ATTACHMENT D.5 Fee Schedule .xlsx

XLSX spreadsheet 60 KB Posted Nov 14, 2023

Attached to: General Surgeon Per Procedure Fayetteville, AR
Solicitation number: 36C25624Q0187
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 16

About this file

Written by GovTribe AI · Dec 20, 2023

This document contains a fee schedule attachment for a federal contract opportunity to provide general surgeon services on a per procedure basis in Fayetteville, Arkansas. The fee schedule lists over 400 Current Procedural Terminology codes covering a range of surgical procedures, along with the estimated quantity of each procedure, CMS unit cost, and fields to include the offeror's percentage of CMS and fixed price per unit. The opportunity includes estimated costs and pricing for four one-year option periods from 2024 to 2028. Review of the fee schedule and included detail on specific medical procedures is intended to inform offerors on the scope of services required to fulfill the surgical requirements of the opportunity issued under solicitation number 36C25624Q0187 by the Department of Veterans Affairs VISN 16.

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File	Type	Posted
36C25624Q0187 .pdf	PDF	Nov 14, 2023
ATTACHMENT D.3 -CONTRACTOR CERTIFICATION IMMIGRATION.pdf	PDF	Nov 14, 2023
ATTACHMENT D.2 - CONTRACTOR KEY PERSONNEL AND COI.pdf	PDF	Nov 14, 2023
ATTACHMENT D.1 QASP.pdf	PDF	Nov 14, 2023
ATTACHMENT D.4 - EXPERIENCE REFERENCE CONTRACT WORKSHEET.pdf	PDF	Nov 14, 2023

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BASE YR

					ESTIMATED COST - POP 1 JAN 2024 - 31 DEC 2024
			CLIN	CPT/HCPCS Code	Short Description	CMS Unit Cost
Est Qty	U/I	% of CMS Unit Cost	Fixed Priced EA	Estimated Total Fee For Base Year
			0001AA	10060	Drainage of skin abscess	$123.78	2	EA	%	$	$
			0001AB	10061	Drainage of skin abscess	$210.49	4	EA	%	$	$
			0001AC	10081	Drainage Pilonidal Cyst	$334.57	5	EA	%	$	$
			0001AD	10120	Remove foreign body	$147.74	4	EA	%	$	$
			0001AE	10121	Remove foreign body	$260.26	1	EA	%	$	$
			0001AF	10140	Drainage hematoma	$166.03	1	EA	%	$	$
			0001AG	10180	Complex Drainage Wound	$255.50	3	EA	%	$	$
			0001AH	11008	Remove mesh from abd wall	$243.79	3	EA	%	$	$
			0001AJ	11042	Debride SubQ Tissue	$125.79	2	EA	%	$	$
			0001AK	11043	Deb musc/fascia 20 sq cm/<	$228.19	1	EA	%	$	$
			0001AL	11044	Deb Bone 20 sq cm/<	$306.05	3	EA	%	$	$
			0001AM	11103	Biopsy Skin Lesion	$49.22	2	EA	%	$	$
			0001AN	11400	Exc tr-ext b9+marg< 0.5 cm	$124.88	4	EA	%	$	$
			0001AP	11403	Exc tr-ext b9+marg 2.1 - 3 cm	$193.99	4	EA	%	$	$
			0001AQ	11404	Exc tr-ext b9+marg 3.1 - 4 cm	$219.65	4	EA	%	$	$
			0001AR	11406	Exc tr-ext b9+marg >4.0 cm	$312.05	5	EA	%	$	$
			0001AS	11420	Exc h-f-nk-sp b9+marg < 0.5	$125.09	6	EA	%	$	$
			0001AT	11421	Exc h-f-nk-sp b9+marg 0.6 - 1	$157.49	5	EA	%	$	$
			0001AU	11422	Exc h-f-nk-sp b9+marg 1.1 - 2	$176.42	5	EA	%	$	$
			0001AV	11423	Exc h-f-nk-sp b9+marg 2.1-3	$201.50	2	EA	%	$	$
			0001AW	11424	Exc h-f-nk-sp b9+marg 3.1 - 4	$232.09	1	EA	%	$	$
			0001AX	11426	Exc h-f-nk-sp b9+marg >4	$326.21	2	EA	%	$	$
			0001AY	11441	Exc Face-MM	$170.95	3	EA	%	$	$
			0001AZ	11442	Exc Face-MM	$190.04	3	EA	%	$	$
			0001BA	11444	Exc Face-MM	$279.59	1	EA	%	$	$
			0001BB	11601	Exc TR-Ext Mal	$224.56	3	EA	%	$	$
			0001BC	11602	Exc TR-Ext Mal	$240.81	3	EA	%	$	$
			0001BD	11603	Exc TR-Ext Mal	$274.99	2	EA	%	$	$
			0001BE	11606	Exc TR-Ext Mal	$439.39	1	EA	%	$	$
			0001BF	11620	Exc h-f-nk-sp Mal	$194.52	4	EA	%	$	$
			0001BG	11621	Exc h-f-nk-sp Mal	$225.74	2	EA	%	$	$
			0001BH	11622	Exc h-f-nk-sp Mal	$248.88	4	EA	%	$	$
			0001BJ	11624	Exc h-f-nk-sp Mal	$332.15	1	EA	%	$	$
			0001BK	11640	Exc h-f-nk-sp Mal	$199.05	4	EA	%	$	$
			0001BL	11641	Exc h-f-nk-sp Mal	$233.05	2	EA	%	$	$
			0001BM	11642	Exc h-f-nk-sp Mal	$263.70	6	EA	%	$	$
			0001BN	11643	Exc h-f-nk-sp Mal	$310.84	1	EA	%	$	$
			0001BP	11771	Remove pilonidal cyst exten	$612.82	6	EA	%	$	$
			0001BQ	12001	Repair Superficial Wound	$91.67	1	EA	%	$	$
			0001BR	12004	Repair Superficial Wound	$129.60	1	EA	%	$	$
			0001BS	12011	Repair Superficial Wound	$109.89	1	EA	%	$	$
			0001BT	12013	Repair Superficial Wound	$115.09	1	EA	%	$	$
			0001BU	15120	Skn Splt A-Grft	$833.36	2	EA	%	$	$
			0001BV	15734	Muscle Skin Grft Trunk	$1,349.64	3	EA	%	$	$
			0001BW	17000	Destruction Premalig Lesion	$65.99	3	EA	%	$	$
			0001BX	17003	Destruction Premalig Lesion 2-14	$6.53	3	EA	%	$	$
			0001BY	17282	Destruction Skin Lesion	$203.28	1	EA	%	$	$
			0001BZ	19120	Removal of breast lesion	$505.93	2	EA	%	$	$
			0001CA	19300	Removal of breast tissue	$566.86	3	EA	%	$	$
			0001CB	21552	Exc Face Less SBQ 3 cm />	$402.72	2	EA	%	$	$
			0001CC	21554	Exc Face Less SBQ 5 cm />	$660.89	2	EA	%	$	$
			0001CD	21555	Exc Neck Less SC < 3 cm	$424.69	1	EA	%	$	$
			0001CE	21920	Biopsy Soft Tissue Back	$251.27	1	EA	%	$	$
			0001CF	21931	Exc back les sc 3 cm/>	$422.56	1	EA	%	$	$
			0001CG	21933	Exc back tum deep 5 cm/>	$664.51	1	EA	%	$	$
			0001CH	22900	Exc Abdl Tum Deep	$509.19	2	EA	%	$	$
			0001CJ	22903	Exc Abd less SC 3 cm />	$395.83	2	EA	%	$	$
			0001CK	27590	Amputate leg at thigh	$702.28	3	EA	%	$	$
			0001CL	27880	Amputation of lower leg	$806.12	4	EA	%	$	$
			0001CM	28805	Amputation thru metatarsal	$651.34	5	EA	%	$	$
			0001CN	28810	Amputation toe & metatarsal	$385.01	6	EA	%	$	$
			0001CP	28820	Amputation toe	$294.23	3	EA	%	$	$
			0001CQ	36556	Insert non-tunnel cv cath	$209.01	4	EA	%	$	$
			0001CR	36561	Insert tunneled cv cath	$955.60	7	EA	%	$	$
			0001CS	36590	Removal tunneled cv cath	$220.29	5	EA	%	$	$
			0001CT	38500	Biopsy/removal lymph nodes	$328.95	2	EA	%	$	$
			0001CU	38510	Biopsy/removal lymph nodes	$521.69	3	EA	%	$	$
