36C10G20R0014-041.xlsx
XLSX spreadsheet Posted
- Solicitation number
- 36C10G20R0014
About this file
This pre-solicitation notice provides details for an upcoming request for proposal from the Department of Veterans Affairs to establish a Community Care Network in Alaska. The contractor will be responsible for establishing and maintaining a network of licensed healthcare providers to deliver medical, surgical, complementary and integrative services, durable medical equipment, pharmacy, and dental care to eligible Veterans throughout Alaska. The contractor will serve as a third-party administrator, providing managed healthcare services including exemplary customer service, quality monitoring and improvement, and claims processing and payment. The anticipated solicitation will be a single-award, firm fixed price IDIQ contract with an incentive plan and a base period of performance of 9 months with seven 1-year option periods. The RFP is expected to post on May 11, 2020 with proposals due on June 1, 2020. The contract will fall under NAICS code 524292.
36C10G20R0014 CCN Region 5 Attachment 12 - Maximum Allowable Charges.xlsx
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Maximum Allowable Charge Maximum Allowable Charge Table
| Item Code | Code Type | Description | Maximum Allowable Charge |
| 10004 | CPT | FNA BX W/O IMG GDN EA ADDL | $738.61 |
| 10005 | CPT | FNA BX W/US GDN 1ST LES | $1,125.54 |
| 10006 | CPT | FNA BX W/US GDN EA ADDL | $1,083.44 |
| 10007 | CPT | FNA BX W/FLUOR GDN 1ST LES | $1,125.54 |
| 10008 | CPT | FNA BX W/FLUOR GDN EA ADDL | $1,083.44 |
| 10009 | CPT | FNA BX W/CT GDN 1ST LES | $1,125.54 |
| 10010 | CPT | FNA BX W/CT GDN EA ADDL | $1,083.44 |
| 10011 | CPT | FNA BX W/MR GDN 1ST LES | $1,125.54 |
| 10012 | CPT | FNA BX W/MR GDN EA ADDL | $1,083.44 |
| 10021 | CPT | FINE NEEDLE ASPIRATION W/O IMAGING GUIDANCE | $722.58 |
| 10030 | CPT | IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE | $1,270.89 |
| 10035 | CPT | PERQ SFT TISS LOC DEVICE PLMT 1ST LES W/GDNCE | $1,270.89 |
| 10036 | CPT | PERQ SFT TISS LOC DEVICE PLMT ADD LES W/GDNCE | $896.26 |
| 10040 | CPT | ACNE SURGERY | $255.06 |
| 10060 | CPT | INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE | $255.06 |
| 10061 | CPT | INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE | $722.58 |
| 10080 | CPT | INCISION & DRAINAGE PILONIDAL CYST SIMPLE | $1,270.89 |
| 10081 | CPT | INCISION & DRAINAGE PILONIDAL CYST COMPLICATED | $1,270.89 |
| 10120 | CPT | INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE | $722.58 |
| 10121 | CPT | INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL | $3,258.33 |
| 10140 | CPT | I&D HEMATOMA SEROMA/FLUID COLLECTION | $3,258.33 |
| 10160 | CPT | PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST | $722.58 |
| 10180 | CPT | INCISION & DRAINAGE COMPLEX PO WOUND INFECTION | $5,002.63 |
| 11000 | CPT | DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF | $1,051.82 |
| 11001 | CPT | DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF | $123.32 |
| 11010 | CPT | DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS | $1,270.89 |
| 11011 | CPT | DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC | $1,270.89 |
| 11012 | CPT | DBRDMT FX&/DISLC SUBQ T/M/F BONE | $5,002.63 |
| 11042 | CPT | DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/< | $722.58 |
| 11043 | CPT | DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/< | $1,051.82 |
| 11044 | CPT | DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/< | $3,258.33 |
| 11045 | CPT | DBRDMT SUBCUTANEOUS TISSUE EA ADDL 20 SQ CM | $440.37 |
| 11046 | CPT | DEBRIDEMENT MUSCLE &/FASCIA EA ADDL 20 SQ CM | $514.94 |
| 11047 | CPT | DEBRIDEMENT BONE EACH ADDITIONAL 20 SQ CM | $982.80 |
| 11055 | CPT | PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1 | $255.06 |
| 11056 | CPT | PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4 | $255.06 |
| 11057 | CPT | PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4 | $255.06 |
| 11102 | CPT | TANGNTL BX SKIN SINGLE LES | $403.93 |
| 11103 | CPT | TANGNTL BX SKIN EA SEP/ADDL | $116.97 |
| 11104 | CPT | PUNCH BX SKIN SINGLE LESION | $403.93 |
| 11105 | CPT | PUNCH BX SKIN EA SEP/ADDL | $116.97 |
| 11106 | CPT | INCAL BX SKN SINGLE LES | $622.56 |
| 11107 | CPT | INCAL BX SKN EA SEP/ADDL | $116.97 |
| 11200 | CPT | REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15 | $255.06 |
| 11201 | CPT | REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10 | $59.22 |
| 11300 | CPT | SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/< | $255.06 |
| 11301 | CPT | SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM | $255.06 |
| 11302 | CPT | SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM | $255.06 |
| 11303 | CPT | SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM | $722.58 |
| 11305 | CPT | SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/< | $255.06 |
| 11306 | CPT | SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM | $255.06 |
| 11307 | CPT | SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM | $255.06 |
| 11308 | CPT | SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM | $722.58 |
| 11310 | CPT | SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/< | $255.06 |
| 11311 | CPT | SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM | $255.06 |
| 11312 | CPT | SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM | $722.58 |
| 11313 | CPT | SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM | $722.58 |
| 11400 | CPT | EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/< | $1,270.89 |
| 11401 | CPT | EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM | $722.58 |
| 11402 | CPT | EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM | $1,270.89 |
| 11403 | CPT | EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM/< | $1,270.89 |
| 11404 | CPT | EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM | $3,258.33 |
| 11406 | CPT | EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM | $3,258.33 |
| 11420 | CPT | EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/< | $3,258.33 |
| 11421 | CPT | EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM | $1,270.89 |
| 11422 | CPT | EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM | $3,258.33 |
| 11423 | CPT | EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM | $3,258.33 |
| 11424 | CPT | EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM | $3,258.33 |
| 11426 | CPT | EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM | $5,002.63 |
| 11440 | CPT | EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/< | $1,270.89 |
| 11441 | CPT | EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM | $1,270.89 |
| 11442 | CPT | EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM | $1,270.89 |
| 11443 | CPT | EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM | $3,258.33 |
| 11444 | CPT | EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM | $3,258.33 |
| 11446 | CPT | EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM | $5,002.63 |
| 11450 | CPT | EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR | $5,002.63 |
| 11451 | CPT | EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR | $5,002.63 |
| 11462 | CPT | EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR | $5,002.63 |
| 11463 | CPT | EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR | $5,002.63 |
| 11470 | CPT | EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR | $5,002.63 |
| 11471 | CPT | EXCISION H/P/P/U COMPLEX REPAIR | $5,002.63 |
| 11600 | CPT | EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/< | $1,270.89 |
| 11601 | CPT | EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM | $1,270.89 |
| 11602 | CPT | EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM | $722.58 |
| 11603 | CPT | EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM/< | $1,270.89 |
| 11604 | CPT | EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM | $1,270.89 |
