Line Type SJR CDM Code SJR CDM Description DRG CPT / HCPCS SJR Revenue Code Gross or Average Charge Self Pay Cash Price Min Negotiated Rate Max Negotiated Rate Aetna Better Health MA Aetna Comm Aetna Medicare Aetna Signature Administrators AmeriHealth MA AmeriHealth MC Adv CBC Comm CBC Medicare Cigna Gateway MA Gateway Medicare Geisinger Comm Geisinger MA Geisinger Medicare Highmark Choice Blue Highmark Comm Highmark Medicare Humana Medicare Medicare Multiplan PA Health & Wellness PAMA Tower Health UHC Comm UHC MA UHC MA CHIP UPMC Comm UPMC MA UPMC MA CHIP Vibra Medicare 4407175 10004 Fna Bx W/o Img Gdn Ea Addl 10004 56.00 16.14 - 44.80 14.39 - - - - - 28.70 - 33.60 - - 37.07 - - - - - - - 44.80 - - 33.04 37.52 - 22.90 42.00 21.29 25.05 - 3514916 PS US Fine Needle Asp w/ Guidance 10005 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3515468 US Fine Needle Aspiration Thyroid Gland 10005 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3515471 US Fine Needle Aspiration w/ Guidance 10005 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 5169902 US* FINE NEEDLE ASPIRATION THYROID GLAND 10005 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 4407176 10005 FNA Bx W/Us Gdn 1st Lesion 10005 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 4475322T US FNA BX EACH ADDTL LESION 10006 761 47.00 13.55 - 37.60 12.08 - - - - - 24.09 - 28.20 - - 31.11 - - - - - - - 37.60 - - 27.73 31.49 - 19.22 35.25 17.86 21.02 - 4407177 10006 FNA Bx W/Us Gdn Ea Addl 10006 47.00 13.55 - 37.60 12.08 - - - - - 24.09 - 28.20 - - 31.11 - - - - - - - 37.60 - - 27.73 31.49 - 19.22 35.25 17.86 21.02 - 3514046 NVI Fine Needle Aspiration 10007 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 4407178 10007 FNA Bx W/Fluor Gdn 1st Lesion 10007 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 4407179 10008 FNA Bx W/Fluor Gdn Ea Addl 10008 860.00 247.85 - 688.00 221.02 - - - - - 440.75 - 516.00 - - 569.23 - - - - - - - 688.00 - - 507.40 576.20 - 351.74 645.00 326.89 384.68 - 46150155 CT Fine Needle Aspiration w/ Guidance 10009 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 4407180 10009 FNA Bx W/Ct Gdn 1st Lesion 10009 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 4407181 10010 FNA Bx W/Ct Gdn Ea Addl 10010 929.00 267.74 - 743.20 238.75 - - - - - 476.11 - 557.40 - - 614.91 - - - - - - - 743.20 - - 548.11 622.43 - 379.96 696.75 353.11 415.54 - 46927 FNA SUPERFICIAL TISSUE 10021 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3541994 10021 Fine Needle Aspir W/O Image 10021 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46150180 CT Drain Soft Tissue Fluid w/Cath Perc 10030 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46005027 IR Drainage Soft Tissue 10030 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46200101 US Drainage Soft Tissue 10030 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3538470 10030 Drainage Soft Tissue 10030 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3509483 PERQ DEV SOFT TISS 1ST IM 10035 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 5005293 10035 Perq Dev Soft Tiss 1st Lesion 10035 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3509485T PERQ DEV SOFT TISS ADD IM 10036 761 " 2,266.00 " 653.06 - " 1,812.80 " 582.36 - - - - - " 1,161.33 " - " 1,359.60 " - - " 1,499.87 " - - - - - - - " 1,812.80 " - - " 1,336.94 " " 1,518.22 " - 926.79 " 1,699.50 " 861.31 " 1,013.58 " - 3541996 10040 Acne Surgery 10040 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46335 I&D ABSCESS;SIMPLE/SINGLE 10060 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3538471 10060 I&D Abscess Cyst Simp Single 10060 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48010238 I & D BY MD SIMPLE ABCESS 10060 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46336 I&D ABSCESS;COMPLEX/MULTI 10061 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538472 10061 I&D Abscess Cyst Comp Multiple 10061 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48010475 COMPLICATED INCISION AND DRAIN 10061 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46337 I&D PILONIDAL CYST;SIMPLE 10080 450 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3538219 10080 I&D Pilonidal Cyst Simple 10080 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 470994 I&D PILONIDAL CYST;COMPLX 10081 450 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3538220 10081 