			0001CV	43235	Egd diagnostic brush wash	$281.38	165	EA	%	$	$
			0001CW	43236	Upper GI Scope W/Submuc Inj	$390.88	1	EA	%	$	$
			0001CX	43239	Egd biopsy single/multiple	$367.24	277	EA	%	$	$
			0001CY	43245	Upper GI Scope Dilate Strictr	$577.55	3	EA	%	$	$
			0001CZ	43246	Place gastrostomy tube	$181.38	20	EA	%	$	$
			0001DA	43247	Operative Upper GI Endoscopy	$375.69	10	EA	%	$	$
			0001DB	43248	Uppr GI Endoscopy/Guide Wire	$403.69	10	EA	%	$	$
			0001DC	43249	Esoph egd dilation <30 mm	$1,042.64	30	EA	%	$	$
			0001DD	43250	Dilate Esophagus	$439.58	20	EA	%	$	$
			0001DE	43251	Operative Upper GI Endoscopy	$484.44	19	EA	%	$	$
			0001DF	43255	Operative Upper GI Endoscopy	$610.43	1	EA	%	$	$
			0001DG	43280	Laparoscopy fundoplasty	$965.58	3	EA	%	$	$
			0001DH	43450	Dilate Esophagus	$182.80	30	EA	%	$	$
			0001DJ	43633	Removal of stomach partial	$1,722.33	3	EA	%	$	$
			0001DK	43762	Change gastrostomy tube	$218.80	20	EA	%	$	$
			0001DL	43800	Reconsstruction Pylorus	$833.46	1	EA	%	$	$
			0001DM	43830	Place gastrostomy tube	$631.33	8	EA	%	$	$
			0001DN	44050	Reduce bowel obstruction	$839.89	3	EA	%	$	$
			0001DP	44120	Removal Small Intestine	$1,095.53	5	EA	%	$	$
			0001DQ	44139	Mobilization of colon	$108.02	5	EA	%	$	$
			0001DR	44140	Partial removal of colon	$1,203.75	10	EA	%	$	$
			0001DS	44141	Partial removal of colon	$1,624.17	3	EA	%	$	$
			0001DT	44145	Partial removal of colon	$1,485.35	10	EA	%	$	$
			0001DU	44147	Partial removal of colon	$1,733.32	10	EA	%	$	$
			0001DV	44160	Removal of colon	$1,115.13	5	EA	%	$	$
			0001DW	44188	Lap Colostomy	$1,091.68	3	EA	%	$	$
			0001DX	44204	Laparo partial colectomy	$1,381.66	10	EA	%	$	$
			0001DY	44205	Lap colectomy part w/ileum	$1,201.95	10	EA	%	$	$
			0001DZ	44207	L colectomy/coloproctostomy	$1,633.59	8	EA	%	$	$
			0001EA	44213	Lap mobil splenic fl add-on	$167.69	3	EA	%	$	$
			0001EB	44300	Open Bowel to Skin	$754.69	1	EA	%	$	$
			0001EC	44320	Colostomy	$1,078.24	5	EA	%	$	$
			0001ED	44380	Small Bowel Endoscopy	$189.27	1	EA	%	$	$
			0001EE	44388	Colonoscopy thru stoma spx	$309.01	5	EA	%	$	$
			0001EF	44389	Colonoscopy with Biopsy	$402.54	1	EA	%	$	$
			0001EG	44602	Suture small intestine	$1,262.35	1	EA	%	$	$
			0001EH	44604	Suture large intestine	$947.87	1	EA	%	$	$
			0001EJ	44625	Repair bowel opening	$912.53	1	EA	%	$	$
			0001EK	44626	Repair bowel opening	$1,431.36	6	EA	%	$	$
			0001EL	44640	Repair bowel-skin fistula	$1,254.03	2	EA	%	$	$
			0001EM	44650	Repair bowel fistula	$1,295.45	2	EA	%	$	$
			0001EN	44661	Repair Bowel-Bladder Fistula	$1,392.08	2	EA	%	$	$
			0001EP	44900	Drain App Abscess Open	$703.41	2	EA	%	$	$
			0001EQ	44960	Appendectomy	$786.96	3	EA	%	$	$
			0001ER	44970	Laparoscopy appendectomy	$541.10	18	EA	%	$	$
			0001ES	45100	Biopsy Rectum	$273.54	1	EA	%	$	$
			0001ET	45112	Removal Rectum	$1,662.09	1	EA	%	$	$
			0001EU	45171	Exc Tect Tum Transanal Part	$557.12	2	EA	%	$	$
			0001EV	45172	Exc rect tum transanal full	$746.64	2	EA	%	$	$
			0001EW	45300	Proscosigmoidoscopy	$124.96	2	EA	%	$	$
			0001EX	45330	Diagnostic Sigmoidoscopy	$179.81	15	EA	%	$	$
			0001EY	45331	Sigmoidoscopy and Biopsy	$276.87	8	EA	%	$	$
			0001EZ	45333	Sigmoidoscopy and Polypectomy	$318.95	5	EA	%	$	$
			0001FA	45335	Sigmoidoscopy W/Submuc Inj	$281.69	2	EA	%	$	$
			0001FB	45338	Sigmoidoscopy W/Tumr Remov	$291.90	1	EA	%	$	$
			0001FC	45378	Diagnostic colonoscopy	$333.92	250	EA	%	$	$
			0001FD	45380	Colonoscopy and biopsy	$425.29	175	EA	%	$	$
			0001FE	45381	Colonoscopy submucous njx	$433.95	45	EA	%	$	$
			0001FF	45382	Colonoscopy w/control bleed	$650.86	2	EA	%	$	$
			0001FG	45384	Colonoscopy w/ Lesion Removal	$478.17	175	EA	%	$	$
			0001FH	45385	Colonoscopy w/lesion removal	$447.32	120	EA	%	$	$
			0001FJ	45386	Colonoscopy Dilate Stricture	$594.98	4	EA	%	$	$
			0001FK	45990	Surg dx exam anorectal	$95.19	2	EA	%	$	$
			0001FL	46040	Incision of rectal abscess	$541.82	8	EA	%	$	$
			0001FM	46200	Removal Anal Fissure	$463.74	3	EA	%	$	$
			0001FN	46250	Remove Ext Hem Groups 2+	$467.63	2	EA	%	$	$
			0001FP	46260	Remove in/ex hem groups 2+	$436.18	9	EA	%	$	$
			0001FQ	46270	Removal Anal Fissure SubQ	$523.14	6	EA	%	$	$
			0001FR	46600	Diagnostic Anoscopy	$115.34	3	EA	%	$	$
			0001FS	46604	Anoscopy and dilation	$628.48	6	EA	%	$	$
			0001FT	46922	Excision of anal lesion(s)	$305.41	3	EA	%	$	$
			0001FU	46947	Hemorrhoidopexy by stapling	$350.52	5	EA	%	$	$
			0001FV	47100	Wedge biopsy of liver	$760.76	5	EA	%	$	$
			0001FW	47562	Laparoscopic cholecystectomy	$592.02	45	EA	%	$	$
			0001FX	47563	Laparo cholecystectomy/graph	$645.15	50	EA	%	$	$
			0001FY	47600	Removal of gallbladder	$959.86	4	EA	%	$	$
			0001FZ	47605	Removal Gallbladder	$1,011.51	4	EA	%	$	$
			0001GA	49000	Exploration of abdomen	$690.79	2	EA	%	$	$
			0001GB	49002	Reopening of abdomen	$935.69	3	EA	%	$	$
			0001GC	49020	Drainage abdom abscess open	$1,430.68	3	EA	%	$	$
			0001GD	49320	Diag Laparo Separate Proc	$295.60	2	EA	%	$	$
			0001GE	49322	Laparoscopy Aspiration	$337.91	2	EA	%	$	$
			0001GF	49402	Remove foreign body Abdomen	$767.13	2	EA	%	$	$
			0001GG	49505	Prp i/hern init reduc >5 yr	$469.66	100	EA	%	$	$
			0001GH	49520	Rerepair ing hernia reduce	$568.88	11	EA	%	$	$
			0001GJ	49521	Rerepair ing hernia blocked	$644.16	11	EA	%	$	$
			0001GK	49550	Rpr Rem Hernia Init Reduce	$519.31	2	EA	%	$	$
			0001GL	49555	Rerepair fem hernia reduce	$543.12	1	EA	%	$	$
			0001GM	49591	Rpr aa hrn 1st < 3 cm rdc	$306.79	1	EA	%	$	$
			0001GN	49613	Rpr aa hrn rcr < 3 rdc	$378.66	19	EA	%	$	$
			0001GP	15853	Removal sutr/stapl xreq anes	$10.60	41	EA	%	$	$
			0001GQ	99203	Office/outpatient visit new	$111.60	1000	EA	%	$	$
			0001GR	99204	Office/outpatient visit new	$167.08	45	EA	%	$	$