| 11606 | CPT | EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM | $3,258.33 |
| 11620 | CPT | EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/< | $3,258.33 |
| 11621 | CPT | EXCISION MALIGNANT LESION S/N/H/F/G 0.6-1.0 CM | $1,270.89 |
| 11622 | CPT | EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM | $1,270.89 |
| 11623 | CPT | EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM/< | $3,258.33 |
| 11624 | CPT | EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM | $3,258.33 |
| 11626 | CPT | EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM | $5,002.63 |
| 11640 | CPT | EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/< | $1,270.89 |
| 11641 | CPT | EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM | $1,270.89 |
| 11642 | CPT | EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM | $1,270.89 |
| 11643 | CPT | EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM | $3,258.33 |
| 11644 | CPT | EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM | $3,258.33 |
| 11646 | CPT | EXCISION MALIGNANT LESION F/E/E/N/L >4.0 CM | $5,002.63 |
| 11719 | CPT | TRIMMING NONDYSTROPHIC NAILS ANY NUMBER | $143.47 |
| 11720 | CPT | DEBRIDEMENT NAIL ANY METHOD 1-5 | $143.47 |
| 11721 | CPT | DEBRIDEMENT NAIL ANY METHOD 6/> | $143.47 |
| 11730 | CPT | AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1 | $255.06 |
| 11732 | CPT | AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL | $116.62 |
| 11740 | CPT | EVACUATION SUBUNGUAL HEMATOMA | $221.77 |
| 11750 | CPT | EXCISION NAIL MATRIX PERMANENT REMOVAL | $722.58 |
| 11755 | CPT | BIOPSY NAIL UNIT SEPARATE PROCEDURE | $1,270.89 |
| 11760 | CPT | REPAIR NAIL BED | $1,051.82 |
| 11762 | CPT | RECONSTRUCTION NAIL BED W/GRAFT | $3,084.52 |
| 11765 | CPT | WEDGE EXCISION SKIN NAIL FOLD | $722.58 |
| 11770 | CPT | EXCISION PILONIDAL CYST/SINUS SIMPLE | $5,002.63 |
| 11771 | CPT | EXCISION PILONIDAL CYST/SINUS EXTENSIVE | $5,002.63 |
| 11772 | CPT | EXCISION PILONIDAL CYST/SINUS COMPLICATED | $5,002.63 |
| 11900 | CPT | INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS | $255.06 |
| 11901 | CPT | INJECTION INTRALESIONAL >7 LESIONS | $255.06 |
| 11920 | CPT | TATTOOING INCL MICROPIGMENTATION 6.0 CM/< | $1,051.82 |
| 11921 | CPT | TATTOOING INCL MICROPIGMENTATION 6.1-20.0 CM | $1,051.82 |
| 11922 | CPT | TATTOOING INCL MICROPIGMENTATION EA 20.0 CM | $1,357.81 |
| 11950 | CPT | SUBCUTANEOUS INJECTION FILLING MATERIAL 1 CC/< | $255.06 |
| 11951 | CPT | SUBCUTANEOUS INJECTION FILLING MATRL 1.1-5.0 CC | $1,051.82 |
| 11952 | CPT | SUBCUTANEOUS INJECTION FILLING MATRL 5.1-10.0CC | $1,051.82 |
| 11954 | CPT | SUBCUTANEOUS INJECTION FILLING MATRL >10.0 CC | $722.58 |
| 11960 | CPT | INSERTION TISSUE EXPANDER INCL SBSQ XPNSJ | $5,346.47 |
| 11970 | CPT | REPLACEMENT TISS EXPANDER PERMANENT PROSTHESIS | $9,006.39 |
| 11971 | CPT | REMOVAL TISS EXPANDER W/O INSERTION PROSTHESIS | $5,002.63 |
| 11976 | CPT | REMOVAL IMPLANTABLE CONTRACEPTIVE CAPSULES | $1,270.89 |
| 11980 | CPT | SUBCUTANEOUS HORMONE PELLET IMPLANTATION | $889.82 |
| 11981 | CPT | INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT | $221.77 |
| 11982 | CPT | REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT | $889.82 |
| 11983 | CPT | RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT | $889.82 |
| 12001 | CPT | SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/< | $255.06 |
| 12002 | CPT | SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM | $255.06 |
| 12004 | CPT | SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM | $255.06 |
| 12005 | CPT | SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM | $722.58 |
| 12006 | CPT | SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM | $722.58 |
| 12007 | CPT | SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM | $255.06 |
| 12011 | CPT | SIMPLE REPAIR F/E/E/N/L/M 2.5CM/< | $255.06 |
| 12013 | CPT | SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM | $255.06 |
| 12014 | CPT | SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM | $255.06 |
| 12015 | CPT | SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM | $255.06 |
| 12016 | CPT | SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM | $722.58 |
| 12017 | CPT | SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM | $722.58 |
| 12018 | CPT | SIMPLE REPAIR F/E/E/N/L/M >30.0 CM | $255.06 |
| 12020 | CPT | TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE | $1,051.82 |
| 12021 | CPT | TX SUPERFICIAL WOUND DEHISCENCE W/PACKING | $722.58 |
| 12031 | CPT | REPAIR INTERMEDIATE S/A/T/E 2.5 CM/< | $722.58 |
| 12032 | CPT | REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM | $722.58 |
| 12034 | CPT | REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM | $722.58 |
| 12035 | CPT | REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM | $722.58 |
| 12036 | CPT | REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM | $1,051.82 |
| 12037 | CPT | REPAIR INTERMEDIATE S/A/T/E >30.0 CM | $3,084.52 |
| 12041 | CPT | REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/< | $722.58 |
| 12042 | CPT | REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM | $722.58 |
| 12044 | CPT | REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM | $1,051.82 |
| 12045 | CPT | REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM | $1,051.82 |
| 12046 | CPT | RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM | $722.58 |
| 12047 | CPT | REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM | $3,084.52 |
| 12051 | CPT | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/< | $722.58 |
| 12052 | CPT | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM | $722.58 |
| 12053 | CPT | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM | $722.58 |
| 12054 | CPT | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM | $722.58 |
| 12055 | CPT | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 12.6-20.0CM | $722.58 |
| 12056 | CPT | REPAIR INTERMEDIATE F/E/E/N/L&/MUC 20.1-30.0CM | $722.58 |
| 12057 | CPT | REPAIR INTERMEDIATE F/E/E/N/L&/MUC >30.0 CM | $722.58 |
| 13100 | CPT | REPAIR COMPLEX TRUNK 1.1-2.5 CM | $1,051.82 |
| 13101 | CPT | REPAIR COMPLEX TRUNK 2.6-7.5 CM | $1,051.82 |
| 13102 | CPT | REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/< | $710.35 |
| 13120 | CPT | REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM | $1,051.82 |
| 13121 | CPT | REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM | $1,051.82 |
| 13122 | CPT | REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/< | $652.63 |
| 13131 | CPT | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM | $722.58 |
| 13132 | CPT | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM | $1,051.82 |
| 13133 | CPT | REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/< | $487.08 |
| 13151 | CPT | REPAIR COMPLEX EYELID/NOSE/EAR/LIP 1.1-2.5 CM | $1,051.82 |
| 13152 | CPT | REPAIR COMPLEX EYELID/NOSE/EAR/LIP 2.6-7.5 CM | $1,051.82 |
| 13153 | CPT | REPAIR COMPLX EYELID/NOSE/EAR/LIP EA ADDL 5 CM/< | $546.90 |
| 13160 | CPT | SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC | $3,084.52 |
| 14000 | CPT | ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/< | $3,084.52 |
| 14001 | CPT | ADJNT TIS TRANSFR/REARRANGE TRUNK 10.1-30.0 SQCM | $3,084.52 |
| 14020 | CPT | ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/< | $3,084.52 |
| 14021 | CPT | ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM | $3,084.52 |
| 14040 | CPT | ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/< | $3,084.52 |
| 14041 | CPT | ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM | $3,084.52 |
| 14060 | CPT | ADJT TIS TRNSFR/REARRGMT E/N/E/L DFCT 10 SQ CM/< | $3,084.52 |
| 14061 | CPT | ADJT TIS REARGMT EYE/NOSE/EAR/LIP 10.1-30.0 SQCM | $3,084.52 |
| 14301 | CPT | ADJNT TIS TRNSFR/REARGMT ANY AREA 30.1-60 SQ CM | $5,346.47 |
| 14302 | CPT | ADJT TIS TRNSFR/REARGMT DEFEC EA ADDL 30 SQCM/< | $1,406.34 |