I&D Pilonidal Cyst Complicated 10081 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46339 REMOVAL FOREIGN BODY;SIMP 10120 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538221 10120 Removal Foreign Body Subcutan Simple 10120 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46340 REMOVAL FOREIGN BODY;COMP 10121 450 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538222 10121 Removal Foreign Body Subcutan Complic 10121 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 48010547 REMOVAL OF FOREIGN BODY 10121 361 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46341 I&D HEMATOMA SEROMA FLUID 10140 450 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541997 10140 I&D Hematoma Simple 10140 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 48010239 I & D BY MD HEMATOMA 10140 510 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46342 PUNCTURE ASPIRATION CYST 10160 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3515357 US Breast Asp Subcutaneous Fluid Lt 10160 761 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3515360 US Breast Asp Subcutaneous Fluid Rt 10160 761 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46200061 US Puncture Aspiration Skin Subcutaneous 10160 761 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537866 10160 Aspirate Abscess Hematoma Cyst 10160 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48010559 PUNCTURE/ASPIRATION 10160 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46343 I&D COMPLEX POST-OP WOUND 10180 450 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3537867 10180 I&D Complex Post Op Wound Infection 10180 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 460945 SKIN DEBRIDE TO 10% BODY 11000 761 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3541857 11000 Debridement Up To 10% Body Surface 11000 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3541998 11001 Skin Debride Ea Add 10% 11001 280.00 80.70 - 224.00 71.96 - - - - - 143.50 - 168.00 - - 185.33 - - - - - - - 224.00 - - 165.20 187.60 - 114.52 210.00 106.43 125.24 - 3538473 11004 Debrid Of Skin Sub Tis Mus & Fas 11004 " 7,406.00 " " 2,134.41 " " 1,903.34 " " 5,924.80 " " 1,903.34 " N/A N/A N/A N/A N/A " 3,795.58 " N/A " 4,443.60 " N/A N/A " 4,902.03 " N/A N/A N/A N/A N/A N/A N/A " 5,924.80 " N/A N/A " 4,369.54 " " 4,962.02 " N/A " 3,029.05 " " 5,554.50 " " 2,815.02 " " 3,312.70 " N/A 3538474 11005 Debrid Of Skin Sub Tis Abd Wall 11005 " 2,911.00 " 838.95 748.13 " 2,328.80 " 748.13 N/A N/A N/A N/A N/A " 1,491.89 " N/A " 1,746.60 " N/A N/A " 1,926.79 " N/A N/A N/A N/A N/A N/A N/A " 2,328.80 " N/A N/A " 1,717.49 " " 1,950.37 " N/A " 1,190.60 " " 2,183.25 " " 1,106.47 " " 1,302.09 " N/A 3538475 11006 Debrid Of Skin Sub Tis Ext Genit 11006 674.00 194.25 173.22 539.20 173.22 N/A N/A N/A N/A N/A 345.43 N/A 404.40 N/A N/A 446.12 N/A N/A N/A N/A N/A N/A N/A 539.20 N/A N/A 397.66 451.58 N/A 275.67 505.50 256.19 301.48 N/A 3538476 11008 Rem Pros Material Or Mesh 11008 761 " 7,671.00 " " 2,210.78 " " 1,971.45 " " 6,136.80 " " 1,971.45 " N/A N/A N/A N/A N/A " 3,931.39 " N/A " 4,602.60 " N/A N/A " 5,077.43 " N/A N/A N/A N/A N/A N/A N/A " 6,136.80 " N/A N/A " 4,525.89 " " 5,139.57 " N/A " 3,137.44 " " 5,753.25 " " 2,915.75 " " 3,431.24 " N/A 3541999 11010 Debride Skin Fx 11010 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3538477 11011 Debride SkinMuscle Fx 11011 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542000 11012 Debride Skin/Musc/BoneFx 11012 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 460944 DEBRIDE;SKIN/SUBQ TISSUE 11042 761 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3541858 11042 Debridement Skin And Subcutaneous Tiss 11042 761 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48070024 DEBRIDE SUB QUE 20CM < 11042 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542001 11043 Debridement Skin Sub Tissue Muscle 11043 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 48010484 DEBRIDE SKIN SUBQ MUSC 20CM< 11043 510 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 170001 DEBRID;SKIN SUBQ MUS BONE 11044 450 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542002 11044 Debridement Skin Sub Tissue Musc Bone 11044 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 48010455 DEBRIDEMENT BONE FIRST 20 SQCM 11044 510 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 460943 DEBR SKIN