1ST OPTION YR

					ESTIMATED COST - POP 1 JAN 2025 - 31 DEC 2025
			CLIN	CPT/HCPCS Code	Short Description	CMS Unit Cost
Est Qty	U/I	% of CMS Unit Cost	Fixed Priced EA	Estimated Total Fee For 1st Option Year
			1001AA	10060	Drainage of skin abscess	$123.78	2	EA	%	$	$
			1001AB	10061	Drainage of skin abscess	$210.49	4	EA	%	$	$
			1001AC	10081	Drainage Pilonidal Cyst	$334.57	5	EA	%	$	$
			1001AD	10120	Remove foreign body	$147.74	4	EA	%	$	$
			1001AE	10121	Remove foreign body	$260.26	1	EA	%	$	$
			1001AF	10140	Drainage hematoma	$166.03	1	EA	%	$	$
			1001AG	10180	Complex Drainage Wound	$255.50	3	EA	%	$	$
			1001AH	11008	Remove mesh from abd wall	$243.79	3	EA	%	$	$
			1001AJ	11042	Debride SubQ Tissue	$125.79	2	EA	%	$	$
			1001AK	11043	Deb musc/fascia 20 sq cm/<	$228.19	1	EA	%	$	$
			1001AL	11044	Deb Bone 20 sq cm/<	$306.05	3	EA	%	$	$
			1001AM	11103	Biopsy Skin Lesion	$49.22	2	EA	%	$	$
			1001AN	11400	Exc tr-ext b9+marg< 0.5 cm	$124.88	4	EA	%	$	$
			1001AP	11403	Exc tr-ext b9+marg 2.1 - 3 cm	$193.99	4	EA	%	$	$
			1001AQ	11404	Exc tr-ext b9+marg 3.1 - 4 cm	$219.65	4	EA	%	$	$
			1001AR	11406	Exc tr-ext b9+marg >4.0 cm	$312.05	5	EA	%	$	$
			1001AS	11420	Exc h-f-nk-sp b9+marg < 0.5	$125.09	6	EA	%	$	$
			1001AT	11421	Exc h-f-nk-sp b9+marg 0.6 - 1	$157.49	5	EA	%	$	$
			1001AU	11422	Exc h-f-nk-sp b9+marg 1.1 - 2	$176.42	5	EA	%	$	$
			1001AV	11423	Exc h-f-nk-sp b9+marg 2.1-3	$201.50	2	EA	%	$	$
			1001AW	11424	Exc h-f-nk-sp b9+marg 3.1 - 4	$232.09	1	EA	%	$	$
			1001AX	11426	Exc h-f-nk-sp b9+marg >4	$326.21	2	EA	%	$	$
			1001AY	11441	Exc Face-MM	$170.95	3	EA	%	$	$
			1001AZ	11442	Exc Face-MM	$190.04	3	EA	%	$	$
			1001BA	11444	Exc Face-MM	$279.59	1	EA	%	$	$
			1001BB	11601	Exc TR-Ext Mal	$224.56	3	EA	%	$	$
			1001BC	11602	Exc TR-Ext Mal	$240.81	3	EA	%	$	$
			1001BD	11603	Exc TR-Ext Mal	$274.99	2	EA	%	$	$
			1001BE	11606	Exc TR-Ext Mal	$439.39	1	EA	%	$	$
			1001BF	11620	Exc h-f-nk-sp Mal	$194.52	4	EA	%	$	$
			1001BG	11621	Exc h-f-nk-sp Mal	$225.74	2	EA	%	$	$
			1001BH	11622	Exc h-f-nk-sp Mal	$248.88	4	EA	%	$	$
			1001BJ	11624	Exc h-f-nk-sp Mal	$332.15	1	EA	%	$	$
			1001BK	11640	Exc h-f-nk-sp Mal	$199.05	4	EA	%	$	$
			1001BL	11641	Exc h-f-nk-sp Mal	$233.05	2	EA	%	$	$
			1001BM	11642	Exc h-f-nk-sp Mal	$263.70	6	EA	%	$	$
			1001BN	11643	Exc h-f-nk-sp Mal	$310.84	1	EA	%	$	$
			1001BP	11771	Remove pilonidal cyst exten	$612.82	6	EA	%	$	$
			1001BQ	12001	Repair Superficial Wound	$91.67	1	EA	%	$	$
			1001BR	12004	Repair Superficial Wound	$129.60	1	EA	%	$	$
			1001BS	12011	Repair Superficial Wound	$109.89	1	EA	%	$	$
			1001BT	12013	Repair Superficial Wound	$115.09	1	EA	%	$	$
			1001BU	15120	Skn Splt A-Grft	$833.36	2	EA	%	$	$
			1001BV	15734	Muscle Skin Grft Trunk	$1,349.64	3	EA	%	$	$
			1001BW	17000	Destruction Premalig Lesion	$65.99	3	EA	%	$	$
			1001BX	17003	Destruction Premalig Lesion 2-14	$6.53	3	EA	%	$	$
			1001BY	17282	Destruction Skin Lesion	$203.28	1	EA	%	$	$
			1001BZ	19120	Removal of breast lesion	$505.93	2	EA	%	$	$
			1001CA	19300	Removal of breast tissue	$566.86	3	EA	%	$	$
			1001CB	21552	Exc Face Less SBQ 3 cm />	$402.72	2	EA	%	$	$
			0001CC	21554	Exc Face Less SBQ 5 cm />	$660.89	2	EA	%	$	$
			0001CD	21555	Exc Neck Less SC < 3 cm	$424.69	1	EA	%	$	$
			0001CE	21920	Biopsy Soft Tissue Back	$251.27	1	EA	%	$	$
			0001CF	21931	Exc back les sc 3 cm/>	$422.56	1	EA	%	$	$
			0001CG	21933	Exc back tum deep 5 cm/>	$664.51	1	EA	%	$	$
			0001CH	22900	Exc Abdl Tum Deep	$509.19	2	EA	%	$	$
			0001CJ	22903	Exc Abd less SC 3 cm />	$395.83	2	EA	%	$	$
			0001CK	27590	Amputate leg at thigh	$702.28	3	EA	%	$	$
			0001CL	27880	Amputation of lower leg	$806.12	4	EA	%	$	$
			0001CM	28805	Amputation thru metatarsal	$651.34	5	EA	%	$	$
			0001CN	28810	Amputation toe & metatarsal	$385.01	6	EA	%	$	$
			0001CP	28820	Amputation toe	$294.23	3	EA	%	$	$
			0001CQ	36556	Insert non-tunnel cv cath	$209.01	4	EA	%	$	$
			0001CR	36561	Insert tunneled cv cath	$955.60	7	EA	%	$	$
			0001CS	36590	Removal tunneled cv cath	$220.29	5	EA	%	$	$
			0001CT	38500	Biopsy/removal lymph nodes	$328.95	2	EA	%	$	$
			0001CU	38510	Biopsy/removal lymph nodes	$521.69	3	EA	%	$	$
			0001CV	43235	Egd diagnostic brush wash	$281.38	165	EA	%	$	$
			0001CW	43236	Upper GI Scope W/Submuc Inj	$390.88	1	EA	%	$	$
			0001CX	43239	Egd biopsy single/multiple	$367.24	277	EA	%	$	$
			0001CY	43245	Upper GI Scope Dilate Strictr	$577.55	3	EA	%	$	$
			0001CZ	43246	Place gastrostomy tube	$181.38	20	EA	%	$	$
			0001DA	43247	Operative Upper GI Endoscopy	$375.69	10	EA	%	$	$
			0001DB	43248	Uppr GI Endoscopy/Guide Wire	$403.69	10	EA	%	$	$
			0001DC	43249	Esoph egd dilation <30 mm	$1,042.64	30	EA	%	$	$
			0001DD	43250	Dilate Esophagus	$439.58	20	EA	%	$	$
			0001DE	43251	Operative Upper GI Endoscopy	$484.44	19	EA	%	$	$
			0001DF	43255	Operative Upper GI Endoscopy	$610.43	1	EA	%	$	$
			0001DG	43280	Laparoscopy fundoplasty	$965.58	3	EA	%	$	$
			0001DH	43450	Dilate Esophagus	$182.80	30	EA	%	$	$
			0001DJ	43633	Removal of stomach partial	$1,722.33	3	EA	%	$	$
			0001DK	43762	Change gastrostomy tube	$218.80	20	EA	%	$	$
			0001DL	43800	Reconsstruction Pylorus	$833.46	1	EA	%	$	$
			1001DM	43830	Place gastrostomy tube	$631.33	8	EA	%	$	$
			1001DN	44050	Reduce bowel obstruction	$839.89	3	EA	%	$	$
			1001DP	44120	Removal Small Intestine	$1,095.53	5	EA	%	$	$
			1001DQ	44139	Mobilization of colon	$108.02	5	EA	%	$	$
			1001DR	44140	Partial removal of colon	$1,203.75	10	EA	%	$	$
			1001DS	44141	Partial removal of colon	$1,624.17	3	EA	%	$	$
			1001DT	44145	Partial removal of colon	$1,485.35	10	EA	%	$	$
			1001DU	44147	Partial removal of colon	$1,733.32	10	EA	%	$	$
			1001DV	44160	Removal of colon	$1,115.13	5	EA	%	$	$
			1001DW	44188	Lap Colostomy	$1,091.68	3	EA	%	$	$
			1001DX	44204	Laparo partial colectomy	$1,381.66	10	EA	%	$	$
			1001DY	44205	Lap colectomy part w/ileum	$1,201.95	10	EA	%	$	$
			1001DZ	44207	L colectomy/coloproctostomy	$1,633.59	8	EA	%	$	$
			1001EA	44213	Lap mobil splenic fl add-on	$167.69	3	EA	%	$	$
			1001EB	44300	Open Bowel to Skin	$754.69	1	EA	%	$	$
			1001EC	44320	Colostomy	$1,078.24	5	EA	%	$	$
			1001ED	44380	Small Bowel Endoscopy	$189.27	1	EA	%	$	$
			1001EE	44388	Colonoscopy thru stoma spx	$309.01	5	EA	%	$	$
			1001EF	44389	Colonoscopy with Biopsy	$402.54	1	EA	%	$	$
			1001EG	44602	Suture small intestine	$1,262.35	1	EA	%	$	$
			1001EH	44604	Suture large intestine	$947.87	1	EA	%	$	$
			1001EJ	44625	Repair bowel opening	$912.53	1	EA	%	$	$
			1001EK	44626	Repair bowel opening	$1,431.36	6	EA	%	$	$
			1001EL	44640	Repair bowel-skin fistula	$1,254.03	2	EA	%	$	$
			1001EM	44650	Repair bowel fistula	$1,295.45	2	EA	%	$	$
			1001EN	44661	Repair Bowel-Bladder Fistula	$1,392.08	2	EA	%	$	$
			1001EP	44900	Drain App Abscess Open	$703.41	2	EA	%	$	$
			1001EQ	44960	Appendectomy	$786.96	3	EA	%	$	$
			1001ER	44970	Laparoscopy appendectomy	$541.10	18	EA	%	$	$
			1001ES	45100	Biopsy Rectum	$273.54	1	EA	%	$	$
			1001ET	45112	Removal Rectum	$1,662.09	1	EA	%	$	$
			1001EU	45171	Exc Tect Tum Transanal Part	$557.12	2	EA	%	$	$
			1001EV	45172	Exc rect tum transanal full	$746.64	2	EA	%	$	$
			1001EW	45300	Proscosigmoidoscopy	$124.96	2	EA	%	$	$
			1001EX	45330	Diagnostic Sigmoidoscopy	$179.81	15	EA	%	$	$
			1001EY	45331	Sigmoidoscopy and Biopsy	$276.87	8	EA	%	$	$
			1001EZ	45333	Sigmoidoscopy and Polypectomy	$318.95	5	EA	%	$	$
			1001FA	45335	Sigmoidoscopy W/Submuc Inj	$281.69	2	EA	%	$	$
			1001FB	45338	Sigmoidoscopy W/Tumr Remov	$291.90	1	EA	%	$	$
			1001FC	45378	Diagnostic colonoscopy	$333.92	250	EA	%	$	$
			1001FD	45380	Colonoscopy and biopsy	$425.29	175	EA	%	$	$
			1001FE	45381	Colonoscopy submucous njx	$433.95	45	EA	%	$	$
			1001FF	45382	Colonoscopy w/control bleed	$650.86	2	EA	%	$	$
			1001FG	45384	Colonoscopy w/ Lesion Removal	$478.17	175	EA	%	$	$
			1001FH	45385	Colonoscopy w/lesion removal	$447.32	120	EA	%	$	$
			1001FJ	45386	Colonoscopy Dilate Stricture	$594.98	4	EA	%	$	$
			1001FK	45990	Surg dx exam anorectal	$95.19	2	EA	%	$	$
			1001FL	46040	Incision of rectal abscess	$541.82	8	EA	%	$	$
			1001FM	46200	Removal Anal Fissure	$463.74	3	EA	%	$	$
			1001FN	46250	Remove Ext Hem Groups 2+	$467.63	2	EA	%	$	$
			1001FP	46260	Remove in/ex hem groups 2+	$436.18	9	EA	%	$	$
			1001FQ	46270	Removal Anal Fissure SubQ	$523.14	6	EA	%	$	$
			1001FR	46600	Diagnostic Anoscopy	$115.34	3	EA	%	$	$
			1001FS	46604	Anoscopy and dilation	$628.48	6	EA	%	$	$
			1001FT	46922	Excision of anal lesion(s)	$305.41	3	EA	%	$	$
			1001FU	46947	Hemorrhoidopexy by stapling	$350.52	5	EA	%	$	$
			1001FV	47100	Wedge biopsy of liver	$760.76	5	EA	%	$	$
			1001FW	47562	Laparoscopic cholecystectomy	$592.02	45	EA	%	$	$
			1001FX	47563	Laparo cholecystectomy/graph	$645.15	50	EA	%	$	$
			1001FY	47600	Removal of gallbladder	$959.86	4	EA	%	$	$
			1001FZ	47605	Removal Gallbladder	$1,011.51	4	EA	%	$	$
			1001GA	49000	Exploration of abdomen	$690.79	2	EA	%	$	$
			1001GB	49002	Reopening of abdomen	$935.69	3	EA	%	$	$
			1001GC	49020	Drainage abdom abscess open	$1,430.68	3	EA	%	$	$
			1001GD	49320	Diag Laparo Separate Proc	$295.60	2	EA	%	$	$
			1001GE	49322	Laparoscopy Aspiration	$337.91	2	EA	%	$	$
			1001GF	49402	Remove foreign body Abdomen	$767.13	2	EA	%	$	$
			1001GG	49505	Prp i/hern init reduc >5 yr	$469.66	100	EA	%	$	$
			1001GH	49520	Rerepair ing hernia reduce	$568.88	11	EA	%	$	$
			1001GJ	49521	Rerepair ing hernia blocked	$644.16	11	EA	%	$	$
			1001GK	49550	Rpr Rem Hernia Init Reduce	$519.31	2	EA	%	$	$
			1001GL	49555	Rerepair fem hernia reduce	$543.12	1	EA	%	$	$
			1001GM	49591	Rpr aa hrn 1st < 3 cm rdc	$306.79	1	EA	%	$	$
			1001GN	49613	Rpr aa hrn rcr < 3 rdc	$378.66	19	EA	%	$	$
			1001GP	15853	Removal sutr/stapl xreq anes	$10.60	41	EA	%	$	$
			1001GQ	99203	Office/outpatient visit new	$111.60	1000	EA	%	$	$
			1001GR	99204	Office/outpatient visit new	$167.08	45	EA	%	$	$