| 14350 | CPT | FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE | $3,084.52 |
| 15002 | CPT | PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT | $3,084.52 |
| 15003 | CPT | PREP SITE TRUNK/ARM/LEG ADDL 100 SQ CM/1PCT | $699.80 |
| 15004 | CPT | PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT | $1,051.82 |
| 15005 | CPT | PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT | $1,016.48 |
| 15040 | CPT | HARVEST SKIN TISSUE CLTR SKIN AGRFT 100 CM/< | $3,084.52 |
| 15050 | CPT | PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM | $1,051.82 |
| 15100 | CPT | SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD | $3,084.52 |
| 15101 | CPT | SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD | $1,399.54 |
| 15110 | CPT | EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD | $3,084.52 |
| 15111 | CPT | EPIDRM AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD | $794.57 |
| 15115 | CPT | EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/< | $3,084.52 |
| 15116 | CPT | EPIDERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM | $567.61 |
| 15120 | CPT | SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 % | $5,346.47 |
| 15121 | CPT | SPLIT AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA 1 % | $1,564.88 |
| 15130 | CPT | DERMAL AUTOGRAFT TRUNK/ARM/LEG 1ST 100 CM | $3,084.52 |
| 15131 | CPT | DERMAL AUTOGRAFT TRUNK/ARM/LEG EA 100 CM/EA | $1,736.23 |
| 15135 | CPT | DERMAL AUTOGRAFT F/S/N/H/F/G/M/D GT 1ST 100 | $5,346.47 |
| 15136 | CPT | DERMAL AGRFT F/S/N/H/F/G/M/D GT EA 100 CM/EA | $1,736.23 |
| 15150 | CPT | CLTR SKIN AUTOGRAFT T/A/L 1ST 25 CM/< | $3,084.52 |
| 15151 | CPT | CLTR SKIN AGRFT T/A/L ADDL 1 CM-75 CM | $567.61 |
| 15152 | CPT | CLTR SKIN AGRFT T/A/L EA 100 CM/EA 1%BODY AREA | $567.61 |
| 15155 | CPT | CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT 1ST 25CM/< | $5,346.47 |
| 15156 | CPT | CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT ADDL 1-75CM | $567.61 |
| 15157 | CPT | CLTR SKIN AGRFT F/S/N/H/F/G/M/D GT EA 100 EA | $567.61 |
| 15200 | CPT | FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/< | $3,084.52 |
| 15201 | CPT | FTH/GFT FR W/DIR CLSR TRNK EA ADDL 20 CM/< | $1,156.11 |
| 15220 | CPT | FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/< | $3,084.52 |
| 15221 | CPT | FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM/< | $914.76 |
| 15240 | CPT | FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/< | $3,084.52 |
| 15241 | CPT | FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/< | $1,526.76 |
| 15260 | CPT | FTH/GFT FREE W/DIRECT CLOSURE N/E/E/L 20 SQ CM/< | $3,084.52 |
| 15261 | CPT | FTH/GFT FREE W/DIR CLSR N/E/E/L EA 20 SQ CM/< | $1,541.21 |
| 15271 | CPT | APP SKN SUB GRFT T/A/L AREA/100SQ CM /<1ST 25 | $3,084.52 |
| 15272 | CPT | APP SKN SUB GRFT T/A/L AREA/100SQ CM EA ADL 25SC | $395.46 |
| 15273 | CPT | APP SKN SUBGRFT T/A/L AREA/100SQ CM 1ST 100SQ CM | $5,346.47 |
| 15274 | CPT | APP SKN SUB GRFT T/A/L AREA>/=100SCM ADL 100SQCM | $634.38 |
| 15275 | CPT | SUB GRFT F/S/N/H/F/G/M/D <100SQ CM 1ST 25 SQ CM | $3,084.52 |
| 15276 | CPT | SUB GRFT F/S/N/H/F/G/M/D<100SQ CM EA ADDL25SQ CM | $433.82 |
| 15277 | CPT | SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM 1ST 100SQ CM | $3,084.52 |
| 15278 | CPT | SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM | $742.28 |
| 15570 | CPT | FRMJ DIRECT/TUBED PEDICLE W/WO TRANSFER TRUNK | $3,084.52 |
| 15572 | CPT | FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS | $5,346.47 |
| 15574 | CPT | FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F | $3,084.52 |
| 15576 | CPT | FRMJ DIRECT/TUBED PEDICLE W/WOTR E/N/E/L/NTRORAL | $3,084.52 |
| 15600 | CPT | DELAY FLAP/SECTIONING FLAP TRUNK | $5,346.47 |
| 15610 | CPT | DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS | $3,084.52 |
| 15620 | CPT | DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F | $3,084.52 |
| 15630 | CPT | DELAY FLAP/SCTJ FLAP EYELIDS NOSE EARS/LIPS | $3,084.52 |
| 15650 | CPT | TRANSFER ANY PEDICLE FLAP ANY LOCATION | $3,084.52 |
| 15730 | CPT | MDFC FLAP W/PRSRV VASC PEDCL | $5,346.47 |
| 15731 | CPT | FOREHEAD FLAP W/PRESERVATION VASCULAR PEDICLE | $5,346.47 |
| 15733 | CPT | MUSC MYOQ/FSCQ FLP H&N PEDCL | $5,346.47 |
| 15734 | CPT | MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP TRUNK | $5,346.47 |
| 15736 | CPT | MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR | $3,084.52 |
| 15738 | CPT | MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR | $5,346.47 |
| 15740 | CPT | FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY | $3,084.52 |
| 15750 | CPT | FLAP NEUROVASCULAR PEDICLE | $5,346.47 |
| 15760 | CPT | GRAFT COMPOSITE W/PRIMARY CLOSURE DONOR AREA | $3,084.52 |
| 15769 | CPT | GRFG AUTOL SOFT TISS DIR EXC | $5,054.82 |
| 15770 | CPT | GRAFT DERMA-FAT-FASCIA | $5,346.47 |
| 15771 | CPT | GRFG AUTOL FAT LIPO 50 CC/< | $5,054.82 |
| 15773 | CPT | GRFG AUTOL FAT LIPO 25 CC/< | $2,731.73 |
| 15775 | CPT | PUNCH GRAFT HAIR TRANSPLANT 1-15 PUNCH GRAFTS | $722.58 |
| 15776 | CPT | PUNCH GRAFT HAIR TRANSPLANT >15 PUNCH GRAFTS | $722.58 |
| 15777 | CPT | IMPLNT BIO IMPLNT FOR SOFT TISSUE REINFORCEMENT | $3,012.35 |
| 15780 | CPT | DERMABRASION TOTAL FACE | $5,002.63 |
| 15781 | CPT | DERMABRASION SEGMENTAL FACE | $1,270.89 |
| 15782 | CPT | DERMABRASION REGIONAL OTHER THAN FACE | $3,987.64 |
| 15783 | CPT | DERMABRASION SUPERFICIAL ANY SITE | $722.58 |
| 15786 | CPT | ABRASION 1 LESION | $255.06 |
| 15787 | CPT | ABRASION EACH ADDITIONAL 4 LESIONS OR LESS | $220.44 |
| 15788 | CPT | CHEMICAL PEEL FACIAL EPIDERMAL | $255.06 |
| 15789 | CPT | CHEMICAL PEEL FACIAL DERMAL | $1,051.82 |
| 15792 | CPT | CHEMICAL PEEL NONFACIAL EPIDERMAL | $722.58 |
| 15793 | CPT | CHEMICAL PEEL NONFACIAL DERMAL | $722.58 |
| 15819 | CPT | CERVICOPLASTY | $3,084.52 |
| 15820 | CPT | BLEPHAROPLASTY LOWER EYELID | $3,084.52 |
| 15821 | CPT | BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD | $3,084.52 |
| 15822 | CPT | BLEPHAROPLASTY UPPER EYELID | $3,084.52 |
| 15823 | CPT | BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN | $3,084.52 |
| 15824 | CPT | RHYTIDECTOMY FOREHEAD | $3,084.52 |
| 15825 | CPT | RHYTIDECTOMY NECK W/PLATYSMAL TIGHTENING | $5,346.47 |
| 15826 | CPT | RHYTIDECTOMY GLABELLAR FROWN LINES | $5,346.47 |
| 15828 | CPT | RHYTIDECTOMY CHEEK CHIN & NECK | $5,346.47 |
| 15829 | CPT | RHYTIDECTOMY SMAS FLAP | $5,346.47 |
| 15830 | CPT | EXCISION SKIN ABD INFRAUMBILICAL PANNICULECTOMY | $8,515.77 |
| 15832 | CPT | EXCISION EXCESSIVE SKIN & SUBQ TISSUE THIGH | $5,002.63 |
| 15833 | CPT | EXCISION EXCESSIVE SKIN & SUBQ TISSUE LEG | $5,002.63 |
| 15834 | CPT | EXCISION EXCESSIVE SKIN & SUBQ TISSUE HIP | $5,002.63 |
| 15835 | CPT | EXCISION EXCESSIVE SKIN & SUBQ TISSUE BUTTOCK | $5,002.63 |
| 15836 | CPT | EXCISION EXCESSIVE SKIN & SUBQ TISSUE ARM | $5,002.63 |
| 15837 | CPT | EXC EXCESSIVE SKIN &SUBQ TISSUE FOREARM/HAND | $5,002.63 |
| 15838 | CPT | EXC EXCSV SKIN & SUBQ TISSUE SUBMENTAL FAT PAD | $5,002.63 |
| 15839 | CPT | EXCISION EXCESSIVE SKIN & SUBQ TISSUE OTHER AREA | $5,002.63 |
| 15840 | CPT | GRAFT FACIAL NERVE PARALYSIS FREE FASCIAL GRAFT | $5,346.47 |
| 15841 | CPT | GRAFT FACIAL NERVE PARALYSIS FREE MUSCLE GRAFT | $5,346.47 |
| 15842 | CPT | GRF FACIAL NRV PALYSS FR MUSCLE FLAP MICROSURG | $3,084.52 |
| 15845 | CPT | GRF FACIAL NERVE PARALYSIS REGIONAL MUSCLE TR | $5,346.47 |
| 15847 | CPT | EXCISION EXCESSIVE SKIN & SUBQ TISSUE ABDOMEN | $3,148.08 |
| 15850 | CPT | REMOVAL SUTURES UNDER ANESTHESIA SAME SURGEON | $1,051.82 |
| 15851 | CPT | REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON | $3,084.52 |
| 15852 | CPT | DRESSING CHANGE UNDER ANESTHESIA | $1,051.82 |
| 15860 | CPT | IV INJECTION TEST VASCULAR FLOW FLAP/GRAFT | $889.82 |
| 15876 | CPT | SUCTION ASSISTED LIPECTOMY HEAD & NECK | $5,346.47 |
| 15877 | CPT | SUCTION ASSISTED LIPECTOMY TRUNK | $5,346.47 |
| 15878 | CPT | SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY | $3,084.52 |