SUBC TISS EA AD 11045 761 91.00 26.23 - 72.80 23.39 - - - - - 46.64 - 54.60 - - 60.23 - - - - - - - 72.80 - - 53.69 60.97 - 37.22 68.25 34.59 40.70 - 3542003 11045 Debridemnt Skin Sub Tiss Ea Addtl 20 sq cm 11045 91.00 26.23 - 72.80 23.39 - - - - - 46.64 - 54.60 - - 60.23 - - - - - - - 72.80 - - 53.69 60.97 - 37.22 68.25 34.59 40.70 - 48010443 DEBRIDE SUB QUE ADD 20CM 11045 510 91.00 26.23 - 72.80 23.39 - - - - - 46.64 - 54.60 - - 60.23 - - - - - - - 72.80 - - 53.69 60.97 - 37.22 68.25 34.59 40.70 - 3542004 11046 Debridemnt Musc/Fascia Ea Addtl 20 sq cm 11046 91.00 26.23 - 72.80 23.39 - - - - - 46.64 - 54.60 - - 60.23 - - - - - - - 72.80 - - 53.69 60.97 - 37.22 68.25 34.59 40.70 - 48010444 DEBRID SKIN SUBQ MUSC ADD 20CM 11046 510 91.00 26.23 - 72.80 23.39 - - - - - 46.64 - 54.60 - - 60.23 - - - - - - - 72.80 - - 53.69 60.97 - 37.22 68.25 34.59 40.70 - 3542005 11047 Debridemnt Bone Each Addtl 20 sq cm 11047 412.00 118.74 - 329.60 105.88 - - - - - 211.15 - 247.20 - - 272.70 - - - - - - - 329.60 - - 243.08 276.04 - 168.51 309.00 156.60 184.29 - 3542006 11055 Paring/Cut Benign Les 1 11055 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48070035 11055 PARING CUTTING BENIGN LESION 1 11055 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542007 11056 Paring/Cut Benign Les 2-4 11056 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48070036 11056 PARING CUTTING BENIGN LESION 2-4 11056 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3541641 11057 Pare/Cut Benign Les >4 11057 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4407184 11102 Tangntl Biopsy Skin Single Les 11102 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48070037 11102 TANGENTIAL BIOSPY OF SKIN 1 LESION 11102 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4407185 11103 Tangntl Biopsy Skin Ea Sep/Addl 11103 97.00 27.96 - 77.60 24.93 - - - - - 49.71 - 58.20 - - 64.20 - - - - - - - 77.60 - - 57.23 64.99 - 39.67 72.75 36.87 43.39 - 5446675T PUNCH BIOPSY SKIN SINGLE 11104 761 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 4407186 11104 Punch Biopsy Skin Single Lesion 11104 761 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48070038 11104 PUNCH BIOPSY OF SKIN SINGLE LESION 11104 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 4407187 11105 Punch Biopsy Skin Ea Sep/Addl 11105 761 61.00 17.58 - 48.80 15.68 - - - - - 31.26 - 36.60 - - 40.38 - - - - - - - 48.80 - - 35.99 40.87 - 24.95 45.75 23.19 27.29 - 4407188 11106 Incisional Biopsy Skin Single Les 11106 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 48070039 11106 INCISIONAL BIOPSY OF SKIN 1 LESION 11106 510 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 4407189 11107 Incisional Biopsy Skin Ea Sep/Addl Les 11107 67.00 19.31 - 53.60 17.22 - - - - - 34.34 - 40.20 - - 44.35 - - - - - - - 53.60 - - 39.53 44.89 - 27.40 50.25 25.47 29.97 - 3542008 11200 Exc Tags Up To 15 11200 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542009 11201 Exc Tags Ea Add 10 11201 31.00 8.93 - 24.80 7.97 - - - - - 15.89 - 18.60 - - 20.52 - - - - - - - 24.80 - - 18.29 20.77 - 12.68 23.25 11.78 13.87 - 3542010 11300 Shv Ep/Drm T/A/L 0.5cm Or Less 11300 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542011 11301 Shv Ep/Drm T/A/L 0.6-1.0 cm 11301 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48010583 SHAV EPIDERMAL OR DERMAL LES 11301 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542012 11302 Shv Ep/Drm T/A/L 1.1-2.0cm 11302 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542013 11303 Shv Ep/Drm T/A/L Over 2.0 cm 11303 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542014 11305 Shv Ep/Drm S/N/Hn 0.5cm Or Less 11305 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542015 11306 Shv Ep/Drm S/N/Hn 0.6-1.0cm 11306 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542016 11307 Shv Ep/Drm S/N/Hn 1.1-2.0 cm 11307 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542017 11308 Shv Ep/Drm S/N/Hn > 2.0cm 11308 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542018 11310 Shv Ep/Drm F/E/Lp 0.5cm Or Less 11310 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542021 11311 Shv Ep/Drm F/E/Lp 0.6-1.0 cm 11311 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48010557 SHAVED LESION NOSE 11311 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542022 11312 Shv Ep/Drm F/E/Lp 1.1-2.0 cm 11312 