/nuc phys 278.95 174.71 147.8435 223.1600 cardiac wall motion perfusion 372.65 233.39 197.5045 298.1200 myocard perf spect single 861.35 539.46 456.5155 689.0800 myocardial perfusion ef 372.65 233.39 197.5045 298.1200 myocard perf multi spect 1577.70 988.11 836.1810 1262.1600 myocard perf multi/ef/wall mtn 2323.00 1454.89 1231.1900 1858.4000 myocard perf sngl/ef/wall mtn 1606.65 1006.24 851.5245 1285.3200 ambulance service a.m.h. 343.05 214.85 181.8165 274.4400 deep vein thrombosis study 1034.60 647.97 548.3380 827.6800 gastric emptying/data proc<30g 1459.75 914.24 773.6675 1167.8000 renal flow func/data proc <30 2037.00 1275.77 1079.6100 1629.6000 renal flow multi/data proc <30 1772.00 1109.80 939.1600 1417.6000 sulfur colloid prep 91.50 57.31 48.4950 73.2000 head posterior fossa w/wo 1520.65 952.38 805.9445 1216.5200 head posterior fossa/with 1303.30 816.26 690.7490 1042.6400 head posterior fossa/without 1351.15 846.23 716.1095 1080.9200 head/c-spine w/o contr chg exp 3891.70 2437.37 2062.6010 3113.3600 head/sinuses w/o contr chg exp 3667.05 2296.67 1943.5365 2933.6400 ct head w/out/w chst,abd,pel w 9326.70 5841.31 4943.1510 7461.3600 newborn/obs 287.00 179.75 152.1100 229.6000 newborn nursery 175.00 109.60 92.7500 140.0000 newborn nursery isolette 287.00 179.75 152.1100 229.6000 newborn nursery' 175.00 109.60 92.7500 140.0000 newborn nursery-isolette 175.00 109.60 92.7500 140.0000 newborn/isolette 287.00 179.75 152.1100 229.6000 observation nursery 175.00 109.60 92.7500 140.0000 nursery 1590.17 995.92 842.7901 1272.1360 newborn/isolette 287.00 179.75 152.1100 229.6000 newborn nursery-boarder 287.00 179.75 152.1100 229.6000 newborn nursery boarder 287.00 179.75 152.1100 229.6000 newborn/obsv 287.00 179.75 152.1100 229.6000 neck wo-w/chst w/abd w0-w/pelw 9862.85 6177.10 5227.3105 7890.2800 neck/chest/abd/pel w/c chg exp 9014.23 5645.61 4777.5419 7211.3840 neck/chest/abd/pelv wo c c-exp 8426.60 5277.58 4466.0980 6741.2800 neck w/chst w/abd wo-w/pel w 9279.43 5811.70 4918.0979 7423.5440 neck wo contrast/chest wo 4127.80 2585.24 2187.7340 3302.2400 neck w contrast/chest w 4442.90 2782.59 2354.7370 3554.3200 hd w0/cspn wo/fac wo 5805.30 3635.86 3076.8090 4644.2400 hd wo-w/cst w/abd wo-w/pelv w 9879.48 6187.52 5236.1244 7903.5840 hd wo-w/nk w/cst w/ab wo-w/plw 12170.60 7622.45 6450.4180 9736.4800 hd wo-w/nk w/cst w/abd w/plv w 11905.40 7456.35 6309.8620 9524.3200 hd wo/cspn wo/cst w/ab w/pel w 10614.75 6648.02 5625.8175 8491.8000 hd wo/cspn wo/cst wo/ab wo/pwo 9966.83 6242.22 5282.4199 7973.4640 hd wo/cspn wo/orbits wo 5972.70 3740.70 3165.5310 4778.1600 hd wo/cst w/abd w/pelv w 8476.53 5308.85 4492.5609 6781.2240 hd wo/cst wo/abd wo/pelv wo 7828.60 4903.05 4149.1580 6262.8800 hd wo/nk wo/cst wo/abd wo/plwo 10180.03 6375.75 5395.4159 8144.0240 coronary ct angiography 1205.05 754.72 638.6765 964.0400 ct chest w-con/cor cta 4023.80 2520.11 2132.6140 3219.0400 ct chest w-con/cor cta/functn 4023.80 2520.11 2132.6140 3219.0400 chest w/abd w/pelv w chg exp 6723.08 4210.66 3563.2324 5378.4640 chest w/abd wo/w contrast expl 5042.95 3158.40 2672.7635 4034.3600 chest-w/abd-wo/w/pelv/w expl 6988.28 4376.76 3703.7884 5590.6240 chest/abd w contrast chg expl 4697.70 2942.17 2489.7810 3758.1600 chest/abd w/o contrast chg exp 1782.20 1116.19 944.5660 1425.7600 chest/abd/pelv w/o chg exp 6075.18 3804.88 3219.8454 4860.1440 chest/abdomen w/o contrast 3952.00 2475.14 2094.5600 3161.6000 ccta/function evaluation 1127.90 706.40 597.7870 902.3200 c spn wo/thor spn wo/ls spn wo 6840.10 4283.95 3625.2530 5472.0800 head wo contrast/facial bn wo 3667.05 2296.67 1943.5365 2933.6400 head wo contrast/orbits wo 3834.50 2401.55 2032.2850 3067.6000 head wo-w contrast/fac bn wo-w 5765.80 3611.12 3055.8740 4612.6400 head wo-w contrast/facial w 5082.50 3183.17 2693.7250 4066.0000 head wo-w contrast/orbits with 5206.25 3260.67 2759.3125 4165.0000 head wo-w contrast/orbits wo-w 5765.80 3611.12 3055.8740 4612.6400 thoracic spine wo/l-s spine wo 4701.85 2944.77 2491.9805 3761.4800 abd wo/w-pelv w chg expl 5204.15 3259.36 2758.1995 4163.3200 abd/pelv w/o contrast chg expl 4568.70 2861.38 2421.4110 3654.9600 abd/pelv with contrast chg exp 4858.90 3043.13 2575.2170 3887.1200 abd/pelv wo/w contrast 5405.90 3385.72 2865.1270 4324.7200 abdomen/pelvis wo/w contrast 5405.90 3385.72 2865.1270 4324.7200 ct head wo-neck w/o 4104.90 2570.90 2175.5970 3283.9200 ct head wo/w-neck w contrast 5182.30 3245.67 2746.6190 4145.8400 ct head wo/w-neck wo/w contrst 5765.80 3611.12 3055.8740 4612.6400 ct head wo/w-orbits wo/w 5765.80 3611.12 3055.8740 4612.6400 ct needle placement/procedure 2759.10 1728.02 1462.3230 2207.2800 ct percu drainage/procedure 2759.10 1728.02 1462.3230 2207.2800 ct perfusion w/contrast cbf-e 2531.35 1585.38 1341.6155 2025.0800 ct guide-plmt rad ther fl 1142.20 715.36 605.3660 913.7600 cta abdomen/if run off 4915.05 3078.30 2604.9765 3932.0400 cta abdomen/pelvis 4915.05 3078.30 2604.9765 3932.0400 cta chest/abdomen 4644.65 2908.94 2461.6645 3715.7200 cta chest/abdomen/if run off 4301.45 2694.00 2279.7685 3441.1600 cta chest/abdomen/pelvis 6588.93 4126.64 3492.1329 5271.1440 cta chest/ct adb/ct pel w/con 6299.30 3945.25 3338.6290 5039.4400 cta head/neck 4801.70 3007.30 2544.9010 3841.3600 neck w-chest w-abd w contrast 6988.80 4377.09 3704.0640 5591.0400 neck w-chest w-abd wo/w cntrst 7334.10 4593.35 3887.0730 5867.2800 neck wo-chest wo-abd wo 6303.45 3947.85 3340.8285 5042.7600 neck wo/w-chest w-abd wo/w cnt 7917.50 4958.73 4196.2750 6334.0000 needle brush biopsy 378.55 237.09 200.6315 302.8400 neuromonitoring 2065.45 1293.59 1094.6885 1652.3600 nasal endoscopy 718.65 450.09 380.8845 574.9200 o.r. fee major 1 1/2 hrs 4136.10 2590.44 2192.1330 3308.8800 o.r. fee major 1 hr 3785.60 2370.92 2006.3680 3028.4800 o.r. fee major 1/2 hrs 