| 15879 | CPT | SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY | $5,346.47 |
| 15920 | CPT | EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR | $5,002.63 |
| 15922 | CPT | EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/FLAP CLSR | $5,346.47 |
| 15931 | CPT | EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE | $4,077.97 |
| 15933 | CPT | EXC SACRAL PRESSURE ULC W/PRIM SUTR W/OSTECTOMY | $5,002.63 |
| 15934 | CPT | EXCISION SACRAL PRESSURE ULCER W/SKIN FLAP CLSR | $5,346.47 |
| 15935 | CPT | EXC SACRAL PR ULCER W/SKN FLAP CLSR W/OSTECTOMY | $5,346.47 |
| 15936 | CPT | EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF CLSR | $3,084.52 |
| 15937 | CPT | EXC SAC PR ULC PREPJ MUSC/MYOQ FLAP/SKN GRF OSTC | $3,084.52 |
| 15940 | CPT | EXC ISCHIAL PRESSURE ULCER W/PRIMARY SUTURE | $5,002.63 |
| 15941 | CPT | EXC ISCHIAL PR ULC W/PRIM SUTR W/OSTC ISCHIECT | $5,002.63 |
| 15944 | CPT | EXC ISCHIAL PRESSURE ULCER W/SKIN FLAP CLOSURE | $5,346.47 |
| 15945 | CPT | EXC ISCHIAL PR ULC W/SKN FLAP CLSR W/OSTECTOMY | $3,084.52 |
| 15946 | CPT | EXC ISCHIAL PR ULCER W/OSTC MUSC/MYOQ FLAP/SKIN | $3,084.52 |
| 15950 | CPT | EXC TROCHANTERIC PRESSURE ULCER W/PRIMARY SUTR | $3,258.33 |
| 15951 | CPT | EXC TRCHNTRIC PR ULCER W/PRIM SUTR W/OSTECTOMY | $5,002.63 |
| 15952 | CPT | EXC TROCHANTERIC PR ULCER W/SKIN FLAP CLOSURE | $3,084.52 |
| 15953 | CPT | EXC TRCHNTRIC PR ULC W/SKN FLAP CLSR W/OSTECTOMY | $5,346.47 |
| 15956 | CPT | EXC TROCHANTERIC PR ULCER MUSC/MYOQ FLAP/SKIN | $3,084.52 |
| 15958 | CPT | EXC TRCHNTRIC PR ULC MUSC/MYOQ FLAP/SKIN W/OSTC | $5,346.47 |
| 15999 | CPT | UNLISTED PROCEDURE EXCISION PRESSURE ULCER | $1,270.89 |
| 16000 | CPT | INITIAL TX 1ST DEGREE BURN LOCAL TX | $255.06 |
| 16020 | CPT | DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL | $255.06 |
| 16025 | CPT | DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM | $255.06 |
| 16030 | CPT | DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE | $722.58 |
| 16035 | CPT | ESCHAROTOMY FIRST INCISION | $722.58 |
| 17000 | CPT | DESTRUCTION PREMALIGNANT LESION 1ST | $255.06 |
| 17003 | CPT | DESTRUCTION PREMALIGNANT LESION 2-14 EA | $46.32 |
| 17004 | CPT | DESTRUCTION PREMALIGNANT LESION 15/> | $722.58 |
| 17106 | CPT | DESTRUCTION CUTANEOUS VASC PROLIFERATIVE <10CM | $722.58 |
| 17107 | CPT | DSTRJ CUTANEOUS VASCULAR LESIONS 10.0-50.0 SQ CM | $1,051.82 |
| 17108 | CPT | DSTRJ CUTANEOUS VASCULAR LESIONS >50.0 SQ CM | $3,084.52 |
| 17110 | CPT | DESTRUCTION BENIGN LESIONS UP TO 14 | $255.06 |
| 17111 | CPT | DESTRUCTION BENIGN LESIONS 15/> | $255.06 |
| 17250 | CPT | CHEMICAL CAUTERIZATION GRANULATION TISSUE | $255.06 |
| 17260 | CPT | DESTRUCTION MALIGNANT LESION T/A/L 0.5 CM/< | $255.06 |
| 17261 | CPT | DESTRUCTION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM | $255.06 |
| 17262 | CPT | DESTRUCTION MAL LESION TRUNK/ARM/LEG 1.1-2.0CM | $255.06 |
| 17263 | CPT | DESTRUCTION MAL LESION TRUNK/ARM/LEG 2.1-3.0CM | $255.06 |
| 17264 | CPT | DESTRUCTION MAL LESION TRUNK/ARM/LEG 3.1-4.0CM | $722.58 |
| 17266 | CPT | DESTRUCTION MAL LESION TRUNK/ARM/LEG > 4.0 CM | $722.58 |
| 17270 | CPT | DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.5 CM/> | $255.06 |
| 17271 | CPT | DESTRUCTION MALIGNANT LESION S/N/H/F/G 0.6-1.0CM | $255.06 |
| 17272 | CPT | DESTRUCTION MALIGNANT LESION S/N/H/F/G 1.1-2.0CM | $255.06 |
| 17273 | CPT | DESTRUCTION MALIGNANT LESION S/N/H/F/G 2.1-3.0CM | $722.58 |
| 17274 | CPT | DESTRUCTION MALIGNANT LESION S/N/H/F/G 3.1-4.0CM | $722.58 |
| 17276 | CPT | DSTRJ MAL LESION S/N/H/F/G LESION DIAM > 4.0 CM | $722.58 |
| 17280 | CPT | DESTRUCTION MALIGNANT LESION F/E/E/N/L/M 0.5CM/< | $255.06 |
| 17281 | CPT | DESTRUCTION MAL LESION F/E/E/N/L/M 0.6-1.0CM | $722.58 |
| 17282 | CPT | DESTRUCTION MAL LESION F/E/E/N/L/M 1.1-2.0CM | $722.58 |
| 17283 | CPT | DESTRUCTION MAL LESION F/E/E/N/L/M 2.1-3.0CM | $722.58 |
| 17284 | CPT | DESTRUCTION MAL LESION F/E/E/N/L/M 3.1-4.0CM | $1,051.82 |
| 17286 | CPT | DESTRUCTION MAL LESION F/E/E/N/L/M >4.0 CM | $1,051.82 |
| 17311 | CPT | MOHS MICROGRAPHIC H/N/H/F/G 1ST STAGE 5 BLOCKS | $1,051.82 |
| 17312 | CPT | MOHS MICROGRAPHIC H/N/H/F/G EACH ADDL STAGE | $536.42 |
| 17313 | CPT | MOHS TRUNK/ARM/LEG 1ST STAGE 5 BLOCKS | $1,051.82 |
| 17314 | CPT | MOHS TRUNK/ARM/LEG EA STAGE AFTER 1ST STAGE | $555.98 |
| 17315 | CPT | MOHS TRUNK/ARM/LEG EA ADDL BLOCK ANY STAGE | $430.09 |
| 17340 | CPT | CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE | $84.99 |
| 17360 | CPT | CHEMICAL EXFOLIATION ACNE | $255.06 |
| 17380 | CPT | ELECTROLYSIS EPILATION EACH 30 MINUTES | $1,051.82 |
| 17999 | CPT | UNLISTED PX SKIN MUC MEMBRANE & SUBQ TISSUE | $255.06 |
| 19000 | CPT | PUNCTURE ASPIRATION CYST BREAST | $1,270.89 |
| 19001 | CPT | PUNCTURE ASPIRATION BREAST EACH ADDITIONAL CYST | $247.60 |
| 19020 | CPT | MASTOTOMY W/EXPLORATION/DRAINAGE ABSCESS DEEP | $3,258.33 |
| 19030 | CPT | INJECTION MAMMARY DUCTOGRAM/GALACTOGRAM | $267.36 |
| 19081 | CPT | BX BREAST W/DEVICE 1ST LESION STEREOTACTIC GUID | $3,258.33 |
| 19082 | CPT | BX BREAST W/DEVICE ADDL LESION STEREOTACT GUID | $1,697.74 |
| 19083 | CPT | BX BREAST W/DEVICE 1ST LESION ULTRASOUND GUID | $3,258.33 |
| 19084 | CPT | BX BREAST W/DEVICE ADDL LESION ULTRASOUND GUID | $1,328.75 |
| 19085 | CPT | BX BREAST W/DEVICE 1ST LESION MAGNETIC RES GUID | $3,258.33 |
| 19086 | CPT | BX BREAST W/DEVICE ADDL LESION MAGNET RES GUID | $2,169.94 |
| 19100 | CPT | BX BREAST NEEDLE CORE W/O IMAGING GUIDANCE SPX | $3,258.33 |
| 19101 | CPT | BIOPSY BREAST OPEN INCISIONAL | $6,004.31 |
| 19105 | CPT | ABLTJ CRYOSURGICAL W/US GID EA FIBROADENOMA | $6,004.31 |
| 19110 | CPT | NIPPLE EXPLORATION | $6,004.31 |
| 19112 | CPT | EXCISION LACTIFEROUS DUCT FISTULA | $6,004.31 |
| 19120 | CPT | EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION | $6,004.31 |
| 19125 | CPT | EXC BREAST LES PREOP PLMT RAD MARKER OPEN 1 LES | $6,004.31 |
| 19126 | CPT | EXC BRST LES PREOP PLMT RAD MARKER OPN EA ADDL | $1,680.51 |
| 19281 | CPT | PERQ DEVICE PLACEMENT BREAST LOC 1ST LES W/GDNCE | $1,270.89 |
| 19282 | CPT | PERQ DEVICE PLACEMT BREAST LOC EA LESION W/GDNCE | $685.11 |
| 19283 | CPT | PERQ BREAST LOC DEVICE PLACEMT 1ST STRTCTC GDNCE | $1,270.89 |
| 19284 | CPT | PERQ BREAST LOC DEVICE PLACEMT EA LESION STRTCTC | $1,150.50 |
| 19285 | CPT | PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG | $1,270.89 |
| 19286 | CPT | PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE | $641.60 |
| 19287 | CPT | PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO MR GUID | $1,270.89 |
| 19288 | CPT | PERQ BREAST LOC DEVICE PLACEMT ADD LESIO MR GUID | $2,287.12 |
| 19294 | CPT | PREP TUM CAV IORT PRTL MAST | $3,300.63 |
| 19296 | CPT | PLMT EXPANDABLE CATH BRST FOLLOWING PRTL MAST | $9,302.48 |
| 19297 | CPT | PLMT EXPANDABLE CATH BRST CONCURRENT PRTL MAST | $3,866.67 |
| 19298 | CPT | PLMT RADTHX BRACHYTX BRST FOLLOWING PRTL MAST | $8,515.77 |
| 19300 | CPT | MASTECTOMY GYNECOMASTIA | $6,004.31 |
| 19301 | CPT | MASTECTOMY PARTIAL | $6,004.31 |
| 19302 | CPT | MASTECTOMY PARTIAL W/AXILLARY LYMPHADENECTOMY | $8,515.77 |
| 19303 | CPT | MASTECTOMY SIMPLE COMPLETE | $8,515.77 |
| 19307 | CPT | MAST MODF RAD W/AX LYMPH NOD W/WO PECT/ALIS MIN | $8,515.77 |
| 19316 | CPT | MASTOPEXY | $8,515.77 |
| 19318 | CPT | REDUCTION MAMMAPLASTY | $8,515.77 |
| 19324 | CPT | MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT | $9,302.48 |
| 19325 | CPT | MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT | $9,302.48 |
| 19328 | CPT | REMOVAL INTACT MAMMARY IMPLANT | $6,004.31 |
| 19330 | CPT | REMOVAL MAMMARY IMPLANT MATERIAL | $6,004.31 |
| 19340 | CPT | IMMT INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ | $8,515.77 |
| 19342 | CPT | DLYD INSJ BRST PROSTH FLWG MASTOPEXY MAST/RCNSTJ | $9,302.48 |
| 19350 | CPT | NIPPLE/AREOLA RECONSTRUCTION | $6,004.31 |
| 19355 | CPT | CORRECTION INVERTED NIPPLES | $6,004.31 |
| 19357 | CPT | BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ | $10,044.29 |