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542023 11313 Shv Ep/Drm F/E/Lp Over 2.0 cm 11313 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48010558 SHAVED LESION TEMPLE 11313 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542024 11400 Lesion Benign Trunkarm Leg 0.5cm 11400 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46995 EXC BEN LES TRK 0.6-1.0 11401 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538229 11401 Lesion Benign Trunk Arm Leg 0.6-1.0cm 11401 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542025 11402 Lesion Benign Trunk Arm Leg 1.1-2.0cm 11402 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 48010554 "EXC BENIGN LES,NOT SKIN TAG" 11402 510 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542026 11403 Lesion Benign Trunk Arm Leg 2.1-3.0cm 11403 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542027 11404 Lesion Benign Trunk Arm Leg 3.1-4.0cm 11404 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542028 11406 Lesion Benign Trunk Arm Leg 4.0cm Lge 11406 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542029 11420 Les Ben Scalp Nk Hd Ft Gent 0.5cm 11420 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541860 11421 Les Ben Scalp Nk Hd Ft Gent 0.6-1.0cm 11421 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3541861 11422 Les Ben Scalp Nk Hd Ft Gent 1.1-2.0cm 11422 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541862 11423 Les Ben Scalp Nk Hd Ft Gent 2.1-3.0cm 11423 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541863 11424 Les Ben Scalp Nk Hd Ft Gent 3.1-4.0cm 11424 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541864 11426 Les Ben Scalp Nk Hd Ft Gent 4.0cm Lge 11426 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 48010477 CYST REMOVAL SEBACEOUS 11426 510 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542030 11440 Les Ben Face Ear Lip Lid Nos 0.5cm 11440 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542031 11441 Les Ben Face Ear Lip Lid Nos 0.6-1.0cm 11441 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 48010570 EXC BENIGN LESION .6 TO 1 CM 11441 510 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542032 11442 Les Ben Face Ear Lip Lid Nos 1.1-2.0cm 11442 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542033 11443 Les Ben Face Ear Lip Lid Nos 2.1-3.0cm 11443 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542034 11444 Les Ben Face Ear Lip Lid Nos 3.1-4.0cm 11444 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542035 11446 Les Ben Face Ear Lip Lid Nos 4.0cm Lge 11446 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538479 11450 Exc Hidradinitis Axillary Prim Sut 11450 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538480 11451 Exc Hidradentis W/Comp Cl 11451 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3541865 11462 Exc Hidradinitis Inguinal Prim Sut 11462 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538481 11463 Exc Hidradinitis With Complex Closure 11463 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542036 11470 Exc Hidradinitis Perianal Pri Clos 11470 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538482 11471 Exc Hidradinitis Perianal Oth Clos 11471 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3541866 11600 Lesion Malign Trunk Arm Leg 0.5cm 11600 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3541867 11601 Lesion Malign Trunk Arm Leg 0.6-1.0cm 11601 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3541868 11602 Lesion Malign Trunk Arm Leg 1.1-2.0cm 11602 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48010434 EXCISION MALGNT LESION(1.1-2) 11602 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3541869 11603 Lesion Malign Trunk Arm Leg 2.1-3.0cm 11603 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 48010561 EX MALIG LESION 2.1 TO 3 CM 11603 510 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3541870 11604 Lesion Malign Trunk Arm Leg 3.1-4.0cm 11604 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 48010551 MAL LES TRK ARM LEG 3.1-4 CM 11604 510 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3541871 11606 Lesion Malign Trunk Arm Leg 4.0cm Lge 11606 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541872 11620 Les Mal Scalp Nk Hd Ft Gent 0.5cm 11620 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541873 11621 Les Mal Scalp Nk Hd Ft Gent 0.6-1.0cm 11621 