2564.65 1606.24 1359.2645 2051.7200 o.r. fee minor 1 1/2 hrs 4268.68 2673.47 2262.4004 3414.9440 o.r. fee minor 1 hour 3658.73 2291.46 1939.1269 2926.9840 o.r. fee minor 1/2 hr. 3049.80 1910.09 1616.3940 2439.8400 o.r. fee minor 2 1/2 hrs 1393.85 872.97 738.7405 1115.0800 o.r. fee minor 2 hrs 4787.10 2998.16 2537.1630 3829.6800 o.r. fee minor 4 1/2 hrs 2012.55 1260.46 1066.6515 1610.0400 o.r. fee minor 4 hrs 1857.65 1163.45 984.5545 1486.1200 o.r. fee minor 5 hrs 2167.10 1357.25 1148.5630 1733.6800 o.r. minor 3 1/2 hrs 1703.05 1066.62 902.6165 1362.4400 o.r. minor 3 hrs 1548.20 969.64 820.5460 1238.5600 o.r.fee major 2 1/2 hrs 3638.95 2279.07 1928.6435 2911.1600 o.r.fee major 2 hrs 3266.65 2045.90 1731.3245 2613.3200 o.r.fee major 3 1/2 hrs 4378.40 2742.19 2320.5520 3502.7200 o.r.fee major 3 hours 4009.20 2510.96 2124.8760 3207.3600 o.r.fee major 4 1/2 hrs 5119.90 3206.59 2713.5470 4095.9200 o.r.fee major 4 hrs 4750.70 2975.36 2517.8710 3800.5600 o.r.fee major 5 hrs 5491.20 3439.14 2910.3360 4392.9600 o/p surgery screen 120.65 75.56 63.9445 96.5200 injection of contrast 509.60 319.16 270.0880 407.6800 injection procedure 173.60 108.73 92.0080 138.8800 lithotripsy bilateral 9814.08 6146.56 5201.4624 7851.2640 lithotripsy unilateral 8484.73 5313.98 4496.9069 6787.7840 lithotripsy w/cysto 9814.08 6146.56 5201.4624 7851.2640 lithotripsy-mobile 656.25 411.01 347.8125 525.0000 local/aspir/bx/surg comp para 612.55 383.64 324.6515 490.0400 mid-line cath insertion 1128.40 706.72 598.0520 902.7200 minor surgery 308.50 193.21 163.5050 246.8000 minor surgery/procedure 752.95 471.57 399.0635 602.3600 cystoscopy 718.65 450.09 380.8845 574.9200 cystography 199.60 125.01 105.7880 159.6800 endoscopic ultrasound 2429.30 1521.47 1287.5290 1943.4400 endotracheal intubation 540.80 338.70 286.6240 432.6400 ercp - 1 1/2 hr 4010.23 2511.60 2125.4219 3208.1840 ercp - 1 hr 3436.15 2152.06 1821.1595 2748.9200 ercp - 1/2 hr 2389.90 1496.79 1266.6470 1911.9200 ercp - 2 1/2 hr 4396.63 2753.61 2330.2139 3517.3040 ercp - 2 hr 4494.88 2815.14 2382.2864 3595.9040 facet inj 1st level bilateral 2287.48 1432.65 1212.3644 1829.9840 facet inj 1st level single 1123.20 703.46 595.2960 898.5600 facet inj 1st level unilateral 1734.70 1086.44 919.3910 1387.7600 facet inj ea addl level bilat 793.00 496.66 420.2900 634.4000 facet inj ea addl level single 390.00 244.26 206.7000 312.0000 facet inj ea addl level unilat 669.80 419.50 354.9940 535.8400 esi 1st level bilateral 2071.18 1297.18 1097.7254 1656.9440 esi 1st level single 1214.70 760.77 643.7910 971.7600 cmg w/urethrd pressure 221.55 138.76 117.4215 177.2400 colonoscopy 2987.40 1871.01 1583.3220 2389.9200 amb care-visit level i 239.20 149.81 126.7760 191.3600 amb care-visit level ii 381.70 239.06 202.3010 305.3600 amb care-visit level iii 763.35 478.09 404.5755 610.6800 amb care-visit level iv 1428.95 894.95 757.3435 1143.1600 amb care-visit level v 1466.40 918.41 777.1920 1173.1200 circumcision nb outpatient 1693.10 1060.39 897.3430 1354.4800 brst local/mammo w/o cad lt 1434.15 898.21 760.0995 1147.3200 brst local/mammo w/o cad lt s 1643.70 1029.45 871.1610 1314.9600 broncho removal foreign body 95.70 59.94 50.7210 76.5600 broncho therapeutic aspiration 86.30 54.05 45.7390 69.0400 bronchoscopy 865.78 542.23 458.8634 692.6240 bronchoscopy biopsy 195.50 122.44 103.6150 156.4000 bronchoscopy brush biopsy 116.50 72.96 61.7450 93.2000 bronchoscopy intubation 110.00 68.89 58.3000 88.0000 breast biopsy-surgical compons 6534.30 4092.43 3463.1790 5227.4400 ct surgical/inject procedure 140.40 87.93 74.4120 112.3200 catheter insertion 110.25 69.05 58.4325 88.2000 laryngoscopy 372.00 232.98 197.1600 297.6000 laser 4354.50 2727.22 2307.8850 3483.6000 laparoscopy 589.70 369.33 312.5410 471.7600 joint injection 257.90 161.52 136.6870 206.3200 percut transhepat cholang 1073.30 672.21 568.8490 858.6400 percutaneous need lung bx 320.60 200.79 169.9180 256.4800 hip/knee inj 855.90 536.05 453.6270 684.7200 hysteroscopy 1186.65 743.20 628.9245 949.3200 gastroscopy 2291.65 1435.26 1214.5745 1833.3200 fluoroscopy w/or procedure 159.10 99.64 84.3230 127.2800 gastroscopy w/polypectomy 2941.13 1842.03 1558.7989 2352.9040 gastroscopy with bougie 2310.90 1447.32 1224.7770 1848.7200 flexible sigmoidoscopy 193.60 121.25 102.6080 154.8800 endo cyclo photo congulation 506.45 317.19 268.4185 405.1600 esi 1st level unilateral 1655.70 1036.96 877.5210 1324.5600 esi ea addl level bilat 584.50 366.07 309.7850 467.6000 esi ea addl level bilateral 1001.50 627.24 530.7950 801.2000 esi ea addl level single 390.00 244.26 206.7000 312.0000 esi ea addl level unilateral 669.80 419.50 354.9940 535.8400 ac procedure <30 min 163.30 102.27 86.5490 130.6400 ac procedure >60 min 518.95 325.02 275.0435 415.1600 ac procedure 30-60 min 347.35 217.55 184.0955 277.8800 add'l 1/2 hr surgery 533.50 334.13 282.7550 426.8000 ultrasound surg comp 147.70 92.50 78.2810 118.1600 us breast bx w/needle/surg com 612.55 383.64 324.6515 490.0400 picc cath insertion 1241.80 777.74 658.1540 993.4400 picc/port study 807.05 505.46 427.7365 645.6400 rigid sigmoidoscope 103.25 64.67 54.7225 82.6000 precut endoscop gastrstmy 771.68 483.30 408.9904 617.3440 polypectomy - 1 1/2 hr 6569.68 4114.59 3481.9304 5255.7440 polypectomy - 1 hr 5972.73 3740.72 3165.5469 4778.1840 polypectomy - 1/2 hr 4181.85 2619.09 2216.3805 3345.4800 polypectomy - 2 hrs 5580.63 3495.15 2957.7339 4464.5040 procedure <30 min 88.40 55.36 46.8520 70.7200 prostatectomy (laser) 11431.70 7159.67 6058.8010 9145.3600 rad injection proc pain mgt 964.10 603.82 510.9730 771.2800 rad injection procedure 571.23 357.76 302.7519 456.9840 rad injection procedure bilat 889.73 557.23 471.5569 711.7840 rad injection procedure hip 640.90 401.40 339.6770 512.7200 rad injection procedure shldr 610.35 382.26 