| 19366 | CPT | BREAST RECONSTRUCTION OTHER TECHNIQUE | $8,515.77 |
| 19370 | CPT | OPEN PERIPROSTHETIC CAPSULOTOMY BREAST | $6,004.31 |
| 19371 | CPT | PERIPROSTHETIC CAPSULECTOMY BREAST | $6,004.31 |
| 19380 | CPT | REVISION RECONSTRUCTED BREAST | $8,515.77 |
| 19396 | CPT | PREPARATION MOULAGE CUSTOM BREAST IMPLANT | $6,004.31 |
| 19499 | CPT | UNLISTED PROCEDURE BREAST | $6,004.31 |
| 20100 | CPT | EXPLORATION PENETRATING WOUND SPX NECK | $877.36 |
| 20101 | CPT | EXPLORATION PENETRATING WOUND SPX CHEST | $3,084.52 |
| 20102 | CPT | EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK | $3,084.52 |
| 20103 | CPT | EXPLORATION PENETRATING WOUND SPX EXTREMITY | $1,270.89 |
| 20150 | CPT | EXCISION EPIPHYSEAL BAR | $5,600.93 |
| 20200 | CPT | BIOPSY MUSCLE SUPERFICIAL | $3,258.33 |
| 20205 | CPT | BIOPSY MUSCLE DEEP | $5,002.63 |
| 20206 | CPT | BIOPSY MUSCLE PERCUTANEOUS NEEDLE | $3,258.33 |
| 20220 | CPT | BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL | $3,258.33 |
| 20225 | CPT | BIOPSY BONE TROCAR/NEEDLE DEEP | $3,258.33 |
| 20240 | CPT | BIOPSY BONE OPEN SUPERFICIAL | $5,002.63 |
| 20245 | CPT | BIOPSY BONE OPEN DEEP | $5,002.63 |
| 20250 | CPT | BIOPSY VERTEBRAL BODY OPEN THORACIC | $5,600.93 |
| 20251 | CPT | BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL | $9,006.39 |
| 20500 | CPT | INJECTION SINUS TRACT THERAPEUTIC SEPARATE PROC | $2,681.96 |
| 20501 | CPT | INJECTION SINUS TRACT DIAGNOSTIC | $336.76 |
| 20520 | CPT | REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE | $3,258.33 |
| 20525 | CPT | RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP | $5,002.63 |
| 20526 | CPT | INJECTION THERAPEUTIC CARPAL TUNNEL | $425.25 |
| 20527 | CPT | INJECTION ENZYME PALMAR FASCIAL CORD | $425.25 |
| 20550 | CPT | INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS | $425.25 |
| 20551 | CPT | INJECTION SINGLE TENDON ORIGIN/INSERTION | $425.25 |
| 20552 | CPT | INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES | $425.25 |
| 20553 | CPT | INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES | $425.25 |
| 20555 | CPT | PLACEMENT NEEDLES MUSCLE SUBSEQUENT RADIOELEMENT | $4,751.42 |
| 20600 | CPT | ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US | $425.25 |
| 20604 | CPT | ARTHROCNT ASPIR&/INJ SMALL JT/BURSAW/US REC RPRT | $425.25 |
| 20605 | CPT | ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US | $425.25 |
| 20606 | CPT | ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/US | $1,257.73 |
| 20610 | CPT | ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US | $425.25 |
| 20611 | CPT | ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US | $425.25 |
| 20612 | CPT | ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ | $425.25 |
| 20615 | CPT | ASPIRATION & INJECTION TREATMENT BONE CYST | $1,270.89 |
| 20650 | CPT | INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX | $5,600.93 |
| 20660 | CPT | APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX | $3,148.73 |
| 20662 | CPT | APPLICATION HALO PELVIC INCLUDING REMOVAL | $3,148.73 |
| 20663 | CPT | APPLICATION HALO FEMORAL INCLUDING REMOVAL | $5,600.93 |
| 20665 | CPT | REMOVAL TONG/HALO APPLIED BY ANOTHER INDIVIDUAL | $889.82 |
| 20670 | CPT | REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE | $3,258.33 |
| 20680 | CPT | REMOVAL IMPLANT DEEP | $5,002.63 |
| 20690 | CPT | APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM | $9,006.39 |
| 20692 | CPT | APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM | $8,925.36 |
| 20693 | CPT | ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES | $9,006.39 |
| 20694 | CPT | REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES | $3,148.73 |
| 20696 | CPT | XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST & SUBQ | $12,566.52 |
| 20697 | CPT | XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT | $3,148.73 |
| 20822 | CPT | RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP | $3,148.73 |
| 20900 | CPT | BONE GRAFT ANY DONOR AREA MINOR/SMALL | $9,006.39 |
| 20902 | CPT | BONE GRAFT ANY DONOR AREA MAJOR/LARGE | $9,006.39 |
| 20910 | CPT | CARTILAGE GRAFT COSTOCHONDRAL | $1,051.82 |
| 20912 | CPT | CARTILAGE GRAFT NASAL SEPTUM | $5,346.47 |
| 20920 | CPT | FASCIA LATA GRAFT BY STRIPPER | $3,084.52 |
| 20922 | CPT | FASCIA LATA GRAFT INCISION & AREA EXPOSURE | $3,084.52 |
| 20924 | CPT | TENDON GRAFT FROM A DISTANCE | $9,006.39 |
| 20930 | CPT | ALLOGRAFT FOR SPINE SURGERY ONLY MORSELIZED | $2,450.64 |
| 20931 | CPT | ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL | $2,727.61 |
| 20936 | CPT | AUTOGRAFT SPINE SURGERY LOCAL FROM SAME INCISION | $2,723.26 |
| 20937 | CPT | AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION | $1,912.52 |
| 20938 | CPT | AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC | $3,734.59 |
| 20939 | CPT | BONE MARROW ASPIR BONE GRFG | $2,427.78 |
| 20950 | CPT | MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME | $1,270.89 |
| 20972 | CPT | FREE OSTQ FLAP W/MVASC ANASTOMOSIS METATARSAL | $9,006.39 |
| 20973 | CPT | FR OSTQ FLAP W/MVASC ANAST GRT TOE W/WEB SPACE | $9,006.39 |
| 20975 | CPT | ELECTRICAL STIMULATION BONE HEALING INVASIVE | $2,662.25 |
| 20979 | CPT | LOW INTENSITY US STIMJ BONE HEALING NONINVASIVE | $52.82 |
| 20982 | CPT | ABLATION BONE TUMOR RF PERQ W/IMG GDN WHEN DONE | $9,006.39 |
| 20983 | CPT | ABLATJ BONE TUMOR CRYO PERQ W/IMG GDN WHEN PRFMD | $9,006.39 |
| 20985 | CPT | CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS | $5,225.24 |
| 20999 | CPT | UNLISTED PROCEDURE MUSCSKELETAL SYSTEM GENERAL | $561.49 |
| 21010 | CPT | ARTHROTOMY TEMPOROMANDIBULAR JOINT | $5,080.90 |
| 21011 | CPT | EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ <2CM | $3,258.33 |
| 21012 | CPT | EXCISION TUMOR SOFT TISS FACE/SCALP SUBQ 2 CM/> | $3,258.33 |
| 21013 | CPT | EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL <2CM | $3,258.33 |
| 21014 | CPT | EXC TUMOR SOFT TISS FACE&SCALP SUBFASCIAL 2 CM/> | $5,002.63 |
| 21015 | CPT | RAD RESECTION TUMOR SOFT TISS FACE/SCALP < 2CM | $5,002.63 |
| 21016 | CPT | RAD RESECTION TUMOR SOFT TISS FACE/SCALP 2 CM/> | $5,002.63 |
| 21025 | CPT | EXCISION BONE MANDIBLE | $8,112.38 |
| 21026 | CPT | EXCISION FACIAL BONE | $8,112.38 |
| 21029 | CPT | REMOVAL CONTOURING BENIGN TUMOR FACIAL BONE | $5,080.90 |
| 21030 | CPT | EXC BENIGN TUMOR/CYST MAXL/ZYGOMA ENCL & CURTG | $8,112.38 |
| 21031 | CPT | EXCISION TORUS MANDIBULARIS | $5,080.90 |
| 21032 | CPT | EXCISION MAXILLARY TORUS PALATINUS | $5,080.90 |
| 21034 | CPT | EXCISION MALIGNANT TUMOR MAXILLA/ZYGOMA | $8,112.38 |
| 21040 | CPT | EXCISION BENIGN TUMOR/CYST MANDIBLE ENCL & CURT | $5,080.90 |
| 21044 | CPT | EXCISION MALIGNANT TUMOR MANDIBLE | $8,112.38 |
| 21046 | CPT | EXC BENIGN TUMOR/CYST MNDBL INTRA-ORAL OSTEOT | $8,112.38 |
| 21047 | CPT | EXC B9 TUM/CST MNDBL XTR-ORAL OSTEOT&PRTL MNDB | $8,112.38 |
| 21048 | CPT | EXC BENIGN TUMOR/CYST MAXL INTRA-ORAL OSTEOT | $8,112.38 |
| 21049 | CPT | EXC B9 TUM/CST MAXL XTR-ORAL OSTEOT&PRTL MAXLC | $8,112.38 |
| 21050 | CPT | CONDYLECTOMY TEMPOROMANDIBULAR JOINT SPX | $8,112.38 |
| 21060 | CPT | MENISCECTOMY PRTL/COMPL TEMPOROMANDIBULAR JT SPX | $8,112.38 |
| 21070 | CPT | CORONOIDECTOMY SEPARATE PROCEDURE | $8,112.38 |
| 21073 | CPT | MANIPULATION TMJ THERAPEUTIC REQUIRE ANESTHESIA | $2,681.96 |
| 21076 | CPT | IMPRESSION&PREPARATION SURG OBTURATOR PROSTHES | $2,681.96 |
| 21077 | CPT | IMPRESSION & PREPARATION ORBITAL PROSTHESIS | $8,112.38 |
| 21079 | CPT | IMPRESSION & PREPARATION INTERIM OBTURATOR PROST | $5,080.90 |
| 21080 | CPT | IMPRESSION & PREPJ DEFINITIVE OBTURATOR PROSTHES | $5,080.90 |
| 21081 | CPT | IMPRESSION & PREPJ MANDIBULAR RESECTION PROSTHES | $8,112.38 |
| 21082 | CPT | IMPRESSION & PREPJ PALATAL AUGMENTATION PROSTHES | $5,080.90 |
| 21083 | CPT | IMPRESSION & PREPARATION PALATAL LIFT PROSTHESIS | $5,080.90 |
| 21084 | CPT | IMPRESSION & PREPARATION SPEECH AID PROSTHESIS | $5,080.90 |