2ND OPTION YR

					ESTIMATED COST - POP 1 JAN 2026 - 31 DEC 2026
			CLIN	CPT/HCPCS Code	Short Description	CMS Unit Cost
Est Qty	U/I	% of CMS Unit Cost	Fixed Priced EA	Estimated Total Fee For 1st Option Year
			2001AA	10060	Drainage of skin abscess	$123.78	2	EA	%	$	$
			2001AB	10061	Drainage of skin abscess	$210.49	4	EA	%	$	$
			2001AC	10081	Drainage Pilonidal Cyst	$334.57	5	EA	%	$	$
			2001AD	10120	Remove foreign body	$147.74	4	EA	%	$	$
			2001AE	10121	Remove foreign body	$260.26	1	EA	%	$	$
			2001AF	10140	Drainage hematoma	$166.03	1	EA	%	$	$
			2001AG	10180	Complex Drainage Wound	$255.50	3	EA	%	$	$
			2001AH	11008	Remove mesh from abd wall	$243.79	3	EA	%	$	$
			2001AJ	11042	Debride SubQ Tissue	$125.79	2	EA	%	$	$
			2001AK	11043	Deb musc/fascia 20 sq cm/<	$228.19	1	EA	%	$	$
			2001AL	11044	Deb Bone 20 sq cm/<	$306.05	3	EA	%	$	$
			2001AM	11103	Biopsy Skin Lesion	$49.22	2	EA	%	$	$
			2001AN	11400	Exc tr-ext b9+marg< 0.5 cm	$124.88	4	EA	%	$	$
			2001AP	11403	Exc tr-ext b9+marg 2.1 - 3 cm	$193.99	4	EA	%	$	$
			2001AQ	11404	Exc tr-ext b9+marg 3.1 - 4 cm	$219.65	4	EA	%	$	$
			2001AR	11406	Exc tr-ext b9+marg >4.0 cm	$312.05	5	EA	%	$	$
			2001AS	11420	Exc h-f-nk-sp b9+marg < 0.5	$125.09	6	EA	%	$	$
			2001AT	11421	Exc h-f-nk-sp b9+marg 0.6 - 1	$157.49	5	EA	%	$	$
			2001AU	11422	Exc h-f-nk-sp b9+marg 1.1 - 2	$176.42	5	EA	%	$	$
			2001AV	11423	Exc h-f-nk-sp b9+marg 2.1-3	$201.50	2	EA	%	$	$
			2001AW	11424	Exc h-f-nk-sp b9+marg 3.1 - 4	$232.09	1	EA	%	$	$
			2001AX	11426	Exc h-f-nk-sp b9+marg >4	$326.21	2	EA	%	$	$
			2001AY	11441	Exc Face-MM	$170.95	3	EA	%	$	$
			2001AZ	11442	Exc Face-MM	$190.04	3	EA	%	$	$
			2001BA	11444	Exc Face-MM	$279.59	1	EA	%	$	$
			2001BB	11601	Exc TR-Ext Mal	$224.56	3	EA	%	$	$
			2001BC	11602	Exc TR-Ext Mal	$240.81	3	EA	%	$	$
			2001BD	11603	Exc TR-Ext Mal	$274.99	2	EA	%	$	$
			2001BE	11606	Exc TR-Ext Mal	$439.39	1	EA	%	$	$
			2001BF	11620	Exc h-f-nk-sp Mal	$194.52	4	EA	%	$	$
			2001BG	11621	Exc h-f-nk-sp Mal	$225.74	2	EA	%	$	$
			2001BH	11622	Exc h-f-nk-sp Mal	$248.88	4	EA	%	$	$
			2001BJ	11624	Exc h-f-nk-sp Mal	$332.15	1	EA	%	$	$
			2001BK	11640	Exc h-f-nk-sp Mal	$199.05	4	EA	%	$	$
			2001BL	11641	Exc h-f-nk-sp Mal	$233.05	2	EA	%	$	$
			2001BM	11642	Exc h-f-nk-sp Mal	$263.70	6	EA	%	$	$
			2001BN	11643	Exc h-f-nk-sp Mal	$310.84	1	EA	%	$	$
			2001BP	11771	Remove pilonidal cyst exten	$612.82	6	EA	%	$	$
			2001BQ	12001	Repair Superficial Wound	$91.67	1	EA	%	$	$
			2001BR	12004	Repair Superficial Wound	$129.60	1	EA	%	$	$
			2001BS	12011	Repair Superficial Wound	$109.89	1	EA	%	$	$
			2001BT	12013	Repair Superficial Wound	$115.09	1	EA	%	$	$
			2001BU	15120	Skn Splt A-Grft	$833.36	2	EA	%	$	$
			2001BV	15734	Muscle Skin Grft Trunk	$1,349.64	3	EA	%	$	$
			2001BW	17000	Destruction Premalig Lesion	$65.99	3	EA	%	$	$
			2001BX	17003	Destruction Premalig Lesion 2-14	$6.53	3	EA	%	$	$
			2001BY	17282	Destruction Skin Lesion	$203.28	1	EA	%	$	$
			2001BZ	19120	Removal of breast lesion	$505.93	2	EA	%	$	$
			2001CA	19300	Removal of breast tissue	$566.86	3	EA	%	$	$
			2001CB	21552	Exc Face Less SBQ 3 cm />	$402.72	2	EA	%	$	$
			2001CC	21554	Exc Face Less SBQ 5 cm />	$660.89	2	EA	%	$	$
			2001CD	21555	Exc Neck Less SC < 3 cm	$424.69	1	EA	%	$	$
			2001CE	21920	Biopsy Soft Tissue Back	$251.27	1	EA	%	$	$
			2001CF	21931	Exc back les sc 3 cm/>	$422.56	1	EA	%	$	$
			2001CG	21933	Exc back tum deep 5 cm/>	$664.51	1	EA	%	$	$
			2001CH	22900	Exc Abdl Tum Deep	$509.19	2	EA	%	$	$
			2001CJ	22903	Exc Abd less SC 3 cm />	$395.83	2	EA	%	$	$
			2001CK	27590	Amputate leg at thigh	$702.28	3	EA	%	$	$
			2001CL	27880	Amputation of lower leg	$806.12	4	EA	%	$	$
			2001CM	28805	Amputation thru metatarsal	$651.34	5	EA	%	$	$
			2001CN	28810	Amputation toe & metatarsal	$385.01	6	EA	%	$	$
			2001CP	28820	Amputation toe	$294.23	3	EA	%	$	$
			2001CQ	36556	Insert non-tunnel cv cath	$209.01	4	EA	%	$	$
			2001CR	36561	Insert tunneled cv cath	$955.60	7	EA	%	$	$
			2001CS	36590	Removal tunneled cv cath	$220.29	5	EA	%	$	$
			2001CT	38500	Biopsy/removal lymph nodes	$328.95	2	EA	%	$	$
			2001CU	38510	Biopsy/removal lymph nodes	$521.69	3	EA	%	$	$
			2001CV	43235	Egd diagnostic brush wash	$281.38	165	EA	%	$	$
			2001CW	43236	Upper GI Scope W/Submuc Inj	$390.88	1	EA	%	$	$
			2001CX	43239	Egd biopsy single/multiple	$367.24	277	EA	%	$	$
			2001CY	43245	Upper GI Scope Dilate Strictr	$577.55	3	EA	%	$	$
			2001CZ	43246	Place gastrostomy tube	$181.38	20	EA	%	$	$
			2001DA	43247	Operative Upper GI Endoscopy	$375.69	10	EA	%	$	$
			2001DB	43248	Uppr GI Endoscopy/Guide Wire	$403.69	10	EA	%	$	$
			2001DC	43249	Esoph egd dilation <30 mm	$1,042.64	30	EA	%	$	$
			2001DD	43250	Dilate Esophagus	$439.58	20	EA	%	$	$
			2001DE	43251	Operative Upper GI Endoscopy	$484.44	19	EA	%	$	$
			2001DF	43255	Operative Upper GI Endoscopy	$610.43	1	EA	%	$	$
			2001DG	43280	Laparoscopy fundoplasty	$965.58	3	EA	%	$	$
			2001DH	43450	Dilate Esophagus	$182.80	30	EA	%	$	$
			2001DJ	43633	Removal of stomach partial	$1,722.33	3	EA	%	$	$
			2001DK	43762	Change gastrostomy tube	$218.80	20	EA	%	$	$
			2001DL	43800	Reconsstruction Pylorus	$833.46	1	EA	%	$	$
			2001DM	43830	Place gastrostomy tube	$631.33	8	EA	%	$	$
			2001DN	44050	Reduce bowel obstruction	$839.89	3	EA	%	$	$
			2001DP	44120	Removal Small Intestine	$1,095.53	5	EA	%	$	$
			2001DQ	44139	Mobilization of colon	$108.02	5	EA	%	$	$
			2001DR	44140	Partial removal of colon	$1,203.75	10	EA	%	$	$
			2001DS	44141	Partial removal of colon	$1,624.17	3	EA	%	$	$
			2001DT	44145	Partial removal of colon	$1,485.35	10	EA	%	$	$
			2001DU	44147	Partial removal of colon	$1,733.32	10	EA	%	$	$
			2001DV	44160	Removal of colon	$1,115.13	5	EA	%	$	$
			2001DW	44188	Lap Colostomy	$1,091.68	3	EA	%	$	$
			2001DX	44204	Laparo partial colectomy	$1,381.66	10	EA	%	$	$
			2001DY	44205	Lap colectomy part w/ileum	$1,201.95	10	EA	%	$	$
			2001DZ	44207	L colectomy/coloproctostomy	$1,633.59	8	EA	%	$	$
			2001EA	44213	Lap mobil splenic fl add-on	$167.69	3	EA	%	$	$
			2001EB	44300	Open Bowel to Skin	$754.69	1	EA	%	$	$
			2001EC	44320	Colostomy	$1,078.24	5	EA	%	$	$
			2001ED	44380	Small Bowel Endoscopy	$189.27	1	EA	%	$	$
			2001EE	44388	Colonoscopy thru stoma spx	$309.01	5	EA	%	$	$
			2001EF	44389	Colonoscopy with Biopsy	$402.54	1	EA	%	$	$
			2001EG	44602	Suture small intestine	$1,262.35	1	EA	%	$	$
			2001EH	44604	Suture large intestine	$947.87	1	EA	%	$	$
			2001EJ	44625	Repair bowel opening	$912.53	1	EA	%	$	$
			2001EK	44626	Repair bowel opening	$1,431.36	6	EA	%	$	$
			2001EL	44640	Repair bowel-skin fistula	$1,254.03	2	EA	%	$	$
			2001EM	44650	Repair bowel fistula	$1,295.45	2	EA	%	$	$
			2001EN	44661	Repair Bowel-Bladder Fistula	$1,392.08	2	EA	%	$	$
			2001EP	44900	Drain App Abscess Open	$703.41	2	EA	%	$	$
			2001EQ	44960	Appendectomy	$786.96	3	EA	%	$	$
			2001ER	44970	Laparoscopy appendectomy	$541.10	18	EA	%	$	$
			2001ES	45100	Biopsy Rectum	$273.54	1	EA	%	$	$
			2001ET	45112	Removal Rectum	$1,662.09	1	EA	%	$	$
			2001EU	45171	Exc Tect Tum Transanal Part	$557.12	2	EA	%	$	$
			2001EV	45172	Exc rect tum transanal full	$746.64	2	EA	%	$	$
			2001EW	45300	Proscosigmoidoscopy	$124.96	2	EA	%	$	$
			2001EX	45330	Diagnostic Sigmoidoscopy	$179.81	15	EA	%	$	$
			2001EY	45331	Sigmoidoscopy and Biopsy	$276.87	8	EA	%	$	$
			2001EZ	45333	Sigmoidoscopy and Polypectomy	$318.95	5	EA	%	$	$
			2001FA	45335	Sigmoidoscopy W/Submuc Inj	$281.69	2	EA	%	$	$
			2001FB	45338	Sigmoidoscopy W/Tumr Remov	$291.90	1	EA	%	$	$
			2001FC	45378	Diagnostic colonoscopy	$333.92	250	EA	%	$	$
			2001FD	45380	Colonoscopy and biopsy	$425.29	175	EA	%	$	$
			2001FE	45381	Colonoscopy submucous njx	$433.95	45	EA	%	$	$
			2001FF	45382	Colonoscopy w/control bleed	$650.86	2	EA	%	$	$
			2001FG	45384	Colonoscopy w/ Lesion Removal	$478.17	175	EA	%	$	$
			2001FH	45385	Colonoscopy w/lesion removal	$447.32	120	EA	%	$	$
			2001FJ	45386	Colonoscopy Dilate Stricture	$594.98	4	EA	%	$	$
			2001FK	45990	Surg dx exam anorectal	$95.19	2	EA	%	$	$
			2001FL	46040	Incision of rectal abscess	$541.82	8	EA	%	$	$
			2001FM	46200	Removal Anal Fissure	$463.74	3	EA	%	$	$
			2001FN	46250	Remove Ext Hem Groups 2+	$467.63	2	EA	%	$	$
			2001FP	46260	Remove in/ex hem groups 2+	$436.18	9	EA	%	$	$
			2001FQ	46270	Removal Anal Fissure SubQ	$523.14	6	EA	%	$	$
			2001FR	46600	Diagnostic Anoscopy	$115.34	3	EA	%	$	$
			2001FS	46604	Anoscopy and dilation	$628.48	6	EA	%	$	$
			2001FT	46922	Excision of anal lesion(s)	$305.41	3	EA	%	$	$
			2001FU	46947	Hemorrhoidopexy by stapling	$350.52	5	EA	%	$	$
			2001FV	47100	Wedge biopsy of liver	$760.76	5	EA	%	$	$
			2001FW	47562	Laparoscopic cholecystectomy	$592.02	45	EA	%	$	$
			2001FX	47563	Laparo cholecystectomy/graph	$645.15	50	EA	%	$	$
			2001FY	47600	Removal of gallbladder	$959.86	4	EA	%	$	$
			2001FZ	47605	Removal Gallbladder	$1,011.51	4	EA	%	$	$
			2001GA	49000	Exploration of abdomen	$690.79	2	EA	%	$	$
			2001GB	49002	Reopening of abdomen	$935.69	3	EA	%	$	$
			2001GC	49020	Drainage abdom abscess open	$1,430.68	3	EA	%	$	$
			2001GD	49320	Diag Laparo Separate Proc	$295.60	2	EA	%	$	$
			2001GE	49322	Laparoscopy Aspiration	$337.91	2	EA	%	$	$
			2001GF	49402	Remove foreign body Abdomen	$767.13	2	EA	%	$	$
			2001GG	49505	Prp i/hern init reduc >5 yr	$469.66	100	EA	%	$	$
			2001GH	49520	Rerepair ing hernia reduce	$568.88	11	EA	%	$	$
			2001GJ	49521	Rerepair ing hernia blocked	$644.16	11	EA	%	$	$
			2001GK	49550	Rpr Rem Hernia Init Reduce	$519.31	2	EA	%	$	$
			2001GL	49555	Rerepair fem hernia reduce	$543.12	1	EA	%	$	$
			2001GM	49591	Rpr aa hrn 1st < 3 cm rdc	$306.79	1	EA	%	$	$
			2001GN	49613	Rpr aa hrn rcr < 3 rdc	$378.66	19	EA	%	$	$
			2001GP	15853	Removal sutr/stapl xreq anes	$10.60	41	EA	%	$	$
			2001GQ	99203	Office/outpatient visit new	$111.60	1000	EA	%	$	$
			2001GH	99204	Office/outpatient visit new	$167.08	45	EA	%	$	$