323.4855 488.2800 rad injection procedure spine 964.10 603.82 510.9730 771.2800 sigmoidoscopy 557.45 349.13 295.4485 445.9600 sclerotherapy 735.28 460.50 389.6984 588.2240 scoop procedure 176.20 110.35 93.3860 140.9600 scoop procedure and kit 1782.55 1116.41 944.7515 1426.0400 sigmoidoscopic 525.20 328.93 278.3560 420.1600 small bowel bx 1080.03 676.42 572.4159 864.0240 spinal puncture 1155.45 723.66 612.3885 924.3600 spinal robotics 940.15 588.82 498.2795 752.1200 steroid injection 532.48 333.49 282.2144 425.9840 surg comp need gd bx 173.60 108.73 92.0080 138.8800 surg comp need gd cyst apsp 173.60 108.73 92.0080 138.8800 surg. endoscopy (arthroscopy) 884.00 553.65 468.5200 707.2000 vacuum asst biopsy/clip breast 1998.90 1251.91 1059.4170 1599.1200 vacuum asst needle biopsy brst 3335.30 2088.90 1767.7090 2668.2400 regional anesthesia 399.35 250.11 211.6555 319.4800 add'l 1/2 hr anesthesia 250.65 156.98 132.8445 200.5200 general anesthesia 741.50 464.40 392.9950 593.2000 monitored anesthesia care 399.35 250.11 211.6555 319.4800 platelets 55.15 34.54 29.2295 44.1200 neonatal mult packed cells 156.20 97.83 82.7860 124.9600 deglyc autol packed cells 222.25 139.20 117.7925 177.8000 deglyc red packed cells 233.95 146.52 123.9935 187.1600 deglycerolized packed cells 222.25 139.20 117.7925 177.8000 frozen packed cells 161.05 100.87 85.3565 128.8400 frozen autol packed cells 180.00 112.73 95.4000 144.0000 granulocytes pheresis 599.95 375.75 317.9735 479.9600 buffy coat 42.85 26.84 22.7105 34.2800 hla surcharge (per unit) 98.20 61.50 52.0460 78.5600 stat delivery charge shp9 538.20 337.07 285.2460 430.5600 stat delivery chg shp5 127.70 79.98 67.6810 102.1600 stat delivery chg shp7 165.40 103.59 87.6620 132.3200 stat red cross delivery 46.20 28.94 24.4860 36.9600 special filters 97.20 60.88 51.5160 77.7600 admin platelet pheresis 971.20 608.26 514.7360 776.9600 admin bone-chips 876.55 548.98 464.5715 701.2400 admin bone-femoral head 876.55 548.98 464.5715 701.2400 admin cryoprecipitate 449.15 281.30 238.0495 359.3200 admin ffp 478.80 299.87 253.7640 383.0400 admin leukoreduced rbc 846.75 530.32 448.7775 677.4000 administration packed cells 52.95 33.16 28.0635 42.3600 administration platelets 11.55 7.23 6.1215 9.2400 admin misc products 56.50 35.39 29.9450 45.2000 admin washed packed cells 46.00 28.81 24.3800 36.8000 admin-proc frsh froz plasma 108.85 68.17 57.6905 87.0800 admin-proc-platelets 96.45 60.41 51.1185 77.1600 transfusion administration 1065.43 667.28 564.6779 852.3440 mammogram digital lt 43201080 175.30 109.79 92.9090 140.2400 mammogram digital rt 43201081 175.30 109.79 92.9090 140.2400 mammography 1 side digital 194.80 122.00 103.2440 155.8400 mammography computer detection 29.25 18.32 15.5025 23.4000 mammography diag digital left 363.83 227.86 192.8299 291.0640 mammography diag digital right 363.83 227.86 192.8299 291.0640 mammo bil diag dig w/tomo 658.55 412.45 349.0315 526.8400 mammo bilateral diagn digital 653.10 409.04 346.1430 522.4800 mammo diag dig left w/tomo 630.25 394.73 334.0325 504.2000 mammo diag dig right w/tomo 630.25 394.73 334.0325 504.2000 bilateral mammo diagn digital 204.55 128.11 108.4115 163.6400 code zero bilateral w/tomo 760.25 476.14 402.9325 608.2000 code zero lt w/tomo 630.25 394.73 334.0325 504.2000 code zero rt w/tomo 630.25 394.73 334.0325 504.2000 biophys w/fetal age >14 weeks 1263.60 791.39 669.7080 1010.8800 biophys w/fetal age f/u 1223.05 766.00 648.2165 978.4400 local/aspir/bx & surg comp 709.30 444.23 375.9290 567.4400 local/aspir/bx w/seed &s comp 918.80 575.44 486.9640 735.0400 extremity non vascular 333.45 208.84 176.7285 266.7600 us guidance/localization 1033.80 647.47 547.9140 827.0400 us pelvic & endo/transvaginal 1815.85 1137.27 962.4005 1452.6800 us breast cyst aspiration 285.35 178.71 151.2355 228.2800 mammo screen unilat dig w/tomo 562.65 352.39 298.2045 450.1200 mammo screening unilat digital 468.00 293.11 248.0400 374.4000 screen mammography dig w/tomo 617.80 386.93 327.4340 494.2400 screening mammo unilat digital 233.80 146.43 123.9140 187.0400 screening mammo unilateral1082 204.55 128.11 108.4115 163.6400 screening mammography 204.55 128.11 108.4115 163.6400 screening mammography digital 378.45 237.02 200.5785 302.7600 computer mammogram add-on 29.25 18.32 15.5025 23.4000 mammory ductogram 264.60 165.72 140.2380 211.6800 dispos bag vol ma-jrhc 47.15 29.53 24.9895 37.7200 atrovent unit dose 5.90 3.70 3.1270 4.7200 extoximetry-jrhc 131.75 82.52 69.8275 105.4000 fit testing 11.15 6.98 5.9095 8.9200 parafin bath-half 104.25 65.29 55.2525 83.4000 group therapy pt 15 min 26.10 16.35 13.8330 20.8800 group therapy pt 45 min 78.20 48.98 41.4460 62.5600 infrared-half 104.25 65.29 55.2525 83.4000 biofeedback training full 104.25 65.29 55.2525 83.4000 biofeedback training qtr 52.15 32.66 27.6395 41.7200 therapeutic proc group 30 min 52.50 32.88 27.8250 42.0000 therapeutic proc group half 34.55 21.64 18.3115 27.6400 contrast bath 15 min 52.15 32.66 27.6395 41.7200 group therapy ot 15 min 26.10 16.35 13.8330 20.8800 group therapy ot 45 min 78.20 48.98 41.4460 62.5600 evaluation 30 minutes 99.25 62.16 52.6025 79.4000 eval speech/lang standard 244.40 153.07 129.5320 195.5200 eval speech/language 120 min 416.75 261.01 220.8775 333.4000 eval speech/language 15 min 50.90 31.88 26.9770 40.7200 eval speech/language 30 min 101.75 63.73 53.9275 81.4000 eval speech/language 45 min 152.58 95.56 80.8674 122.0640 eval speech/language 60 min 198.45 124.29 105.1785 158.7600 eval speech/language 75 min 254.33 159.28 134.7949 203.4640 eval speech/language 90 min 297.70 186.45 157.7810 238.1600 eval speech/language extended 367.10 229.91 194.5630 293.6800 eval swallowing 120 min 416.75 261.01 220.8775 333.4000 eval swallowing 15 min 50.90 31.88 26.9770 40.7200 eval swallowing 