| 21085 | CPT | IMPRESSION & PREPARATION ORAL SURGICAL SPLINT | $605.48 |
| 21086 | CPT | IMPRESSION & PREPARATION AURICULAR PROSTHESIS | $5,080.90 |
| 21087 | CPT | IMPRESSION & PREPARATION NASAL PROSTHESIS | $8,112.38 |
| 21088 | CPT | IMPRESSION & PREPARATION FACIAL PROSTHESIS | $5,080.90 |
| 21089 | CPT | UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE | $518.17 |
| 21100 | CPT | APPL HALO APPLIANCE MAXILLOFACIAL FIXATION SPX | $8,112.38 |
| 21110 | CPT | APPL INTERDENTAL FIXATION DEVICE NON-FX/DISLC | $2,681.96 |
| 21116 | CPT | INJECTION TEMPOROMANDIBULAR JOINT ARTHROGRAPHY | $149.98 |
| 21120 | CPT | GENIOPLASTY AUGMENTATION | $8,112.38 |
| 21121 | CPT | GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE | $5,080.90 |
| 21122 | CPT | GENIOPLASTY 2/> SLIDING OSTEOTOMIES | $8,112.38 |
| 21123 | CPT | GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS | $5,080.90 |
| 21125 | CPT | AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL | $8,112.38 |
| 21127 | CPT | AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL | $8,112.38 |
| 21137 | CPT | REDUCTION FOREHEAD CONTOURING ONLY | $5,080.90 |
| 21138 | CPT | RDCTJ FHD CNTRG & PROSTHETIC MATRL/BONE GRAFT | $8,112.38 |
| 21139 | CPT | RDCTJ FHD CNTRG & SETBACK ANT FRONTAL SINUS WALL | $8,112.38 |
| 21150 | CPT | RCNSTJ MIDFACE LEFORT II ANTERIOR INTRUSION | $8,112.38 |
| 21172 | CPT | RCNSTJ SUPERIOR-LATERAL ORBITAL RIM & LOWER FHD | $8,112.38 |
| 21175 | CPT | RCNSTJ BIFRONTAL SUPERIOR-LAT ORB RIMS & LWR FHD | $8,112.38 |
| 21181 | CPT | RCNSTJ CONTOURING BENIGN TUMOR CRNL BONES XTRC | $8,112.38 |
| 21193 | CPT | RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF | $8,112.38 |
| 21195 | CPT | RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD | $8,112.38 |
| 21198 | CPT | OSTEOTOMY MANDIBLE SEGMENTAL | $8,112.38 |
| 21199 | CPT | OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT | $8,112.38 |
| 21206 | CPT | OSTEOTOMY MAXILLA SEGMENTAL | $8,112.38 |
| 21208 | CPT | OSTEOPLASTY FACIAL BONES AUGMENTATION | $8,112.38 |
| 21209 | CPT | OSTEOPLASTY FACIAL BONES REDUCTION | $8,112.38 |
| 21210 | CPT | GRAFT BONE NASAL/MAXILLARY/MALAR AREAS | $8,112.38 |
| 21215 | CPT | GRAFT BONE MANDIBLE | $8,112.38 |
| 21230 | CPT | GRAFT RIB CRTLG AUTOGENOUS FACE/CHIN/NOSE/EAR | $8,112.38 |
| 21235 | CPT | GRAFT EAR CRTLG AUTOGENOUS NOSE/EAR | $8,112.38 |
| 21240 | CPT | ARTHRP TEMPOROMANDIBULAR JOINT W/WO AUTOGRAFT | $8,112.38 |
| 21242 | CPT | ARTHROPLASTY TEMPOROMANDIBULAR JT W/ALLOGRAFT | $8,112.38 |
| 21243 | CPT | ARTHRP TMPRMAND JOINT W/PROSTHETIC REPLACEMENT | $12,566.52 |
| 21244 | CPT | RCNSTJ MNDBL XTRORAL W/TRANSOSTEAL BONE PLATE | $8,112.38 |
| 21245 | CPT | RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT PARTIAL | $8,112.38 |
| 21246 | CPT | RCNSTJ MNDBL/MAXL SUBPRIOSTEAL IMPLANT COMPLETE | $8,112.38 |
| 21248 | CPT | RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT PARTIAL | $8,112.38 |
| 21249 | CPT | RCNSTJ MANDIBLE/MAXL ENDOSTEAL IMPLANT COMPLETE | $8,112.38 |
| 21256 | CPT | RECONSTRUCTION ORBIT W/OSTEOTOMIES & BONE GRAFTS | $8,112.38 |
| 21260 | CPT | PERIORBITAL OSTEOTOMIES BONE GRAFTS EXTRACRANIAL | $8,112.38 |
| 21261 | CPT | PERIORBITAL OSTEOTOMIES W/BONE GRAFTS ICRA & XTR | $8,112.38 |
| 21263 | CPT | PERIORBITAL OSTEOTOMIES W/BONE GRAFTS W/FOREHEAD | $8,112.38 |
| 21267 | CPT | ORBITAL REPOSITIONING W/BONE GRAFTS EXTRACRANIAL | $8,112.38 |
| 21270 | CPT | MALAR AUGMENTATION PROSTHETIC MATERIAL | $8,112.38 |
| 21275 | CPT | SECONDARY REVISION ORBITOCRANIOFACIAL RCNSTJ | $8,112.38 |
| 21280 | CPT | MEDIAL CANTHOPEXY SEPARATE PROCEDURE | $5,080.90 |
| 21282 | CPT | LATERAL CANTHOPEXY | $5,080.90 |
| 21295 | CPT | REDUCTION MASSETER MUSCLE & BONE EXTRAORAL | $2,681.96 |
| 21296 | CPT | REDUCTION MASSETER MUSCLE & BONE INTRAORAL | $5,080.90 |
| 21299 | CPT | UNLISTED CRANIOFACIAL & MAXILLOFACIAL PROCEDURE | $518.17 |
| 21310 | CPT | CLOSED TREATMENT NASAL FRACTURE W/O MANIPULATION | $561.49 |
| 21315 | CPT | CLOSED TX NASAL FRACTURE W/O STABILIZATION | $2,681.96 |
| 21320 | CPT | CLOSED TREATMENT NASAL FRACTURE W/STABILIZATION | $5,080.90 |
| 21325 | CPT | OPEN TREATMENT NASAL FRACTURE UNCOMPLICATED | $5,080.90 |
| 21330 | CPT | OPEN TX NASAL FX COMP W/INT&/XTRNL SKELETAL FI | $8,112.38 |
| 21335 | CPT | OPEN TX NASAL FX W/CONCOMITANT OPTX FXD SEPTUM | $5,080.90 |
| 21336 | CPT | OPEN TX NASAL SEPTAL FRACTURE W/WO STABILIZATION | $5,600.93 |
| 21337 | CPT | CLOSED TX NASAL SEPTAL FRACT W/WO STABILIZATION | $5,080.90 |
| 21338 | CPT | OPEN TX NASOETHMOID FX W/O EXTERNAL FIXATION | $8,112.38 |
| 21339 | CPT | OPEN TX NASOETHMOID FX W/EXTERNAL FIXATION | $8,112.38 |
| 21340 | CPT | PERCUTANEOUS TX NASOETHMOID COMPLEX FRACTURE | $5,080.90 |
| 21345 | CPT | CLOSED TX NASOMAXILLARY COMPLEX FRACTURE | $2,681.96 |
| 21346 | CPT | OPTX NASOMAX CPLX FX LEFT II TYPE W/WIRG & FXJ | $8,112.38 |
| 21355 | CPT | PERCUTANEOUS TX MALAR AREA FRACTURE | $5,080.90 |
| 21356 | CPT | OPEN TX DEPRESSED ZYGOMATIC ARCH FRACTURE | $8,112.38 |
| 21360 | CPT | OPEN TX DEPRESSED MALAR FRACTURE | $8,112.38 |
| 21365 | CPT | OPEN TX COMP FX MALAR W/INTERNAL FX&MULT SURG | $8,112.38 |
| 21385 | CPT | OPEN TX ORBITAL FLOOR BLOWOUT FX TRANSANTRAL | $8,112.38 |
| 21386 | CPT | OPEN TX ORBITAL FLOOR BLOWOUT FX PERIORBITAL | $8,112.38 |
| 21387 | CPT | OPEN TX ORBITAL FLOOR BLOWOUT FX COMBINED APPR | $8,112.38 |
| 21390 | CPT | OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/ALLPLSTC | $8,112.38 |
| 21395 | CPT | OPTX ORB FLOOR BLWT FX PRI/BITAL APPR W/BONE GRF | $8,112.38 |
| 21400 | CPT | CLSD TX FX ORBIT EXCEPT BLOWOUT W/O MANIPULATION | $877.36 |
| 21401 | CPT | CLOSED TX FX ORBIT EXCEPT BLOWOUT W/MANIPULATION | $2,681.96 |
| 21406 | CPT | OPEN TX FX ORBIT EXCEPT BLOWOUT W/O IMPLANT | $8,112.38 |
| 21407 | CPT | OPEN TX FX ORBIT EXCEPT BLOWOUT W/IMPLANT | $8,112.38 |
| 21408 | CPT | OPEN TX FX ORBIT EXCEPT BLOWOUT W/BONE GRAFT | $8,112.38 |
| 21421 | CPT | CLOSED TX PALATAL/MAXILLARY FX W/FIXATION/SPLINT | $5,080.90 |
| 21440 | CPT | CLTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX | $5,080.90 |
| 21445 | CPT | OPTX MANDIBULAR/MAXILLARY ALVEOLAR RIDGE FX SPX | $8,112.38 |
| 21450 | CPT | CLOSED TX MANDIBULAR FRACTURE W/O MANIPULATION | $877.36 |
| 21451 | CPT | CLOSED TX MANDIBULAR FRACTURE W/MANIPULATION | $2,681.96 |
| 21452 | CPT | PERCUTANEOUS TX MANDIBULAR FX W/EXTERNAL FIXJ | $8,112.38 |
| 21453 | CPT | CLOSED TX MANDIBULAR FX W/INTERDENTAL FIXATION | $8,112.38 |
| 21454 | CPT | OPEN TX MANDIBULAR FX W/EXTERNAL FIXATION | $8,112.38 |
| 21461 | CPT | OPEN TX MANDIBULAR FX W/O INTERDENTAL FIXATION | $8,112.38 |
| 21462 | CPT | OPEN TX MANDIBULAR FX W/INTERDENTAL FIXATION | $8,112.38 |
| 21465 | CPT | OPEN TREATMENT MANDIBULAR CONDYLAR FRACTURE | $8,112.38 |
| 21470 | CPT | OPTX COMP MANDIBULAR FX MLT APPR W/INT FIXATION | $8,112.38 |
| 21480 | CPT | CLOSED TX TEMPOROMANDIBULAR DISLOCATION 1ST/SBSQ | $561.49 |
| 21485 | CPT | CLOSED TX TEMPOROMANDIBULAR DISLC COMP 1ST/SBSQ | $2,681.96 |
| 21490 | CPT | OPEN TREATMENT TEMPOROMANDIBULAR DISLOCATION | $5,080.90 |
| 21497 | CPT | INTERDENTAL WIRING OTHER THAN FRACTURE | $2,681.96 |
| 21499 | CPT | UNLISTED MUSCULOSKELETAL PROCEDURE HEAD | $518.17 |
| 21501 | CPT | I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX | $5,002.63 |
| 21502 | CPT | I&D DP ABSC/HMTMA SOFT TISS NCK/THORAX PRTL RI | $5,600.93 |
| 21550 | CPT | BIOPSY SOFT TISSUE NECK/THORAX | $3,258.33 |
| 21552 | CPT | EXC TUMOR SOFT TIS NECK/ANT THORAX SUBQ 3 CM/> | $5,002.63 |
| 21554 | CPT | EXC TUMOR SOFT TISSUE NECK/THORAX SUBFASC 5 CM/> | $5,002.63 |
| 21555 | CPT | EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM | $3,258.33 |
| 21556 | CPT | EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM | $5,002.63 |
| 21557 | CPT | RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM | $5,002.63 |
| 21558 | CPT | RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX 5CM/> | $5,002.63 |
| 21600 | CPT | EXCISION RIB PARTIAL | $9,006.39 |