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3541874 11622 Les Mal Scalp Nk Hd Ft Gent 1.1-2.0cm 11622 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 48010582 EXC MAL LESION 11622 510 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3541875 11623 Les Mal Scalp Nk Hd Ft Gent 2.1-3.0cm 11623 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541876 11624 Les Mal Scalp Nk Hd Ft Gent 3.1-4.0cm 11624 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541877 11626 Les Mal Scalp Nk Hd Ft Gent 4.0cm Lge 11626 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542037 11640 Les Mal Face Ear Lip Lid Nos 0.5cm 11640 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542038 11641 Les Mal Face Ear Lip Lid Nos 0.6-1.0cm 11641 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542039 11642 Les Mal Face Ear Lip Lid Nos 1.1-2.0cm 11642 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 48010565 EXCISION MALIGNANT LESION 11642 510 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542040 11643 Les Mal Face Ear Lip Lid Nos 2.1-3.0cm 11643 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541878 11644 Les Mal Face Ear Lip Lid Nos 3.1-4.0cm 11644 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542041 11646 Les Mal Face Ear Lip Lid Nos 4.0cm Lge 11646 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 460914 TRIM NONDYSTROPHIC NAILS 11719 450 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 3538234 11719 Trimming Of Nail 11719 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 48010431 TRIM NAILS NON-DYSTROPHIC 11719 510 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 460948 DEBR NAIL ANY METHOD 1-5 11720 450 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 3538235 11720 Debrid 1-5 Nails Any Meth 11720 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 48010417 DEBRIDE NAILS 1-5 11720 510 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 3542042 11721 Debrid Nails 6 Or More 11721 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 48010418 DEBR4IDE NAILS 6 OR MORE 11721 510 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 46347 NAIL AVULSION SIMPLE;SING 11730 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3537868 11730 Avulsion Nail Plate Par Comp Sim Sing 11730 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48010419 AVULSION NAIL PLATE 11730 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3541879 11732 Avulsion Each Addit Nail Plate 11732 49.00 14.12 - 39.20 12.59 - - - - - 25.11 - 29.40 - - 32.43 - - - - - - - 39.20 - - 28.91 32.83 - 20.04 36.75 18.62 21.92 - 48070050 11732 AVUL EA ADDITIONAL NAIL PLATE 11732 510 49.00 14.12 - 39.20 12.59 - - - - - 25.11 - 29.40 - - 32.43 - - - - - - - 39.20 - - 28.91 32.83 - 20.04 36.75 18.62 21.92 - 46349 EVAC SUBUNGUAL HEMATOMA 11740 450 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3538236 11740 Evac Subungual Hemat 11740 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 48010421 EVACUATION NAIL HEMATOMA 11740 510 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 46732 NAIL EXCISION 11750 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538237 11750 Excision Nail Matrix 11750 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48070051 11750 EXCISION OF NAIL/NAIL MATRIX 11750 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542043 11755 Biopsy Of Nail Unit 11755 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46810 REPAIR NAIL BED 11760 450 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538239 11760 Repair Of Nail Bed 11760 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3541880 11762 Recons Of Nail Bed W Graft 11762 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 46989 WEDGE EXCISION SKIN NAIL 11765 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538240 11765 Wedge Exc Of Skin Of Nail Fold 11765 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538115 11770 Excision Pilonidal Cyst Sinus Simple 11770 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3541881 11771 Excision Pilonidal Cyst Sinus Exten 11771 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538116 11772 Excision Pilonidal Cyst Sinus Compl 11772 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3541882 11900 Inj Intralesional Up To 7 11900 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3541883 11901 Inj Intralesional More Than 7 11901 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3541884 