3RD OPTION YR

					ESTIMATED COST - POP 1 JAN 2027 - 31 DEC 2027
			CLIN	CPT/HCPCS Code	Short Description	CMS Unit Cost
Est Qty	U/I	% of CMS Unit Cost	Fixed Priced EA	Estimated Total Fee For 1st Option Year
			3001AA	10060	Drainage of skin abscess	$123.78	2	EA	%	$	$
			3001AB	10061	Drainage of skin abscess	$210.49	4	EA	%	$	$
			3001AC	10081	Drainage Pilonidal Cyst	$334.57	5	EA	%	$	$
			3001AD	10120	Remove foreign body	$147.74	4	EA	%	$	$
			3001AE	10121	Remove foreign body	$260.26	1	EA	%	$	$
			3001AF	10140	Drainage hematoma	$166.03	1	EA	%	$	$
			3001AG	10180	Complex Drainage Wound	$255.50	3	EA	%	$	$
			3001AH	11008	Remove mesh from abd wall	$243.79	3	EA	%	$	$
			3001AJ	11042	Debride SubQ Tissue	$125.79	2	EA	%	$	$
			3001AK	11043	Deb musc/fascia 20 sq cm/<	$228.19	1	EA	%	$	$
			3001AL	11044	Deb Bone 20 sq cm/<	$306.05	3	EA	%	$	$
			3001AM	11103	Biopsy Skin Lesion	$49.22	2	EA	%	$	$
			3001AN	11400	Exc tr-ext b9+marg< 0.5 cm	$124.88	4	EA	%	$	$
			3001AP	11403	Exc tr-ext b9+marg 2.1 - 3 cm	$193.99	4	EA	%	$	$
			3001AQ	11404	Exc tr-ext b9+marg 3.1 - 4 cm	$219.65	4	EA	%	$	$
			3001AR	11406	Exc tr-ext b9+marg >4.0 cm	$312.05	5	EA	%	$	$
			3001AS	11420	Exc h-f-nk-sp b9+marg < 0.5	$125.09	6	EA	%	$	$
			3001AT	11421	Exc h-f-nk-sp b9+marg 0.6 - 1	$157.49	5	EA	%	$	$
			3001AU	11422	Exc h-f-nk-sp b9+marg 1.1 - 2	$176.42	5	EA	%	$	$
			3001AV	11423	Exc h-f-nk-sp b9+marg 2.1-3	$201.50	2	EA	%	$	$
			3001AW	11424	Exc h-f-nk-sp b9+marg 3.1 - 4	$232.09	1	EA	%	$	$
			3001AX	11426	Exc h-f-nk-sp b9+marg >4	$326.21	2	EA	%	$	$
			3001AY	11441	Exc Face-MM	$170.95	3	EA	%	$	$
			3001AZ	11442	Exc Face-MM	$190.04	3	EA	%	$	$
			3001BA	11444	Exc Face-MM	$279.59	1	EA	%	$	$
			3001BB	11601	Exc TR-Ext Mal	$224.56	3	EA	%	$	$
			3001BC	11602	Exc TR-Ext Mal	$240.81	3	EA	%	$	$
			3001BD	11603	Exc TR-Ext Mal	$274.99	2	EA	%	$	$
			3001BE	11606	Exc TR-Ext Mal	$439.39	1	EA	%	$	$
			3001BF	11620	Exc h-f-nk-sp Mal	$194.52	4	EA	%	$	$
			3001BG	11621	Exc h-f-nk-sp Mal	$225.74	2	EA	%	$	$
			3001BH	11622	Exc h-f-nk-sp Mal	$248.88	4	EA	%	$	$
			3001BJ	11624	Exc h-f-nk-sp Mal	$332.15	1	EA	%	$	$
			3001BK	11640	Exc h-f-nk-sp Mal	$199.05	4	EA	%	$	$
			3001BL	11641	Exc h-f-nk-sp Mal	$233.05	2	EA	%	$	$
			3001BM	11642	Exc h-f-nk-sp Mal	$263.70	6	EA	%	$	$
			3001BN	11643	Exc h-f-nk-sp Mal	$310.84	1	EA	%	$	$
			3001BP	11771	Remove pilonidal cyst exten	$612.82	6	EA	%	$	$
			3001BQ	12001	Repair Superficial Wound	$91.67	1	EA	%	$	$
			3001BR	12004	Repair Superficial Wound	$129.60	1	EA	%	$	$
			3001BS	12011	Repair Superficial Wound	$109.89	1	EA	%	$	$
			3001BT	12013	Repair Superficial Wound	$115.09	1	EA	%	$	$
			3001BU	15120	Skn Splt A-Grft	$833.36	2	EA	%	$	$
			3001BV	15734	Muscle Skin Grft Trunk	$1,349.64	3	EA	%	$	$
			3001BW	17000	Destruction Premalig Lesion	$65.99	3	EA	%	$	$
			3001BX	17003	Destruction Premalig Lesion 2-14	$6.53	3	EA	%	$	$
			3001BY	17282	Destruction Skin Lesion	$203.28	1	EA	%	$	$
			3001BZ	19120	Removal of breast lesion	$505.93	2	EA	%	$	$
			3001CA	19300	Removal of breast tissue	$566.86	3	EA	%	$	$
			3001CB	21552	Exc Face Less SBQ 3 cm />	$402.72	2	EA	%	$	$
			3001CC	21554	Exc Face Less SBQ 5 cm />	$660.89	2	EA	%	$	$
			3001CD	21555	Exc Neck Less SC < 3 cm	$424.69	1	EA	%	$	$
			3001CE	21920	Biopsy Soft Tissue Back	$251.27	1	EA	%	$	$
			3001CF	21931	Exc back les sc 3 cm/>	$422.56	1	EA	%	$	$
			3001CG	21933	Exc back tum deep 5 cm/>	$664.51	1	EA	%	$	$
			3001CH	22900	Exc Abdl Tum Deep	$509.19	2	EA	%	$	$
			3001CJ	22903	Exc Abd less SC 3 cm />	$395.83	2	EA	%	$	$
			3001CK	27590	Amputate leg at thigh	$702.28	3	EA	%	$	$
			3001CL	27880	Amputation of lower leg	$806.12	4	EA	%	$	$
			3001CM	28805	Amputation thru metatarsal	$651.34	5	EA	%	$	$
			3001CN	28810	Amputation toe & metatarsal	$385.01	6	EA	%	$	$
			3001CP	28820	Amputation toe	$294.23	3	EA	%	$	$
			3001CQ	36556	Insert non-tunnel cv cath	$209.01	4	EA	%	$	$
			3001CR	36561	Insert tunneled cv cath	$955.60	7	EA	%	$	$
			3001CS	36590	Removal tunneled cv cath	$220.29	5	EA	%	$	$
			3001CT	38500	Biopsy/removal lymph nodes	$328.95	2	EA	%	$	$
			3001CU	38510	Biopsy/removal lymph nodes	$521.69	3	EA	%	$	$
			3001CV	43235	Egd diagnostic brush wash	$281.38	165	EA	%	$	$
			3001CW	43236	Upper GI Scope W/Submuc Inj	$390.88	1	EA	%	$	$
			3001CX	43239	Egd biopsy single/multiple	$367.24	277	EA	%	$	$
			3001CY	43245	Upper GI Scope Dilate Strictr	$577.55	3	EA	%	$	$
			3001CZ	43246	Place gastrostomy tube	$181.38	20	EA	%	$	$
			3001DA	43247	Operative Upper GI Endoscopy	$375.69	10	EA	%	$	$
			3001DB	43248	Uppr GI Endoscopy/Guide Wire	$403.69	10	EA	%	$	$
			3001DC	43249	Esoph egd dilation <30 mm	$1,042.64	30	EA	%	$	$
			3001DD	43250	Dilate Esophagus	$439.58	20	EA	%	$	$
			3001DE	43251	Operative Upper GI Endoscopy	$484.44	19	EA	%	$	$
			3001DF	43255	Operative Upper GI Endoscopy	$610.43	1	EA	%	$	$
			3001DG	43280	Laparoscopy fundoplasty	$965.58	3	EA	%	$	$