| 21601 | CPT | EXC CHEST WALL TUMOR W/RIBS | $4,965.82 |
| 21610 | CPT | COSTOTRANSVERSECTOMY SEPARATE PROCEDURE | $5,600.93 |
| 21685 | CPT | HYOID MYOTOMY & SUSPENSION | $8,112.38 |
| 21700 | CPT | DIVISION SCALENUS ANTICUS W/O RESCJ CERVICAL RIB | $7,013.46 |
| 21720 | CPT | DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST | $5,600.93 |
| 21725 | CPT | DIVISION STERNOCLEIDOMASTOID OPEN W/CAST | $1,270.89 |
| 21742 | CPT | REPAIR PECTUS EXCAVATM/CARINATM MINLY W/O THRSC | $5,600.93 |
| 21743 | CPT | REPAIR PECTUS EXCAVATM/CARINATM MINLY W/THRSC | $5,600.93 |
| 21811 | CPT | OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 1-3 RIBS | $7,013.46 |
| 21812 | CPT | OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 4-6 RIBS | $6,417.29 |
| 21813 | CPT | OPEN TX RIB FX W/FIXJ THORACOSCOPIC VIS 7+ RIBS | $3,148.73 |
| 21820 | CPT | CLOSED TREATMENT STERNUM FRACTURE | $561.49 |
| 21899 | CPT | UNLISTED PROCEDURE NECK/THORAX | $518.17 |
| 21920 | CPT | BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL | $3,258.33 |
| 21925 | CPT | BIOPSY SOFT TISSUE BACK/FLANK DEEP | $3,258.33 |
| 21930 | CPT | EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM | $3,258.33 |
| 21931 | CPT | EXCISION TUMOR SOFT TIS BACK/FLANK SUBQ 3 CM/> | $3,258.33 |
| 21932 | CPT | EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL <5CM | $5,002.63 |
| 21933 | CPT | EXC TUMOR SOFT TISS BACK/FLANK SUBFASCIAL 5 CM/> | $5,002.63 |
| 21935 | CPT | RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK <5CM | $5,002.63 |
| 21936 | CPT | RAD RESECTION TUMOR SOFT TISSUE BACK/FLANK 5CM/> | $5,002.63 |
| 22100 | CPT | PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV | $9,006.39 |
| 22101 | CPT | PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC | $7,013.46 |
| 22102 | CPT | PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR | $9,006.39 |
| 22103 | CPT | PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA | $2,160.75 |
| 22310 | CPT | CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING | $561.49 |
| 22315 | CPT | CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ | $4,751.42 |
| 22505 | CPT | MANIPULATION SPINE REQUIRING ANESTHESIA | $3,148.73 |
| 22510 | CPT | PERQ VERTEBROPLASTY UNI/BI INJX CERVICOTHORACIC | $5,600.93 |
| 22511 | CPT | PERQ VERTEBROPLASTY UNI/BI INJECTION LUMBOSACRAL | $5,600.93 |
| 22512 | CPT | VERTEBROPLASTY EACH ADDL CERVICOTHOR/LUMBOSACRAL | $2,848.29 |
| 22513 | CPT | PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION | $9,006.39 |
| 22514 | CPT | PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR | $9,006.39 |
| 22515 | CPT | PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH | $4,272.45 |
| 22526 | CPT | PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY 1 LEVEL | $2,191.98 |
| 22527 | CPT | PERQ INTRDSCL ELECTROTHRM ANNULOPLASTY ADDL LVL | $1,198.63 |
| 22551 | CPT | ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 | $8,925.36 |
| 22552 | CPT | ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC | $2,444.18 |
| 22554 | CPT | ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2 | $8,925.36 |
| 22585 | CPT | ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC | $2,309.40 |
| 22612 | CPT | ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR | $8,925.36 |
| 22614 | CPT | ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL | $3,398.00 |
| 22633 | CPT | ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR | $9,329.00 |
| 22840 | CPT | POSTERIOR NON-SEGMENTAL INSTRUMENTATION | $3,339.20 |
| 22842 | CPT | POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG | $3,258.39 |
| 22845 | CPT | ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS | $2,135.60 |
| 22853 | CPT | INSJ BIOMECHANICAL DEVICE | $2,268.75 |
| 22854 | CPT | INSJ BIOMECHANICAL DEVICE | $2,361.28 |
| 22856 | CPT | TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV | $12,566.52 |
| 22858 | CPT | TOT DISC ARTHRP ANT APPR DISC 2ND LEVEL CERVICAL | $3,928.91 |
| 22859 | CPT | INSJ BIOMECHANICAL DEVICE | $2,390.69 |
| 22867 | CPT | INSJ STABLJ DEV W/DCMPRN | $12,566.52 |
| 22868 | CPT | INSJ STABLJ DEV W/DCMPRN | $2,272.86 |
| 22869 | CPT | INSJ STABLJ DEV W/O DCMPRN | $10,936.95 |
| 22870 | CPT | INSJ STABLJ DEV W/O DCMPRN | $1,430.22 |
| 22899 | CPT | UNLISTED PROCEDURE SPINE | $561.49 |
| 22900 | CPT | EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL <5CM | $5,002.63 |
| 22901 | CPT | EXC TUMOR SOFT TISSUE ABDL WALL SUBFASCIAL 5CM/> | $5,002.63 |
| 22902 | CPT | EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ <3CM | $3,258.33 |
| 22903 | CPT | EXC TUMOR SOFT TISSUE ABDOMINAL WALL SUBQ 3 CM/> | $5,002.63 |
| 22904 | CPT | RAD RESECTION TUMOR SOFT TISSUE ABDL WALL <5CM | $5,002.63 |
| 22905 | CPT | RAD RESECTION TUMOR SOFT TISSUE ABDL WALL 5 CM/> | $5,002.63 |
| 22999 | CPT | UNLISTED PX ABDOMEN MUSCULOSKELETAL SYSTEM | $561.49 |
| 23000 | CPT | REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN | $5,002.63 |
| 23020 | CPT | CAPSULAR CONTRACTURE RELEASE | $5,600.93 |
| 23030 | CPT | I&D SHOULDER DEEP ABSCESS/HEMATOMA | $5,002.63 |
| 23031 | CPT | I&D SHOULDER INFECTED BURSA | $4,077.97 |
| 23035 | CPT | INCISION BONE CORTEX SHOULDER AREA | $3,148.73 |
| 23040 | CPT | ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB | $5,600.93 |
| 23044 | CPT | ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB | $5,600.93 |
| 23065 | CPT | BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL | $3,258.33 |
| 23066 | CPT | BIOPSY SOFT TISSUE SHOULDER DEEP | $5,002.63 |
| 23071 | CPT | EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/> | $3,258.33 |
| 23073 | CPT | EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/> | $5,002.63 |
| 23075 | CPT | EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM | $3,258.33 |
| 23076 | CPT | EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM | $5,002.63 |
| 23077 | CPT | RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM | $5,002.63 |
| 23078 | CPT | RAD RESECTION TUMOR SOFT TISSUE SHOULDER 5 CM/> | $5,002.63 |
| 23100 | CPT | ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY | $4,751.42 |
| 23101 | CPT | ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG | $5,600.93 |
| 23105 | CPT | ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY | $9,006.39 |
| 23106 | CPT | ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX | $5,600.93 |
| 23107 | CPT | ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB | $9,006.39 |
| 23120 | CPT | CLAVICULECTOMY PARTIAL | $5,600.93 |
| 23125 | CPT | CLAVICULECTOMY TOTAL | $5,600.93 |
| 23130 | CPT | PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE | $5,600.93 |
| 23140 | CPT | EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA | $5,600.93 |
| 23145 | CPT | EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/AGRFT | $5,600.93 |
| 23146 | CPT | EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT | $9,006.39 |
| 23150 | CPT | EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS | $5,600.93 |
| 23155 | CPT | EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/AGRFT | $9,006.39 |
| 23156 | CPT | EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT | $9,006.39 |
| 23170 | CPT | SEQUESTRECTOMY CLAVICLE | $4,751.42 |
| 23172 | CPT | SEQUESTRECTOMY SCAPULA | $5,600.93 |
| 23174 | CPT | SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK | $7,013.46 |
| 23180 | CPT | PARTIAL EXCISION BONE CLAVICLE | $7,013.46 |
| 23182 | CPT | PARTIAL EXCISION BONE SCAPULA | $7,013.46 |
| 23184 | CPT | PARTIAL EXCISION BONE PROXIMAL HUMERUS | $9,006.39 |
| 23190 | CPT | OSTECTOMY SCAPULA PARTIAL | $5,600.93 |
| 23195 | CPT | RESECTION HUMERAL HEAD | $9,006.39 |
| 23330 | CPT | REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS | $1,270.89 |
| 23333 | CPT | REMOVAL SHOULDER FOREIGN BODY DEEP SUBFASCIAL/IM | $4,077.97 |
| 23334 | CPT | PROSTHESIS REMOVAL HUMERAL/GLENOID COMPONENT | $5,002.63 |
| 23350 | CPT | INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG | $355.69 |