30 min 101.75 63.73 53.9275 81.4000 eval swallowing 45 min 152.58 95.56 80.8674 122.0640 eval swallowing 60 min 198.45 124.29 105.1785 158.7600 eval swallowing 75 min 254.33 159.28 134.7949 203.4640 eval swallowing 90 min 297.70 186.45 157.7810 238.1600 laryngeal func study 15 min 50.90 31.88 26.9770 40.7200 group therapy st 15 min 26.10 16.35 13.8330 20.8800 group therapy st 45 min 78.20 48.98 41.4460 62.5600 tx speech/language 15 min 50.90 31.88 26.9770 40.7200 tx speech/language 30 min 99.25 62.16 52.6025 79.4000 tx speech/language 45 min 152.58 95.56 80.8674 122.0640 tx speech/language 60 min 198.45 124.29 105.1785 158.7600 tx speech/language 75 min 254.33 159.28 134.7949 203.4640 tx speech/language 90 min 305.15 191.12 161.7295 244.1200 tx swallowing 15 min 54.08 33.87 28.6624 43.2640 tx swallowing 30 min 99.25 62.16 52.6025 79.4000 tx swallowing 45 min 152.58 95.56 80.8674 122.0640 tx swallowing 60 min 198.45 124.29 105.1785 158.7600 tx swallowing 75 min 254.33 159.28 134.7949 203.4640 tx swallowing 90 min 305.15 191.12 161.7295 244.1200 physician er followup low-mod 92.85 58.15 49.2105 74.2800 arm splint 132.00 82.67 69.9600 105.6000 proc 0-15 min w/indermil 691.75 433.24 366.6275 553.4000 proc 0-15 min w/staple 726.25 454.85 384.9125 581.0000 thoracentesis & supplies 1295.60 811.43 686.6680 1036.4800 surgical proc 0-15 minutes 617.80 386.93 327.4340 494.2400 surgical proc 16-30 minutes 655.20 410.35 347.2560 524.1600 surgical proc 31-45 minutes 829.90 519.77 439.8470 663.9200 surgical proc 46-60 minutes 1064.95 666.98 564.4235 851.9600 surgical procedure 660.40 413.61 350.0120 528.3200 surgical procedure >60 minutes 1493.45 935.35 791.5285 1194.7600 transfusion administration 1648.40 1032.39 873.6520 1318.7200 transvenous pacer (temp) 7173.90 4493.01 3802.1670 5739.1200 ama charge 22.30 13.97 11.8190 17.8400 intra-arterial injection 65.00 40.71 34.4500 52.0000 intramuscular of an antibiotic 27.20 17.04 14.4160 21.7600 intravenous injection 174.70 109.41 92.5910 139.7600 lumbar puncture & supply 907.20 568.18 480.8160 725.7600 lumbar puncture & supply adult 856.20 536.24 453.7860 684.9600 lumbar puncture & supply ped 851.10 533.04 451.0830 680.8800 peripheral insert cntrl cath+s 935.85 586.12 496.0005 748.6800 burn dressing - large 583.45 365.41 309.2285 466.7600 burn dressing - medium 347.35 217.55 184.0955 277.8800 burn dressing - small 258.95 162.18 137.2435 207.1600 iv hydration init hr & set up 634.40 397.32 336.2320 507.5200 iv infus drug init hr & set up 613.60 384.30 325.2080 490.8800 paracentesis & supply 949.85 594.89 503.4205 759.8800 eye irrigation & supply 692.85 433.93 367.2105 554.2800 exercise oximetry 66.20 41.46 35.0860 52.9600 comp pft w/o broncho 430.55 269.65 228.1915 344.4400 comp pulm func w/broncho 552.98 346.33 293.0794 442.3840 comp pulm func w/obroncho 215.10 134.72 114.0030 172.0800 microcon hepa filtration unit 15.90 9.96 8.4270 12.7200 body box lung volumes 163.80 102.59 86.8140 131.0400 pulm stress test 6min walk-exp 204.62 128.15 108.4486 163.6960 us cardiac comp/doppler/cfv 2555.30 1600.38 1354.3090 2044.2400 tee/color flow velocity 3426.80 2146.20 1816.2040 2741.4400 swan ganz catheter insert 584.40 366.01 309.7320 467.5200 cardiac cath 7632.25 4780.08 4045.0925 6105.8000 cystography w/biopsy 122.10 76.47 64.7130 97.6800 colonoscopy w/poly 1 hr 1149.50 719.93 609.2350 919.6000 colonoscopy w/poly 1/2 hr 919.80 576.07 487.4940 735.8400 colonoscopy w/poly 2 hr 1379.25 863.82 731.0025 1103.4000 colonoscopy/poly 1 1/2 hr 1264.50 791.96 670.1850 1011.6000 cysto w/retrograde 250.90 157.14 132.9770 200.7200 cystogram 28.20 17.66 14.9460 22.5600 ligation of skin tags 46.80 29.31 24.8040 37.4400 emg (cysto) 217.30 136.09 115.1690 173.8400 laser 919.10 575.63 487.1230 735.2800 gastroscopy exam-jrhc 460.10 288.16 243.8530 368.0800 urethro pressure profile 174.85 109.51 92.6705 139.8800 do not use 187.50 117.43 99.3750 150.0000 sigmoidoscopy- jrhc 92.75 58.09 49.1575 74.2000 sigmoid colonscopy 225.48 141.21 119.5044 180.3840 est pt,comprehen visit lang. 198.00 124.01 104.9400 158.4000 est pt,comprehensive visit 247.45 154.98 131.1485 197.9600 est pt, detailed. 182.00 113.99 96.4600 145.6000 est pt,comprehensive visit. 258.00 161.59 136.7400 206.4000 est pt,comprehensive vst lang 198.00 124.01 104.9400 158.4000 est pt,comprehensive vst lang. 198.00 124.01 104.9400 158.4000 est pt,expanded 112.23 70.29 59.4819 89.7840 est pt,expanded lang 102.00 63.88 54.0600 81.6000 est pt,expanded language 102.00 63.88 54.0600 81.6000 est pt,expanded language. 102.00 63.88 54.0600 81.6000 est pt,expanded-e 126.90 79.48 67.2570 101.5200 est pt,expanded. 122.00 76.41 64.6600 97.6000 est pt,prob focused language 75.00 46.97 39.7500 60.0000 est pt,problem focused 88.40 55.36 46.8520 70.7200 est pt,problem focused lang 75.00 46.97 39.7500 60.0000 est pt,problem focused lang. 75.00 46.97 39.7500 60.0000 est pt,problem focused. 86.70 54.30 45.9510 69.3600 est pt, detailed 187.35 117.34 99.2955 149.8800 est pt, detailed lang 145.00 90.81 76.8500 116.0000 est pt, detailed language 150.80 94.45 79.9240 120.6400 new pt, complex-e 375.45 235.14 198.9885 300.3600 new pt, comprehensive lang 221.00 138.41 117.1300 176.8000 new pt, comprehensive language 221.00 138.41 117.1300 176.8000 new pt, comprehensive-e 302.65 189.55 160.4045 242.1200 new pt, comprehensive. 291.00 182.25 154.2300 232.8000 new pt, detailed 171.35 107.32 90.8155 137.0800 new pt, detailed lang 148.00 92.69 78.4400 118.4000 new pt, detailed language 148.00 92.69 78.4400 118.4000 new pt, detailed language. 148.00 92.69 78.4400 118.4000 new pt, detailed-e 194.50 121.82 103.0850 155.6000 new pt, detailed. 187.00 117.12 99.1100 149.6000 new pt, complex 331.85 207.84 175.8805 265.4800 new pt, complex lang 270.00 169.10 143.1000 216.0000 new pt, complex language 270.00 169.10 143.1000 216.0000 new pt, complex language. 