11920 Tattoo Cor Col Def 6.0sq cm Or Less 11920 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542045 11921 Tattooing Color Def6.1-20 Provider 11921 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 4477186T NON PROVIDER 11921 Tattoo 6.1 - 20cm 11921 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3541885 11950 Subcut Inj Filling Material <= 1 cc 11950 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3541886 11951 Subcut Inj Filling Material 1.1-5Cc 11951 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3541887 11952 Subcut Inj Filling Material 5.1-10Cc 11952 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3541888 11954 Subcut Inj Filling Material >10Cc 11954 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538484 11960 Ins Tissue Expand Subsq Expan 11960 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538117 11970 Rep Tissue Expander W Perm Prosthesis 11970 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538118 11971 Rem Tissue Expander W/O Insert Prosthesis 11971 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542046 11976 Rem Imp Cont Dev 11976 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542047 11981 Insertion Antibiotic Beads 11981 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3542048 11982 Removal Of Antibiotc Beads 11982 " 1,419.00 " 408.96 - " 1,319.43 " 364.68 " 1,274.77 " 277.42 " 1,318.42 " 233.47 274.67 727.24 274.67 851.40 233.47 293.90 939.24 247.20 274.67 " 1,055.54 " " 1,319.43 " 271.92 280.16 274.67 " 1,135.20 " 251.32 - 837.21 950.73 241.71 580.37 " 1,064.25 " 539.36 634.72 280.16 3542049 11983 Remval W/Insertion Beads 11983 " 1,419.00 " 408.96 - " 1,319.43 " 364.68 " 1,274.77 " 277.42 " 1,318.42 " 233.47 274.67 727.24 274.67 851.40 233.47 293.90 939.24 247.20 274.67 " 1,055.54 " " 1,319.43 " 271.92 280.16 274.67 " 1,135.20 " 251.32 - 837.21 950.73 241.71 580.37 " 1,064.25 " 539.36 634.72 280.16 46218 SIM RPR TRK UP TO 2.5 CM 12001 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3537873 12001 Sim Rep Trunk Limb Neck Scalp 2.5cm 12001 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48010563 SIMPLE WOUND CLOSURE 12001 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46219 SIM REP TRK/LMB 2.6-7.5 12002 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3538242 12002 Sim Rep Trunk Lmb Nk Sc 2.6-7.5cm 12002 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46352 SIM REP TRK/LMB 7.6-12.5 12004 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3541889 12004 Sim Rep Trunk Limb Nk Sc 7.6-12.5cm 12004 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46353 SIM REP TRK/LMB 12.6-20.0 12005 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537874 12005 Sim Rep Trunk Limb Neck Sc 12.6-20cm 12005 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46763 RPR TRK LM NK SC 20.1-30C 12006 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538119 12006 Sim Rep Trunk Limb Neck Sc 20.1-30cm 12006 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 460936 SIM REP TR LM >30.0 12007 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3538120 12007 Sim Rep Trunk Limb Neck Scalp >30cm 12007 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46222 SIM REP FACE EAR EYE 2.5 12011 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542050 12011 Sim Rep Face Ear Lip Lid Nose 2.5cm 12011 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46220 SIM REP FACE EAR EYE 2.6- 12013 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3538243 12013 Sim Rep Face Ear Lip Lid Nos 2.6-5.0cm 12013 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46221 SIM REP FACE EAR EYE 5.1- 12014 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3538485 12014 Sim Rep Face Ear Lip Lid No 5.1-7.5cm 12014 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46812 SIM REP FACE EAR EYE 7.6- 12015 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3538486 12015 Sim Rep Face Ear Lip Lid No 7.6-12.5cm 12015 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 460919 SIM REP FACE EAR EYE 12.6 12016 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46827 SIM REP FACE EAR EYE 20.1 12017 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538487 12017 Sim Rep Face Ear Lip Ld Nose 20.1-30cm 12017 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538488 12018 Sim Rep Face Ear Lip Lid Nose >30.0cm 12018 