			3001DH	43450	Dilate Esophagus	$182.80	30	EA	%	$	$
			3001DJ	43633	Removal of stomach partial	$1,722.33	3	EA	%	$	$
			3001DK	43762	Change gastrostomy tube	$218.80	20	EA	%	$	$
			3001DL	43800	Reconsstruction Pylorus	$833.46	1	EA	%	$	$
			3001DM	43830	Place gastrostomy tube	$631.33	8	EA	%	$	$
			3001DN	44050	Reduce bowel obstruction	$839.89	3	EA	%	$	$
			3001DP	44120	Removal Small Intestine	$1,095.53	5	EA	%	$	$
			3001DQ	44139	Mobilization of colon	$108.02	5	EA	%	$	$
			3001DR	44140	Partial removal of colon	$1,203.75	10	EA	%	$	$
			3001DS	44141	Partial removal of colon	$1,624.17	3	EA	%	$	$
			3001DT	44145	Partial removal of colon	$1,485.35	10	EA	%	$	$
			3001DU	44147	Partial removal of colon	$1,733.32	10	EA	%	$	$
			3001DV	44160	Removal of colon	$1,115.13	5	EA	%	$	$
			3001DW	44188	Lap Colostomy	$1,091.68	3	EA	%	$	$
			3001DX	44204	Laparo partial colectomy	$1,381.66	10	EA	%	$	$
			3001DY	44205	Lap colectomy part w/ileum	$1,201.95	10	EA	%	$	$
			3001DZ	44207	L colectomy/coloproctostomy	$1,633.59	8	EA	%	$	$
			3001EA	44213	Lap mobil splenic fl add-on	$167.69	3	EA	%	$	$
			3001EB	44300	Open Bowel to Skin	$754.69	1	EA	%	$	$
			3001EC	44320	Colostomy	$1,078.24	5	EA	%	$	$
			3001ED	44380	Small Bowel Endoscopy	$189.27	1	EA	%	$	$
			3001EE	44388	Colonoscopy thru stoma spx	$309.01	5	EA	%	$	$
			3001EF	44389	Colonoscopy with Biopsy	$402.54	1	EA	%	$	$
			3001EG	44602	Suture small intestine	$1,262.35	1	EA	%	$	$
			3001EH	44604	Suture large intestine	$947.87	1	EA	%	$	$
			3001EJ	44625	Repair bowel opening	$912.53	1	EA	%	$	$
			3001EK	44626	Repair bowel opening	$1,431.36	6	EA	%	$	$
			3001EL	44640	Repair bowel-skin fistula	$1,254.03	2	EA	%	$	$
			3001EM	44650	Repair bowel fistula	$1,295.45	2	EA	%	$	$
			3001EN	44661	Repair Bowel-Bladder Fistula	$1,392.08	2	EA	%	$	$
			3001EP	44900	Drain App Abscess Open	$703.41	2	EA	%	$	$
			3001EQ	44960	Appendectomy	$786.96	3	EA	%	$	$
			3001ER	44970	Laparoscopy appendectomy	$541.10	18	EA	%	$	$
			3001ES	45100	Biopsy Rectum	$273.54	1	EA	%	$	$
			3001ET	45112	Removal Rectum	$1,662.09	1	EA	%	$	$
			3001EU	45171	Exc Tect Tum Transanal Part	$557.12	2	EA	%	$	$
			3001EV	45172	Exc rect tum transanal full	$746.64	2	EA	%	$	$
			3001EW	45300	Proscosigmoidoscopy	$124.96	2	EA	%	$	$
			3001EX	45330	Diagnostic Sigmoidoscopy	$179.81	15	EA	%	$	$
			3001EY	45331	Sigmoidoscopy and Biopsy	$276.87	8	EA	%	$	$
			3001EZ	45333	Sigmoidoscopy and Polypectomy	$318.95	5	EA	%	$	$
			3001FA	45335	Sigmoidoscopy W/Submuc Inj	$281.69	2	EA	%	$	$
			3001FB	45338	Sigmoidoscopy W/Tumr Remov	$291.90	1	EA	%	$	$
			3001FC	45378	Diagnostic colonoscopy	$333.92	250	EA	%	$	$
			3001FD	45380	Colonoscopy and biopsy	$425.29	175	EA	%	$	$
			3001FE	45381	Colonoscopy submucous njx	$433.95	45	EA	%	$	$
			3001FF	45382	Colonoscopy w/control bleed	$650.86	2	EA	%	$	$
			3001FG	45384	Colonoscopy w/ Lesion Removal	$478.17	175	EA	%	$	$
			3001FH	45385	Colonoscopy w/lesion removal	$447.32	120	EA	%	$	$
			3001FJ	45386	Colonoscopy Dilate Stricture	$594.98	4	EA	%	$	$
			3001FK	45990	Surg dx exam anorectal	$95.19	2	EA	%	$	$
			3001FL	46040	Incision of rectal abscess	$541.82	8	EA	%	$	$
			3001FM	46200	Removal Anal Fissure	$463.74	3	EA	%	$	$
			3001FN	46250	Remove Ext Hem Groups 2+	$467.63	2	EA	%	$	$
			3001FP	46260	Remove in/ex hem groups 2+	$436.18	9	EA	%	$	$
			3001FQ	46270	Removal Anal Fissure SubQ	$523.14	6	EA	%	$	$
			3001FR	46600	Diagnostic Anoscopy	$115.34	3	EA	%	$	$
			3001FS	46604	Anoscopy and dilation	$628.48	6	EA	%	$	$
			3001FT	46922	Excision of anal lesion(s)	$305.41	3	EA	%	$	$
			3001FU	46947	Hemorrhoidopexy by stapling	$350.52	5	EA	%	$	$
			3001FV	47100	Wedge biopsy of liver	$760.76	5	EA	%	$	$
			3001FW	47562	Laparoscopic cholecystectomy	$592.02	45	EA	%	$	$
			3001FX	47563	Laparo cholecystectomy/graph	$645.15	50	EA	%	$	$
			3001FY	47600	Removal of gallbladder	$959.86	4	EA	%	$	$
			3001FZ	47605	Removal Gallbladder	$1,011.51	4	EA	%	$	$
			3001GA	49000	Exploration of abdomen	$690.79	2	EA	%	$	$
			3001GB	49002	Reopening of abdomen	$935.69	3	EA	%	$	$
			3001GC	49020	Drainage abdom abscess open	$1,430.68	3	EA	%	$	$
			3001GD	49320	Diag Laparo Separate Proc	$295.60	2	EA	%	$	$
			3001GE	49322	Laparoscopy Aspiration	$337.91	2	EA	%	$	$
			3001GF	49402	Remove foreign body Abdomen	$767.13	2	EA	%	$	$
			3001GG	49505	Prp i/hern init reduc >5 yr	$469.66	100	EA	%	$	$
			3001GH	49520	Rerepair ing hernia reduce	$568.88	11	EA	%	$	$
			3001GJ	49521	Rerepair ing hernia blocked	$644.16	11	EA	%	$	$
			3001GK	49550	Rpr Rem Hernia Init Reduce	$519.31	2	EA	%	$	$
			3001GL	49555	Rerepair fem hernia reduce	$543.12	1	EA	%	$	$
			3001GM	49591	Rpr aa hrn 1st < 3 cm rdc	$306.79	1	EA	%	$	$
			3001GN	49613	Rpr aa hrn rcr < 3 rdc	$378.66	19	EA	%	$	$
			3001GP	15853	Removal sutr/stapl xreq anes	$10.60	41	EA	%	$	$
			3001GQ	99203	Office/outpatient visit new	$111.60	1000	EA	%	$	$
			3001GH	99204	Office/outpatient visit new	$167.08	45	EA	%	$	$