| 23395 | CPT | MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE | $9,006.39 |
| 23397 | CPT | MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE | $9,006.39 |
| 23400 | CPT | SCAPULOPEXY | $9,006.39 |
| 23405 | CPT | TENOTOMY SHOULDER AREA 1 TENDON | $9,006.39 |
| 23406 | CPT | TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION | $7,013.46 |
| 23410 | CPT | OPEN REPAIR OF ROTATOR CUFF ACUTE | $9,006.39 |
| 23412 | CPT | OPEN REPAIR OF ROTATOR CUFF CHRONIC | $9,006.39 |
| 23415 | CPT | CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY | $9,006.39 |
| 23420 | CPT | RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC | $9,006.39 |
| 23430 | CPT | TENODESIS LONG TENDON BICEPS | $9,006.39 |
| 23440 | CPT | RESECTION/TRANSPLANTATION LONG TENDON BICEPS | $7,013.46 |
| 23450 | CPT | CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON | $9,006.39 |
| 23455 | CPT | CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR | $9,006.39 |
| 23460 | CPT | CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK | $9,006.39 |
| 23462 | CPT | CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR | $9,006.39 |
| 23465 | CPT | CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK | $9,006.39 |
| 23466 | CPT | CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS | $9,006.39 |
| 23470 | CPT | ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY | $8,925.36 |
| 23473 | CPT | REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT | $8,925.36 |
| 23480 | CPT | OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION | $9,006.39 |
| 23485 | CPT | OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL | $8,925.36 |
| 23490 | CPT | PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE | $9,006.39 |
| 23491 | CPT | PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS | $8,925.36 |
| 23500 | CPT | CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION | $561.49 |
| 23505 | CPT | CLSD TX CLAVICULAR FRACTURE W/MANIPULATION | $3,148.73 |
| 23515 | CPT | OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION | $9,006.39 |
| 23520 | CPT | CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION | $3,148.73 |
| 23525 | CPT | CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION | $561.49 |
| 23530 | CPT | OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC | $9,006.39 |
| 23532 | CPT | OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF | $9,006.39 |
| 23540 | CPT | CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION | $561.49 |
| 23545 | CPT | CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION | $561.49 |
| 23550 | CPT | OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC | $9,006.39 |
| 23552 | CPT | OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF | $9,006.39 |
| 23570 | CPT | CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION | $561.49 |
| 23575 | CPT | CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION | $3,148.73 |
| 23585 | CPT | OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD | $9,006.39 |
| 23600 | CPT | CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION | $561.49 |
| 23605 | CPT | CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ | $3,148.73 |
| 23615 | CPT | OPEN TREATMENT PROXIMAL HUMERAL FRACTURE | $8,925.36 |
| 23616 | CPT | OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT | $12,566.52 |
| 23620 | CPT | CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ | $561.49 |
| 23625 | CPT | CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION | $3,148.73 |
| 23630 | CPT | OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE | $9,006.39 |
| 23650 | CPT | CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES | $561.49 |
| 23655 | CPT | CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES | $3,148.73 |
| 23660 | CPT | OPEN TX ACUTE SHOULDER DISLOCATION | $9,006.39 |
| 23665 | CPT | CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ | $3,148.73 |
| 23670 | CPT | OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX | $9,006.39 |
| 23675 | CPT | CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ | $3,148.73 |
| 23680 | CPT | OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE | $8,925.36 |
| 23700 | CPT | MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS | $3,148.73 |
| 23800 | CPT | ARTHRODESIS GLENOHUMERAL JOINT | $9,006.39 |
| 23802 | CPT | ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT | $8,925.36 |
| 23921 | CPT | DISRTCJ SHOULDER SECONDARY CLSR/SCAR REVISION | $3,084.52 |
| 23929 | CPT | UNLISTED PROCEDURE SHOULDER | $561.49 |
| 23930 | CPT | I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA | $4,077.97 |
| 23931 | CPT | INCISION&DRAINAGE UPPER ARM/ELBOW BURSA | $3,258.33 |
| 23935 | CPT | INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW | $5,600.93 |
| 24000 | CPT | ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB | $5,600.93 |
| 24006 | CPT | ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX | $5,600.93 |
| 24065 | CPT | BIOPSY SOFT TISSUE UPPER ARM/ELBOW SUPERFICIAL | $3,258.33 |
| 24066 | CPT | BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP | $5,002.63 |
| 24071 | CPT | EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/> | $5,002.63 |
| 24073 | CPT | EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/> | $5,002.63 |
| 24075 | CPT | EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM | $3,258.33 |
| 24076 | CPT | EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM | $5,002.63 |
| 24077 | CPT | RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM | $5,002.63 |
| 24079 | CPT | RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW 5CM/> | $5,002.63 |
| 24100 | CPT | ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY | $5,600.93 |
| 24101 | CPT | ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB | $5,600.93 |
| 24102 | CPT | ARTHROTOMY ELBOW W/SYNOVECTOMY | $5,600.93 |
| 24105 | CPT | EXCISION OLECRANON BURSA | $5,600.93 |
| 24110 | CPT | EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS | $5,600.93 |
| 24115 | CPT | EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT | $9,006.39 |
| 24116 | CPT | EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT | $9,006.39 |
| 24120 | CPT | EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN | $5,600.93 |
| 24125 | CPT | EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT | $5,600.93 |
| 24126 | CPT | EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT | $9,006.39 |
| 24130 | CPT | EXCISION RADIAL HEAD | $5,600.93 |
| 24134 | CPT | SEQUESTRECTOMY SHAFT/DISTAL HUMERUS | $9,006.39 |
| 24136 | CPT | SEQUESTRECTOMY RADIAL HEAD OR NECK | $5,600.93 |
| 24138 | CPT | SEQUESTRECTOMY OLECRANON PROCESS | $9,006.39 |
| 24140 | CPT | PARTIAL EXCISION BONE HUMERUS | $5,600.93 |
| 24145 | CPT | PARTIAL EXCISION BONE RADIAL HEAD/NECK | $9,006.39 |
| 24147 | CPT | PARTIAL EXCISION BONE OLECRANON PROCESS | $5,600.93 |
| 24149 | CPT | RAD RESCJ CAPSL TISS&HTRTPC BONE ELBW CONTRCT | $9,006.39 |
| 24150 | CPT | RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS | $9,006.39 |
| 24152 | CPT | RADICAL RESECTION TUMOR RADIAL HEAD/NECK | $9,006.39 |
| 24155 | CPT | RESECTION ELBOW JOINT ARTHRECTOMY | $5,600.93 |
| 24160 | CPT | PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS | $5,600.93 |
| 24164 | CPT | PROSTHESIS REMOVAL RADIAL HEAD | $5,600.93 |
| 24200 | CPT | RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS | $3,258.33 |
| 24201 | CPT | REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP | $5,002.63 |
| 24220 | CPT | INJECTION ELBOW ARTHROGRAPHY | $348.61 |
| 24300 | CPT | MANIPULATION ELBOW UNDER ANESTHESIA | $3,148.73 |
| 24301 | CPT | MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE | $9,006.39 |
| 24305 | CPT | TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON | $5,600.93 |
This is the start of the file's text. The full file is on GovTribe.
File details come from the government source that posted it. Updated .