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46354 TX WOUND DEHISCENCE; SIMP 12020 450 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3541890 12020 Treat Superficial Wound Dehis Simp Clos 12020 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 46355 TX WOUND DEHIS; W/PACKING 12021 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537497 12021 Treat Super Wound W Pack 12021 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46356 INT RPR SCL TRK HD FT 2.5 12031 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537877 12031 Int Rep Trunk Limb Neck Scalp 0-2.5cm 12031 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48010555 CLOSURE WOUND 2.5 CM OR LESS 12031 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46357 INT REP SCL TK HD FT 2.6- 12032 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537878 12032 Int Rep Trunk Limb Nk Sc 2.6-7.5cm 12032 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48010560 CLOSURE WOUND 2.6 TO 7.5 CM 12032 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46727 INT REP SCL TK HD FT 7.6- 12034 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537879 12034 Int Rep Trunk Limb Nk Sc 7.6-12.5cm 12034 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46811 INT REP SC TK HD FT 12.6- 12035 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537880 12035 Int Rep Trunk Limb Neck Sc 12.6-20cm 12035 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46992 INT REP SC TK HD FT 20.1- 12036 450 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3537881 12036 Int Rep Trunk Limb Scalp 20.1-30cm 12036 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 46846 INT REP SC TK HD FT>30.0 12037 450 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538121 12037 Int Rep Trunk Limb Scalp >30cm 12037 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 46358 INT REP NK HN FT GEN 2.5 12041 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537883 12041 Int Rep Neck Hands Feet Genit 2.5cm 12041 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46359 INT REP NK HN FT GEN 2.6- 12042 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537884 12042 Int Rep Neck Hands Ft Gent 2.6-7.5cm 12042 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46824 INT REP NK HN FT GEN 7.6- 12044 450 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538248 12044 Int Rep Neck Hands Ft Gen 7.6-12.5cm 12044 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 5338671T 12045 Int Rep Neck Hand Ft Gen 12.6-20cm 12045 450 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3541891 12045 Int Rep Neck Hands Ft Gent 12.6-20cm 12045 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538122 12046 Int Rep Neck Hands Ft Gent 20.1-30cm 12046 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3619220 12047 Int Rep Neck Hands Feet Genit >30cm 12047 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 46360 INT REP FACE EAR EYE 2.5 12051 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538249 12051 Int Rep Fc Er Lid Lp No 2.5cm 12051 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48010564 INTERMEDIATE LAYERED CLOSURE 12051 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46361 INT REP FACE EAR EYE 2.6- 12052 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538250 12052 Int Rep Face Ear Lip Lid Nose 2.6-5cm 12052 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46728 INT REP FACE EAR EYE 5.1- 12053 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538251 12053 Int Rep Face Ear Lip Lid Nos 5.1-7.5cm 12053 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46769 INT RPR FACE EAR EYE 7.6- 12054 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538252 12054 Int Rep Face Ear Lip Lid No 7.6-12.5cm 12054 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46770 INT RPR FACE EAR 12.6-20C 12055 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538253 12055 Int Rep Face Ear Lip Ld Nose 12.6-20cm 12055 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3619239 12056 Int Rep Fc Er Ld Lp 20.1-30.0 12056 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538489 12057 Int Rep Fc Er Ld Lp >30.0cm 12057 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542051 13100 Complex Repair Trunk 1.1-2.5cm 13100 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542052 13101 Complex Repair Trnk 2.6-7.5cm 13101 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542053 