4TH OPTION YR

					ESTIMATED COST - POP 1 JAN 2028 - 31 DEC 2028
			CLIN	CPT/HCPCS Code	Short Description	CMS Unit Cost
Est Qty	U/I	% of CMS Unit Cost	Fixed Priced EA	Estimated Total Fee For 1st Option Year
			4001AA	10060	Drainage of skin abscess	$123.78	2	EA	%	$	$
			4001AB	10061	Drainage of skin abscess	$210.49	4	EA	%	$	$
			4001AC	10081	Drainage Pilonidal Cyst	$334.57	5	EA	%	$	$
			4001AD	10120	Remove foreign body	$147.74	4	EA	%	$	$
			4001AE	10121	Remove foreign body	$260.26	1	EA	%	$	$
			4001AF	10140	Drainage hematoma	$166.03	1	EA	%	$	$
			4001AG	10180	Complex Drainage Wound	$255.50	3	EA	%	$	$
			4001AH	11008	Remove mesh from abd wall	$243.79	3	EA	%	$	$
			4001AJ	11042	Debride SubQ Tissue	$125.79	2	EA	%	$	$
			4001AK	11043	Deb musc/fascia 20 sq cm/<	$228.19	1	EA	%	$	$
			4001AL	11044	Deb Bone 20 sq cm/<	$306.05	3	EA	%	$	$
			4001AM	11103	Biopsy Skin Lesion	$49.22	2	EA	%	$	$
			4001AN	11400	Exc tr-ext b9+marg< 0.5 cm	$124.88	4	EA	%	$	$
			4001AP	11403	Exc tr-ext b9+marg 2.1 - 3 cm	$193.99	4	EA	%	$	$
			4001AQ	11404	Exc tr-ext b9+marg 3.1 - 4 cm	$219.65	4	EA	%	$	$
			4001AR	11406	Exc tr-ext b9+marg >4.0 cm	$312.05	5	EA	%	$	$
			4001AS	11420	Exc h-f-nk-sp b9+marg < 0.5	$125.09	6	EA	%	$	$
			4001AT	11421	Exc h-f-nk-sp b9+marg 0.6 - 1	$157.49	5	EA	%	$	$
			4001AU	11422	Exc h-f-nk-sp b9+marg 1.1 - 2	$176.42	5	EA	%	$	$
			4001AV	11423	Exc h-f-nk-sp b9+marg 2.1-3	$201.50	2	EA	%	$	$
			4001AW	11424	Exc h-f-nk-sp b9+marg 3.1 - 4	$232.09	1	EA	%	$	$
			4001AX	11426	Exc h-f-nk-sp b9+marg >4	$326.21	2	EA	%	$	$
			4001AY	11441	Exc Face-MM	$170.95	3	EA	%	$	$
			4001AZ	11442	Exc Face-MM	$190.04	3	EA	%	$	$
			4001BA	11444	Exc Face-MM	$279.59	1	EA	%	$	$
			4001BB	11601	Exc TR-Ext Mal	$224.56	3	EA	%	$	$
			4001BC	11602	Exc TR-Ext Mal	$240.81	3	EA	%	$	$
			4001BD	11603	Exc TR-Ext Mal	$274.99	2	EA	%	$	$
			4001BE	11606	Exc TR-Ext Mal	$439.39	1	EA	%	$	$
			4001BF	11620	Exc h-f-nk-sp Mal	$194.52	4	EA	%	$	$
			4001BG	11621	Exc h-f-nk-sp Mal	$225.74	2	EA	%	$	$
			4001BH	11622	Exc h-f-nk-sp Mal	$248.88	4	EA	%	$	$
			4001BJ	11624	Exc h-f-nk-sp Mal	$332.15	1	EA	%	$	$
			4001BK	11640	Exc h-f-nk-sp Mal	$199.05	4	EA	%	$	$
			4001BL	11641	Exc h-f-nk-sp Mal	$233.05	2	EA	%	$	$
			4001BM	11642	Exc h-f-nk-sp Mal	$263.70	6	EA	%	$	$
			4001BN	11643	Exc h-f-nk-sp Mal	$310.84	1	EA	%	$	$
			4001BP	11771	Remove pilonidal cyst exten	$612.82	6	EA	%	$	$
			4001BQ	12001	Repair Superficial Wound	$91.67	1	EA	%	$	$
			4001BR	12004	Repair Superficial Wound	$129.60	1	EA	%	$	$
			4001BS	12011	Repair Superficial Wound	$109.89	1	EA	%	$	$
			4001BT	12013	Repair Superficial Wound	$115.09	1	EA	%	$	$
			4001BU	15120	Skn Splt A-Grft	$833.36	2	EA	%	$	$
			4001BV	15734	Muscle Skin Grft Trunk	$1,349.64	3	EA	%	$	$
			4001BW	17000	Destruction Premalig Lesion	$65.99	3	EA	%	$	$
			4001BX	17003	Destruction Premalig Lesion 2-14	$6.53	3	EA	%	$	$
			4001BY	17282	Destruction Skin Lesion	$203.28	1	EA	%	$	$
			4001BZ	19120	Removal of breast lesion	$505.93	2	EA	%	$	$
			4001CA	19300	Removal of breast tissue	$566.86	3	EA	%	$	$
			4001CB	21552	Exc Face Less SBQ 3 cm />	$402.72	2	EA	%	$	$
			4001CC	21554	Exc Face Less SBQ 5 cm />	$660.89	2	EA	%	$	$
			4001CD	21555	Exc Neck Less SC < 3 cm	$424.69	1	EA	%	$	$
			4001CE	21920	Biopsy Soft Tissue Back	$251.27	1	EA	%	$	$
			4001CF	21931	Exc back les sc 3 cm/>	$422.56	1	EA	%	$	$
			4001CG	21933	Exc back tum deep 5 cm/>	$664.51	1	EA	%	$	$
			4001CH	22900	Exc Abdl Tum Deep	$509.19	2	EA	%	$	$
			4001CJ	22903	Exc Abd less SC 3 cm />	$395.83	2	EA	%	$	$
			4001CK	27590	Amputate leg at thigh	$702.28	3	EA	%	$	$
			4001CL	27880	Amputation of lower leg	$806.12	4	EA	%	$	$
			4001CM	28805	Amputation thru metatarsal	$651.34	5	EA	%	$	$
			4001CN	28810	Amputation toe & metatarsal	$385.01	6	EA	%	$	$
			4001CP	28820	Amputation toe	$294.23	3	EA	%	$	$
			4001CQ	36556	Insert non-tunnel cv cath	$209.01	4	EA	%	$	$
			4001CR	36561	Insert tunneled cv cath	$955.60	7	EA	%	$	$
			4001CS	36590	Removal tunneled cv cath	$220.29	5	EA	%	$	$
			4001CT	38500	Biopsy/removal lymph nodes	$328.95	2	EA	%	$	$
			4001CU	38510	Biopsy/removal lymph nodes	$521.69	3	EA	%	$	$
			4001CV	43235	Egd diagnostic brush wash	$281.38	165	EA	%	$	$
			4001CW	43236	Upper GI Scope W/Submuc Inj	$390.88	1	EA	%	$	$
			4001CX	43239	Egd biopsy single/multiple	$367.24	277	EA	%	$	$
			4001CY	43245	Upper GI Scope Dilate Strictr	$577.55	3	EA	%	$	$
			4001CZ	43246	Place gastrostomy tube	$181.38	20	EA	%	$	$
			4001DA	43247	Operative Upper GI Endoscopy	$375.69	10	EA	%	$	$
			4001DB	43248	Uppr GI Endoscopy/Guide Wire	$403.69	10	EA	%	$	$
			4001DC	43249	Esoph egd dilation <30 mm	$1,042.64	30	EA	%	$	$
			4001DD	43250	Dilate Esophagus	$439.58	20	EA	%	$	$
			4001DE	43251	Operative Upper GI Endoscopy	$484.44	19	EA	%	$	$
			4001DF	43255	Operative Upper GI Endoscopy	$610.43	1	EA	%	$	$
			4001DG	43280	Laparoscopy fundoplasty	$965.58	3	EA	%	$	$
			4001DH	43450	Dilate Esophagus	$182.80	30	EA	%	$	$