270.00 169.10 143.1000 216.0000 new pt, complex. 361.00 226.09 191.3300 288.8000 new pt, comprehensive 267.10 167.28 141.5630 213.6800 new pt,expanded 115.33 72.23 61.1249 92.2640 new pt,expanded language 106.00 66.39 56.1800 84.8000 new pt,expanded language. 106.00 66.39 56.1800 84.8000 new pt,expanded-e 130.00 81.42 68.9000 104.0000 new pt,expanded. 125.00 78.29 66.2500 100.0000 new pt,prob focused language. 69.00 43.21 36.5700 55.2000 new pt,problem focused 74.00 46.35 39.2200 59.2000 new pt,problem focused lang 69.00 43.21 36.5700 55.2000 new pt,problem focused lang. 69.00 43.21 36.5700 55.2000 new pt,problem focused-e 76.95 48.19 40.7835 61.5600 new pt,problem focused. 74.00 46.35 39.2200 59.2000 med mngmnt e/m 3 estab md 15m 92.20 57.74 48.8660 73.7600 intermediate consult 78.00 48.85 41.3400 62.4000 intmd rpr n-hf/gent7.6-12.5-e 1737.70 1088.32 920.9810 1390.1600 intmd rpr s/a/t/ext 2.5cm/<-ex 791.45 495.69 419.4685 633.1600 intmd rpr s/tr/ext 7.6-12.5cm 1359.85 851.67 720.7205 1087.8800 limited consult 56.00 35.07 29.6800 44.8000 inj intralesional </w7-exp 532.80 333.69 282.3840 426.2400 insert pessary/other device-e 378.10 236.80 200.3930 302.4800 insert pessary/other device-np 360.25 225.62 190.9325 288.2000 new pt, comprehensive 412.70 258.47 218.7310 330.1600 new pt, complex visit 756.45 473.76 400.9185 605.1600 new pt, expanded 182.50 114.30 96.7250 146.0000 new pt, expanded-np 202.80 127.01 107.4840 162.2400 new pt, problem focused 112.15 70.24 59.4395 89.7200 new pt, detailed visit 262.10 164.15 138.9130 209.6800 new pt, detailed visit-np 282.35 176.84 149.6455 225.8800 new pt, comprehensive-np 440.95 276.17 233.7035 352.7600 new pt, complex-np 499.20 312.65 264.5760 399.3600 new pt visit level i 139.96 87.66 74.1788 111.9680 new pt visit level i-exp 167.45 104.87 88.7485 133.9600 new pt visit level i-m 131.05 82.08 69.4565 104.8400 new pt visit level ii 208.41 130.53 110.4573 166.7280 new pt visit level ii-exp 238.15 149.15 126.2195 190.5200 new pt visit level ii-m 218.40 136.78 115.7520 174.7200 new pt visit level ii-np 196.57 123.11 104.1821 157.2560 new pt visit level iii 285.92 179.07 151.5376 228.7360 new pt visit level iii-exp 316.15 198.00 167.5595 252.9200 new pt visit level iii-m 210.10 131.59 111.3530 168.0800 new pt visit level iii-np 269.70 168.91 142.9410 215.7600 new pt visit level iv 418.99 262.42 222.0647 335.1920 new pt visit level iv-exp 440.95 276.17 233.7035 352.7600 new pt visit level iv-m 440.95 276.17 233.7035 352.7600 new pt visit level iv-np 402.47 252.06 213.3091 321.9760 new pt visit level v 493.09 308.82 261.3377 394.4720 new pt visit level v-exp 505.45 316.56 267.8885 404.3600 new pt visit level v-m 330.70 207.12 175.2710 264.5600 new pt visit level v-np 469.03 293.76 248.5859 375.2240 neg pressure wound therapy-e 522.00 326.93 276.6600 417.6000 office consult, expanded 142.61 89.32 75.5833 114.0880 ear cartilage graft-explosion 8392.80 5256.41 4448.1840 6714.2400 dx bone marrow bx & aspir-exp 2348.60 1470.93 1244.7580 1878.8800 office consult, complex 325.43 203.81 172.4779 260.3440 office consult, comprehensive 261.22 163.60 138.4466 208.9760 office consult, detailed 194.41 121.76 103.0373 155.5280 collaborative care 1st mo-70 255.85 160.24 135.6005 204.6800 collaborative care subseq mo 242.75 152.03 128.6575 194.2000 clean out mastoid cavity-exp 1015.05 635.73 537.9765 812.0400 biopsy of floor of mouth-exp 1917.80 1201.12 1016.4340 1534.2400 biopsy of nail unit-explosion 1747.55 1094.49 926.2015 1398.0400 biopsy of salivary gland-exp 1742.85 1091.55 923.7105 1394.2800 biopsy/exc of lymph nodes-exp 5928.70 3713.14 3142.2110 4742.9600 est pt, detailed-np 303.68 190.19 160.9504 242.9440 est pt, detailed 266.10 166.66 141.0330 212.8800 est pt, expanded 183.30 114.80 97.1490 146.6400 est pt, expanded-np 228.28 142.97 120.9884 182.6240 est pt, minimum visit 75.20 47.10 39.8560 60.1600 est pt, problem focused 129.20 80.92 68.4760 103.3600 est pt, problem focused-np 152.38 95.43 80.7614 121.9040 est pt,comprehensive visit-np 369.73 231.56 195.9569 295.7840 excise excess skin & tissue-e 7918.40 4959.29 4196.7520 6334.7200 excise pharynx lesion-office 4685.75 2934.69 2483.4475 3748.6000 excision of nail fold toe-off 1135.40 711.10 601.7620 908.3200 excision on tongue/mouth floor 7363.50 4611.76 3902.6550 5890.8000 exc benign lesion 3.1-3 trunkn 755.05 472.89 400.1765 604.0400 exc f/e/e/n/l mal+mrg 2.1-3-e 2900.55 1816.61 1537.2915 2320.4400 exc face les sbq 2cm/>-exp 2661.30 1666.77 1410.4890 2129.0400 exc face les sc <2cm-exp 3080.50 1929.32 1632.6650 2464.4000 exc h-f-nk-sp mal & marg 0.5/> 2455.80 1538.07 1301.5740 1964.6400 exc s/b/h/f/g mal+mrg 2.1-3-e 2901.60 1817.27 1537.8480 2321.2800 exc tr-ext mal&marg 3.4-4cm-e 2134.60 1336.90 1131.3380 1707.6800 exc tr-ext mal+marg 2.1-3cm 1492.40 934.69 790.9720 1193.9200 exc tumor, soft tiss neck sub 4348.90 2723.72 2304.9170 3479.1200 office consult,problem focused 86.80 54.36 46.0040 69.4400 office consult-problem focused 132.50 82.98 70.2250 106.0000 office consultation, expanded 138.75 86.90 73.5375 111.0000 office consultation,expanded 136.53 85.51 72.3609 109.2240 office consult,complex - stj 341.20 213.69 180.8360 272.9600 office consult,comprehens-stj 260.20 162.96 137.9060 208.1600 office consult,detailed - stj 182.90 114.55 96.9370 146.3200 office consult,expanded - stj 138.75 86.90 73.5375 111.0000 office consult,prob focus-stj 77.40 48.48 41.0220 61.9200 office consult,prob focused 76.17 47.70 40.3701 60.9360 office consultation-complex 238.53 149.39 126.4209 190.8240 office consultation-compreh 180.36 112.96 95.5908 144.2880 office consultation-detailed 153.70 96.26 81.4610 122.9600 office consultation-expanded 137.80 86.30 73.0340 110.2400 office consultation-extend 146.24 91.59 77.5072 116.9920 office consultation-intermed 131.11 82.12 69.4883 104.8880 office consultation-limit 126.07 78.96 66.8171 100.8560 est pt visit level i 62.15 38.92 32.9395 49.7200 est pt visit level i-exp 158.10 99.02 83.7930 126.4800 est pt visit level i-m 58.25 36.48 30.8725 46.6000 est pt visit level ii 154.69 96.89 81.9857 123.7520 est pt visit level ii-exp 169.50 106.16 89.8350 135.6000 est pt visit level ii-m 165.35 103.56 87.6355 132.2800 est pt visit level ii-np 144.92 90.76 76.8076 115.9360 est pt visit level iii 226.67 141.96 120.1351 181.3360 est pt visit level iii-exp 243.35 152.41 128.9755 194.6800 est pt visit level iii-m 238.15 149.15 126.2195 190.5200 est pt visit level iii-np 231.57 145.03 122.7321 185.2560 est pt visit level iv 307.10 192.33 162.7630 245.6800 est pt visit level iv-exp 323.45 202.58 171.4285 258.7600 est pt visit level iv-m 313.05 196.06 165.9165 250.4400 est pt visit level iv-np 306.80 192.15 162.6040 245.4400 est pt visit level v 374.65 234.64 198.5645 299.7200 est pt visit level v-exp 376.50 235.80 199.5450 301.2000 est pt visit level v-m 229.85 143.96 121.8205 183.8800 est pt visit level v-np 343.55 215.17 182.0815 274.8400 est pt, comprehensive visit 371.85 232.89 197.0805 297.4800 flu vaccine/administration 98.80 61.88 52.3640 79.0400 ext tr-ext b9 +marg 0.5cm<-exp 1794.70 1124.02 951.1910 1435.7600 extended consult 107.00 67.01 56.7100 85.6000 eye exam with photos-explosion 224.80 140.79 119.1440 179.8400 i & d skin/subcutaneous-exp 592.30 370.96 313.9190 473.8400 i&d bartholin abcess-office 605.30 379.10 320.8090 484.2400 i&d simple-explosion 515.85 323.08 273.4005 412.6800 iangential bx skin single les 344.25 215.60 182.4525 275.4000 incision proc on middle ear-e 625.25 391.59 331.3825 500.2000 incisional bx skin single les 596.95 373.87 316.3835 477.5600 bladder instillation-o-np 498.15 311.99 264.0195 398.5200 complex consult 201.00 125.89 106.5300 160.8000 comprehensive consult 154.00 96.45 81.6200 123.2000 catheterization simple 217.35 136.13 115.1955 173.8800 catheter-office-np 129.48 81.09 68.6244 103.5840 control throat bleeding simple 1073.30 672.21 568.8490 858.6400 consultation-1 hour 80.70 50.54 42.7710 64.5600 consultation-1/2 hour 40.40 25.30 21.4120 32.3200 counseling - 1/2 hr-dr 40.40 25.30 21.4120 32.3200 counseling 1 hr-jrhc 97.95 61.35 51.9135 78.3600 counseling 1 hr-md 80.70 50.54 42.7710 64.5600 counseling 1/2 hr-jrhc 49.00 30.69 25.9700 39.2000 counseling 1/2 hr-md 40.40 25.30 21.4120 32.3200 counseling-1hour-dr 80.70 50.54 42.7710 64.5600 cpr training 71.80 44.97 38.0540 57.4400 destroy premal lesion 15/> 812.25 508.71 430.4925 649.8000 dilation of salivary duct-exp 3656.15 2289.85 1937.7595 2924.9200 irrigation of vagina 261.05 163.50 138.3565 208.8400 irrigation of vagina-np 73.50 46.03 38.9550 58.8000 skin full graft een & lips-exp 4866.15 3047.67 2579.0595 3892.9200 skin full graft sclp/arm/leg-e 3983.70 2494.99 2111.3610 3186.9600 skin full grft face/genit/hf-o 3754.20 2351.26 1989.7260 3003.3600 shave skin lesion > 2.0cm-exp 660.40 413.61 350.0120 528.3200 shave skin lesion 0.5cm/< 390.00 244.26 206.7000 312.0000 shave skin lesion 0.5cm/<-exp 599.30 375.34 317.6290 479.4400 shave skin lesion 0.6-1.0 cm 440.95 276.17 233.7035 352.7600 shave skin lesion 1.1-2.0 cm 479.45 300.28 254.1085 383.5600 shave skin lesion 1.1-2.0cm 433.35 271.41 229.6755 346.6800 rplc gtube no revj trc-exp-off 428.45 268.34 227.0785 342.7600 punch bx skin single lesion 375.77 235.34 199.1581 300.6160 punch bx skin single lesion-e 580.30 363.44 307.5590 464.2400 pre-placement fce 105.00 65.76 55.6500 84.0000 polypectomy-office-exp 2506.40 1569.76 1328.3920 2005.1200 release of nasal adhesions-off 1493.40 935.32 791.5020 1194.7200 remove drug implant device-exp 879.40 550.77 466.0820 703.5200 remove ear canal lesion(s)-off 4182.85 2619.72 2216.9105 3346.2800 removal foreign body, foot-off 1311.90 821.64 695.3070 1049.5200 removal of salivary stone-exp 4291.05 2687.48 2274.2565 3432.8400 repair of ear drum-office-exp 5330.15 3338.27 2824.9795 4264.1200 repair of hammertoe-exp 8266.30 5177.18 4381.1390 6613.0400 drain/inj joint/bursa w/o us 744.85 466.50 394.7705 595.8800 drain/inj joint/bursa w/o us-e 786.45 492.55 416.8185 629.1600 lysis of labial lesion(s)-e 4287.90 2685.51 2272.5870 3430.3200 drain external ear lesion-off 2548.38 1596.05 1350.6414 2038.7040 apply short leg cast-exp 748.55 468.82 396.7315 598.8400 behavioral health integ-20 min 101.55 63.60 53.8215 81.2400 tangntl bx skin single les-exp 597.60 374.28 316.7280 478.0800 strapping/supply unna boot 214.90 134.59 113.8970 171.9200 tube change complicated-np 302.65 189.55 160.4045 242.1200 tis trnf f/c/c/m/n/a/g/h/f-exp 4002.95 2507.05 2121.5635 3202.3600 tis trnfr e/n/e/l 10.1-30-exp 4094.50 2564.39 2170.0850 3275.6000 water vapor therapy-office 3298.55 2065.88 1748.2315 2638.8400 visualization of windpipe-exp 1450.25 908.29 768.6325 1160.2000 welcome to medicare 381.18 238.73 202.0254 304.9440 welcome to medicare-n 325.77 204.03 172.6581 260.6160 ambulance service amh 319.40 200.04 169.2820 255.5200 ambulance service-eh 479.00 300.00 253.8700 383.2000 ambulance - amsterdam 711.35 445.52 377.0155 569.0800 ambulance - out of area 1421.70 890.41 753.5010 1137.3600 telephone/use per day 1.35 0.85 0.7155 1.0800 breast bilat with contr + cad 3716.95 2327.93 1969.9835 2973.5600 breast bilat wo contr + cad 3716.95 2327.93 1969.9835 2973.5600 breast bilat wo/w contr + cad 4336.80 2716.14 2298.5040 3469.4400 breast unilat with contr + cad 3716.95 2327.93 1969.9835 2973.5600 breast unilat wo contr + cad 3716.95 2327.93 1969.9835 2973.5600 breast unilat wo/w contr + cad 4724.70 2959.08 2504.0910 3779.7600 bone biopsy needle 