			4001DJ	43633	Removal of stomach partial	$1,722.33	3	EA	%	$	$
			4001DK	43762	Change gastrostomy tube	$218.80	20	EA	%	$	$
			4001DL	43800	Reconsstruction Pylorus	$833.46	1	EA	%	$	$
			4001DM	43830	Place gastrostomy tube	$631.33	8	EA	%	$	$
			4001DN	44050	Reduce bowel obstruction	$839.89	3	EA	%	$	$
			4001DP	44120	Removal Small Intestine	$1,095.53	5	EA	%	$	$
			4001DQ	44139	Mobilization of colon	$108.02	5	EA	%	$	$
			4001DR	44140	Partial removal of colon	$1,203.75	10	EA	%	$	$
			4001DS	44141	Partial removal of colon	$1,624.17	3	EA	%	$	$
			4001DT	44145	Partial removal of colon	$1,485.35	10	EA	%	$	$
			4001DU	44147	Partial removal of colon	$1,733.32	10	EA	%	$	$
			4001DV	44160	Removal of colon	$1,115.13	5	EA	%	$	$
			4001DW	44188	Lap Colostomy	$1,091.68	3	EA	%	$	$
			4001DX	44204	Laparo partial colectomy	$1,381.66	10	EA	%	$	$
			4001DY	44205	Lap colectomy part w/ileum	$1,201.95	10	EA	%	$	$
			4001DZ	44207	L colectomy/coloproctostomy	$1,633.59	8	EA	%	$	$
			4001EA	44213	Lap mobil splenic fl add-on	$167.69	3	EA	%	$	$
			4001EB	44300	Open Bowel to Skin	$754.69	1	EA	%	$	$
			4001EC	44320	Colostomy	$1,078.24	5	EA	%	$	$
			4001ED	44380	Small Bowel Endoscopy	$189.27	1	EA	%	$	$
			4001EE	44388	Colonoscopy thru stoma spx	$309.01	5	EA	%	$	$
			4001EF	44389	Colonoscopy with Biopsy	$402.54	1	EA	%	$	$
			4001EG	44602	Suture small intestine	$1,262.35	1	EA	%	$	$
			4001EH	44604	Suture large intestine	$947.87	1	EA	%	$	$
			4001EJ	44625	Repair bowel opening	$912.53	1	EA	%	$	$
			4001EK	44626	Repair bowel opening	$1,431.36	6	EA	%	$	$
			4001EL	44640	Repair bowel-skin fistula	$1,254.03	2	EA	%	$	$
			4001EM	44650	Repair bowel fistula	$1,295.45	2	EA	%	$	$
			4001EN	44661	Repair Bowel-Bladder Fistula	$1,392.08	2	EA	%	$	$
			4001EP	44900	Drain App Abscess Open	$703.41	2	EA	%	$	$
			4001EQ	44960	Appendectomy	$786.96	3	EA	%	$	$
			4001ER	44970	Laparoscopy appendectomy	$541.10	18	EA	%	$	$
			4001ES	45100	Biopsy Rectum	$273.54	1	EA	%	$	$
			4001ET	45112	Removal Rectum	$1,662.09	1	EA	%	$	$
			4001EU	45171	Exc Tect Tum Transanal Part	$557.12	2	EA	%	$	$
			4001EV	45172	Exc rect tum transanal full	$746.64	2	EA	%	$	$
			4001EW	45300	Proscosigmoidoscopy	$124.96	2	EA	%	$	$
			4001EX	45330	Diagnostic Sigmoidoscopy	$179.81	15	EA	%	$	$
			4001EY	45331	Sigmoidoscopy and Biopsy	$276.87	8	EA	%	$	$
			4001EZ	45333	Sigmoidoscopy and Polypectomy	$318.95	5	EA	%	$	$
			4001FA	45335	Sigmoidoscopy W/Submuc Inj	$281.69	2	EA	%	$	$
			4001FB	45338	Sigmoidoscopy W/Tumr Remov	$291.90	1	EA	%	$	$
			4001FC	45378	Diagnostic colonoscopy	$333.92	250	EA	%	$	$
			4001FD	45380	Colonoscopy and biopsy	$425.29	175	EA	%	$	$
			4001FE	45381	Colonoscopy submucous njx	$433.95	45	EA	%	$	$
			4001FF	45382	Colonoscopy w/control bleed	$650.86	2	EA	%	$	$
			4001FG	45384	Colonoscopy w/ Lesion Removal	$478.17	175	EA	%	$	$
			4001FH	45385	Colonoscopy w/lesion removal	$447.32	120	EA	%	$	$
			4001FJ	45386	Colonoscopy Dilate Stricture	$594.98	4	EA	%	$	$
			4001FK	45990	Surg dx exam anorectal	$95.19	2	EA	%	$	$
			4001FL	46040	Incision of rectal abscess	$541.82	8	EA	%	$	$
			4001FM	46200	Removal Anal Fissure	$463.74	3	EA	%	$	$
			4001FN	46250	Remove Ext Hem Groups 2+	$467.63	2	EA	%	$	$
			4001FP	46260	Remove in/ex hem groups 2+	$436.18	9	EA	%	$	$
			4001FQ	46270	Removal Anal Fissure SubQ	$523.14	6	EA	%	$	$
			4001FR	46600	Diagnostic Anoscopy	$115.34	3	EA	%	$	$
			4001FS	46604	Anoscopy and dilation	$628.48	6	EA	%	$	$
			4001FT	46922	Excision of anal lesion(s)	$305.41	3	EA	%	$	$
			4001FU	46947	Hemorrhoidopexy by stapling	$350.52	5	EA	%	$	$
			4001FV	47100	Wedge biopsy of liver	$760.76	5	EA	%	$	$
			4001FW	47562	Laparoscopic cholecystectomy	$592.02	45	EA	%	$	$
			4001FX	47563	Laparo cholecystectomy/graph	$645.15	50	EA	%	$	$
			4001FY	47600	Removal of gallbladder	$959.86	4	EA	%	$	$
			4001FZ	47605	Removal Gallbladder	$1,011.51	4	EA	%	$	$
			4001GA	49000	Exploration of abdomen	$690.79	2	EA	%	$	$
			4001GB	49002	Reopening of abdomen	$935.69	3	EA	%	$	$
			4001GC	49020	Drainage abdom abscess open	$1,430.68	3	EA	%	$	$
			4001GD	49320	Diag Laparo Separate Proc	$295.60	2	EA	%	$	$
			4001GE	49322	Laparoscopy Aspiration	$337.91	2	EA	%	$	$
			4001GF	49402	Remove foreign body Abdomen	$767.13	2	EA	%	$	$
			4001GG	49505	Prp i/hern init reduc >5 yr	$469.66	100	EA	%	$	$
			4001GH	49520	Rerepair ing hernia reduce	$568.88	11	EA	%	$	$
			4001GJ	49521	Rerepair ing hernia blocked	$644.16	11	EA	%	$	$
			4001GK	49550	Rpr Rem Hernia Init Reduce	$519.31	2	EA	%	$	$
			4001GL	49555	Rerepair fem hernia reduce	$543.12	1	EA	%	$	$
			4001GM	49591	Rpr aa hrn 1st < 3 cm rdc	$306.79	1	EA	%	$	$
			4001GN	49613	Rpr aa hrn rcr < 3 rdc	$378.66	19	EA	%	$	$
			4001GP	15853	Removal sutr/stapl xreq anes	$10.60	41	EA	%	$	$
			4001GQ	99203	Office/outpatient visit new	$111.60	1000	EA	%	$	$
			4001GH	99204	Office/outpatient visit new	$167.08	45	EA	%	$	$

File details come from the government source that posted it. Updated Nov 14, 2023.