245.45 153.73 130.0885 196.3600 needle biopsy jamshidi 45.45 28.47 24.0885 36.3600 catheter foley 5cc 25.35 15.88 13.4355 20.2800 dionosil 169.10 105.91 89.6230 135.2800 pantopaque 94.30 59.06 49.9790 75.4400 gastro set 378.45 237.02 200.5785 302.7600 gastrografin 81.95 51.33 43.4335 65.5600 omnipaque 240 209.90 131.46 111.2470 167.9200 omnipaque 300 230.90 144.61 122.3770 184.7200 xray prep kit #3 7.10 4.45 3.7630 5.6800 vent kit 39.50 24.74 20.9350 31.6000 maglinte balloon ent cath 325.20 203.67 172.3560 260.1600 reno m 60-10cc 11.95 7.48 6.3335 9.5600 reno m 60-50cc 56.15 35.17 29.7595 44.9200 reno m 76-50cc 49.90 31.25 26.4470 39.9200 reno m dip 101.60 63.63 53.8480 81.2800 sitz marks capsule 28.20 17.66 14.9460 22.5600 sinografin 45.30 28.37 24.0090 36.2400 atropine up to 0.3mg 1.10 0.69 0.5830 0.8800 topotecan 4mg 4035.00 2527.12 2138.5500 3228.0000 vincristine sulfate 2 mg 180.65 113.14 95.7445 144.5200 ivig pre-administration 105.00 65.76 55.6500 84.0000 neupogen 300 mcg 923.40 578.33 489.4020 738.7200 cisplatin 50 mg 94.75 59.34 50.2175 75.8000 cyclophosphamide 1 gm 82.30 51.54 43.6190 65.8400 cyclophosphamide 200 mg 16.95 10.62 8.9835 13.5600 cyclophosphamide 500 mg 41.35 25.90 21.9155 33.0800 dacarbazine 200mg 29.40 18.41 15.5820 23.5200 filgrastim 480mcg 1697.75 1063.30 899.8075 1358.2000 eye stream ophth. irrig. soln. 73.84 46.24 39.1352 59.0720 erythromycin opht oint. 20.03 12.54 10.6159 16.0240 cipro 500mg tab 0.60 0.38 0.3180 0.4800 lorazepam 1mg po tab 1.60 1.00 0.8480 1.2800 lomotil 2.5mg tab 1.05 0.66 0.5565 0.8400 leucovorin oral 25 mg tab 10.50 6.58 5.5650 8.4000 kayexolate 15g/60ml susp 19.40 12.15 10.2820 15.5200 isoniazid 100 mg tab 0.40 0.25 0.2120 0.3200 isoniazid 300 mg tab 1.05 0.66 0.5565 0.8400 pharmacy 38 3.20 2.00 1.6960 2.5600 pharmacy 30 3.15 1.97 1.6695 2.5200 pharmacy 29 5.10 3.19 2.7030 4.0800 pharmacy 25 2.85 1.78 1.5105 2.2800 pharmacy 32 3.65 2.29 1.9345 2.9200 pharmacy 33 2.25 1.41 1.1925 1.8000 pharmacy 34 2.25 1.41 1.1925 1.8000 pharmacy 35 2.25 1.41 1.1925 1.8000 pharmacy 42 2.80 1.75 1.4840 2.2400 pharmacy 16 2.90 1.82 1.5370 2.3200 pharmacy 17 3.70 2.32 1.9610 2.9600 pharmacy 18 3.80 2.38 2.0140 3.0400 pharmacy 19 4.20 2.63 2.2260 3.3600 pharmacy 20 2.40 1.50 1.2720 1.9200 pharmacy 11 2.80 1.75 1.4840 2.2400 pharmacy 12 3.55 2.22 1.8815 2.8400 pharmacy 13 2.60 1.63 1.3780 2.0800 pharmacy 14 3.10 1.94 1.6430 2.4800 pepcid 20 mg po 0.15 0.09 0.0795 0.1200 compazine 5 mg (oral) 0.70 0.44 0.3710 0.5600 oxycodone 5mg tab 0.50 0.31 0.2650 0.4000 ibuprophen 200mg 1.70 1.06 0.9010 1.3600 imitrex 25mg tab 112.20 70.27 59.4660 89.7600 tetracaine .5% opht.soln 37.69 23.60 19.9757 30.1520 ventolin neb sol 2.5mg/3ml 0.75 0.47 0.3975 0.6000 zaroxolyn 5mg tab 2.85 1.78 1.5105 2.2800 zithromax 250 mg tab 13.50 8.46 7.1550 10.8000 zithromax 250mg tab 1.45 0.91 0.7685 1.1600 zofran 4 mg (oral) 9.15 5.73 4.8495 7.3200 zyloprim 300 mg tab 0.55 0.34 0.2915 0.4400 zyrtec 10mg tab 9.25 5.79 4.9025 7.4000 ativan 1 mg tab 0.45 0.28 0.2385 0.3600 benedryl 25mg tab 0.25 0.16 0.1325 0.2000 tylenol 325 mg 0.40 0.25 0.2120 0.3200 tylenol 500mg tab 0.35 0.22 0.1855 0.2800 pharmacy 9 2.95 1.85 1.5635 2.3600 pharmacy 6 4.10 2.57 2.1730 3.2800 albuterol nebulizer 2.5mg /3ml 0.70 0.44 0.3710 0.5600 albuterol single dose (2.5mg) 0.75 0.47 0.3975 0.6000 acyclovir 200mg tab 16.60 10.40 8.7980 13.2800 doxycycline 100 mg tab 0.45 0.28 0.2385 0.3600 ramipril 10mg capsule 1.60 1.00 0.8480 1.2800 rantidine 150mg tab 2.45 1.53 1.2985 1.9600 cast application-forearm 112.65 70.55 59.7045 90.1200 intra-arterial injection 59.40 37.20 31.4820 47.5200 intravenous injection 59.40 37.20 31.4820 47.5200 intramuscular of an antibiotic 59.40 37.20 31.4820 47.5200 recovery room 266.25 166.75 141.1125 213.0000 recovery room l2 30 mins 133.10 83.36 70.5430 106.4800 add'l 1/2 hr recovery room 135.20 84.68 71.6560 108.1600 add'l 15 mins recovery room l2 65.50 41.02 34.7150 52.4000 newborn hearing screen 45.00 28.18 23.8500 36.0000 epidural insertion 65.50 41.02 34.7150 52.4000 epidural monitoring 74.90 46.91 39.6970 59.9200 fetal monitoring 89.60 56.12 47.4880 71.6800 fetal monitoring 12-16 hrs 100.20 62.76 53.1060 80.1600 fetal monitoring 16-20-hrs 111.30 69.71 58.9890 89.0400 fetal monitoring 4-8 hrs 77.95 48.82 41.3135 62.3600 fetal monitoring 8-12 hrs 89.05 55.77 47.1965 71.2400 cervical suture remover 59.30 37.14 31.4290 47.4400 blood patch 76.95 48.19 40.7835 61.5600 holter monitor 529.35 331.53 280.5555 423.4800 48-54 hrs chemo observation 840.85 526.62 445.6505 672.6800 42-48 hrs chemo observation 757.70 474.55 401.5810 606.1600 36-42 hrs chemo observation 674.55 422.47 357.5115 539.6400 4-6 hrs chemo observation 173.25 108.51 91.8225 138.6000 4-8 hrs observation 173.15 108.44 91.7695 138.5200 54-60 hrs chemo observation 924.00 578.70 489.7200 739.2000 6-8 hrs chemo observation 231.00 144.68 122.4300 184.8000 60-66 hrs chemo observation 1007.20 630.81 533.8160 805.7600 66-72 hrs chemo observation 1090.35 682.89 577.8855 872.2800 observ 1 hr detox 25.00 15.66 13.2500 20.0000 ob obser/treat 0-2 hrs 56.20 35.20 29.7860 44.9600 ob obser/treat 2-5 hrs 112.05 70.18 59.3865 89.6400 monitoring 1 hr detox 25.00 15.66 13.2500 20.0000 30-36 hrs chemo observation 591.40 370.39 313.4420 473.1200 8-12 hrs chemo observation 258.75 162.06 137.1375 207.0000 24-30 hrs chemo observation 508.20 318.29 269.3460 406.5600 20-24 hrs chemo observation 425.05 266.21 225.2765 340.0400 12-16 hrs observation 303.00 189.77 160.5900 242.4000 2-4 hrs chemo observation 115.50 72.34 61.2150 92.4000 0-2 hrs chemo observation 57.75 36.17 30.6075 46.2000 12-14 hrs chemo observation 314.20 196.78 166.5260 251.3600 16-20 hrs chemo observation 369.60 231.48 195.8880 295.6800 mammo guidance/localization 1033.80 647.47 547.9140 827.0400 picc cath insertion 1074.30 672.83 569.3790 859.4400 picc line/cath removal 101.90 63.82 54.0070 81.5200 application of unna boot 347.70 217.76 184.2810 278.1600 rad treatment room 556.40 348.47 294.8920 445.1200 sc/im inj ah w/mont &education 66.83 41.85 35.4199 53.4640 sc/im inj al w/mont & eductn 90.28 56.54 47.8484 72.2240 us treatment room 556.40 348.47 294.8920 445.1200 med administration level 22.30 13.97 11.8190 17.8400 intramuscular of an antibiotic 27.20 17.04 14.4160 21.7600 intravenous injection 62.20 38.96 32.9660 49.7600 intra-arterial injection 59.40 37.20 31.4820 47.5200 circumcision 196.55 123.10 104.1715 157.2400 im injection antibiotic 59.40 37.20 31.4820 47.5200 g-tube replacement 105.05 65.79 55.6765 84.0400 iv injection 75.78 47.46 40.1634 60.6240 0-4 hrs observation 86.70 54.30 45.9510 69.3600 meningoccal vaccine 186.90 117.06 99.0570 149.5200 med rev md w/min psychothpy al 162.05 101.49 85.8865 129.6400 multiple family grp min 60m ah 119.60 74.91 63.3880 95.6800 multiple family grp min 60m al 130.00 81.42 68.9000 104.0000 group therapy up to 1.5hrs 134.05 83.96 71.0465 107.2400 group therapy 60 min ah 156.10 97.77 82.7330 124.8800 group therapy 60 min al 155.50 97.39 82.4150 124.4000 family therapy w pat >30min 196.25 122.91 104.0125 157.0000 family therapy w/pt 60 min ah 161.20 100.96 85.4360 128.9600 family therapy w/pt 60 min al 177.85 111.39 94.2605 142.2800 collat vst wo pat>30 min ah 163.57 102.44 86.6921 130.8560 collat vst wo pat>30 min al 176.08 110.28 93.3224 140.8640 fetal monitoring 20-24 hrs 122.45 76.69 64.8985 97.9600 peripheral artery test-explos 334.90 209.75 177.4970 267.9200 comp pft w/bronchodilator expl 75.30 47.16 39.9090 60.2400 motor/sensory neuropathy 2080.00 1302.70 1102.4000 1664.0000 pre-op teaching and tests 29.25 18.32 15.5025 23.4000 wound/ostomy routine ip visit 109.20 68.39 57.8760 87.3600 cardiac rehab evaluation 80.00 50.10 42.4000 64.0000 cardiac rehab exercise 119.95 75.12 63.5735 95.9600 cardiac rehab phase iii 68.10 42.65 36.0930 54.4800 cardiac rehab-monitored 30 min 80.00 50.10 42.4000 64.0000 cardiac rehab-monitored-15 min 40.10 25.11 21.2530 32.0800 cardiac rehab-unmonitored 15mi 40.10 25.11 21.2530 32.0800 cardiac rehab-unmonitored 30 m 80.00 50.10 42.4000 64.0000 med mgmnt routine 15min drug-e 186.52 116.82 98.8556 149.2160 med rvw md w/min psychotrpic-e 240.50 150.63 127.4650 192.4000 med training/suppt-addic med 273.00 170.98 144.6900 218.4000 medication mgmnt compx drug 240.50 150.63 127.4650 192.4000 medication mgmnt routine-e 184.10 115.30 97.5730 147.2800 counseling ind-full drug srv 162.50 101.77 86.1250 130.0000 counseling ind brief drug srv 108.42 67.90 57.4626 86.7360 pharmacotherapy acute 451.50 282.77 239.2950 361.2000 pharmacotherapy maintenance 451.50 282.77 239.2950 361.2000 addiction cnsling grp-drug srv 115.15 72.12 61.0295 92.1200 addiction evaluation drug srv 203.05 127.17 107.6165 162.4400 addiction rehab(half)-drug srv 108.35 67.86 57.4255 86.6800 addiction rehab(full) drug srv 203.05 127.17 107.6165 162.4400 addiction rehab(half)-alch srv 112.70 70.58 59.7310 90.1600 addiction rehab(full) alch srv 203.05 127.17 107.6165 162.4400 addiction evaluation alch srv 203.05 127.17 107.6165 162.4400 addiction cnsling grp-alch srv 115.15 72.12 61.0295 92.1200 phy consult initial 210.65 131.93 111.6445 168.5200 physician assessment 162.75 101.93 86.2575 130.2000 counseling ind-full alch srv 162.50 101.77 86.1250 130.0000 counseling ind brief alch srv 104.25 65.29 55.2525 83.4000 medication mgmnt complex 240.50 150.63 127.4650 192.4000 medication mgmnt compx 30min 329.70 206.49 174.7410 263.7600 medication mgmnt compx 30min-e 328.65 205.83 174.1845 262.9200 med training/suppt-addic med 273.00 170.98 144.6900 218.4000 med rvw md w/min psychotrpic-e 240.50 150.63 127.4650 192.4000 med mgmnt compx 30min alch 300.55 188.23 159.2915 240.4400 med mgmnt routine 15min alch-e 183.73 115.07 97.3769 146.9840 alcohol/drug serv-amb detox-e 283.90 177.81 150.4670 227.1200 adult day care 17.55 10.99 9.3015 14.0400 office consult, complex 432.21 270.69 229.0713 345.7680 office consult, detailed 230.41 144.31 122.1173 184.3280 office consult, comprehensive 328.06 205.46 173.8718 262.4480 ed consult - complex 360.00 225.47 190.8000 288.0000 ed consult - comprehensive 265.35 166.19 140.6355 212.2800 ed consult - detailed 192.30 120.44 101.9190 153.8400 ed consult - expanded 155.70 97.51 82.5210 124.5600 ed consult - limited 120.60 75.53 63.9180 96.4800 office consult, expanded 191.65 120.03 101.5745 153.3200 detailed ip consult - initial 112.53 70.47 59.6409 90.0240 comprehensive ip const-initl 157.44 98.60 83.4432 125.9520 complex ip consult - initial 205.16 128.49 108.7348 164.1280 ip consult - detailed 189.23 118.52 100.2919 151.3840 ip initial consult - comples 376.70 235.93 199.6510 301.3600 ip initial consult - complex 257.14 161.05 136.2842 205.7120 ip initial consult - detailed 152.29 95.38 80.7137 121.8320 ip initial consult - expanded 123.30 77.22 65.3490 98.6400 ip initial consult - focused 94.35 59.09 50.0055 75.4800 ip initial consult - limited 95.82 60.01 50.7846 76.6560 ip initial consult-comprehensi 200.81 125.77 106.4293 160.6480 focused ip consult - initial 58.06 36.36 30.7718 46.4480 expanded ip consult - initial 80.39 50.35 42.6067 64.3120 op/obsv consult complex 110min 394.20 246.89 208.9260 315.3600 op/obsv consult conprehn 80min 290.60 182.00 154.0180 232.4800 op/obsv consult detailed 55min 210.60 131.90 111.6180 168.4800 op/obsv consult expanded 40min 170.50 106.78 90.3650 136.4000 op/obsv consult limited 20 min 132.05 82.70 69.9865 105.6400 office consult,prob focused 85.40 53.49 45.2620 68.3200 office consultation,expanded 153.00 95.82 81.0900 122.4000 office consult,problem focused 104.87 65.68 55.5811 83.8960