13102 Complex Repair Trunk Ea Addtl 5 cm Or Less 13102 149.00 42.94 - 119.20 38.29 - - - - - 76.36 - 89.40 - - 98.62 - - - - - - - 119.20 - - 87.91 99.83 - 60.94 111.75 56.63 66.65 - 46731 RPR COMP SC ARM 1.1-2.5CM 13120 450 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538255 13120 Com Rep Scl Arm Leg 1.1-2.5cm 13120 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 46764 RPR COMP SC ARM 2.6-7.5CM 13121 450 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538256 13121 Com Rep Scl Arm Leg 2.6-7.5cm 13121 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 48010549 CPLX RP SCALP ARM LEG 2.6 -7.5 13121 510 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 46765 RPR COMP SC ARM EA AD 5CM 13122 450 240.00 69.17 - 192.00 61.68 - - - - - 123.00 - 144.00 - - 158.86 - - - - - - - 192.00 - - 141.60 160.80 - 98.16 180.00 91.22 107.35 - 3538257 13122 Com Rep Scl Arm Leg Each Addl 5 cm Or Less 13122 240.00 69.17 - 192.00 61.68 - - - - - 123.00 - 144.00 - - 158.86 - - - - - - - 192.00 - - 141.60 160.80 - 98.16 180.00 91.22 107.35 - 48010550 CPLX EACH ADD. 5 CM OR< 13122 510 240.00 69.17 - 192.00 61.68 - - - - - 123.00 - 144.00 - - 158.86 - - - - - - - 192.00 - - 141.60 160.80 - 98.16 180.00 91.22 107.35 - 46730 RPR COM FOREHEAD 1.1-2.5C 13131 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538258 13131 Com Rep Fc Nk Hd Ft 1.1-2.5cm 13131 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 46766 RPR COM FOREHEAD 2.6-7.5C 13132 450 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538259 13132 Com Rep Fc Nk Hd Ft 2.6-7.5cm 13132 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 46779 RPR COM FORHEAD EA AD 5CM 13133 450 282.00 81.27 - 225.60 72.47 - - - - - 144.53 - 169.20 - - 186.66 - - - - - - - 225.60 - - 166.38 188.94 - 115.34 211.50 107.19 126.14 - 3538260 13133 Com Rep Fc Nk Hd Ft Ea Addt 5 cm Or Less 13133 282.00 81.27 - 225.60 72.47 - - - - - 144.53 - 169.20 - - 186.66 - - - - - - - 225.60 - - 166.38 188.94 - 115.34 211.50 107.19 126.14 - 46767 RPR COM EY NS ER 1.1-2.5C 13151 450 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538261 13151 Com Rep Eye Nose Ear 1.1-2.5cm 13151 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 46768 RPR COM EY NS ER 2.6-7.5C 13152 450 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542054 13152 Rep Com Lids Nose Ears Lips 2.6-7.5cm 13152 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542055 13153 Com Rep Lids Nose Each Addt 5 cm Or Less 13153 117.00 33.72 - 93.60 30.07 - - - - - 59.96 - 70.20 - - 77.44 - - - - - - - 93.60 - - 69.03 78.39 - 47.85 87.75 44.47 52.33 - 3541892 13160 Secondary Clos Surg Wound Ext Comp 13160 510 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542056 14000 Adj Tis Trans Trk 10cm Or Less 14000 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542057 14001 Adj Tis Trans Trk 10.1-30 cm 14001 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542058 14020 Adj Tis Tran Scl Ar Lg 10 cm< 14020 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542059 14021 Adj Tis Trans Scl Ar Lg 10.1-30 cm 14021 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542060 14040 Adj Tis Tra Fc Nk Hd Ft 10 cm< 14040 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542061 14041 Adj Tis Trans Fc Nk Hd Ft 10.0-30 cm 14041 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542062 14060 Adj Tis Trans Ey Nd Lp 10 cm< 14060 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542063 14061 Adj Tis Tran Ey Nd Lp 10.1-30 cm 14061 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542064 14301 Adj Tiss Trnsfr 30.1-60 sq cm 14301 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3542065 14302 Adj Tiss Trnsfr Ea Addit 30sq cm 14302 400.00 115.28 - 320.00 102.80 - - - - - 205.00 - 240.00 - - 264.76 - - - - - - - 320.00 - - 236.00 268.00 - 163.60 300.00 152.04 178.92 - 3538490 14350 Fillet Fing Toe Flap Prep Site 14350 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542066 15002 Surg Prep Of Recip Site First 100 15002 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538491 15003 Surg Prep Ea Add 100sq cm 15003 564.00 162.54 - 451.20 144.95 - - - - - 289.05 - 338.40 - - 373.31 - - - - - - - 451.20 - - 332.76 377.88 - 230.68 423.00 214.38 252.28 - 3542067 15004 Surg Prep Of Recip Site FaceScalp 15004 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 48010556 SURG SITE PREP (FEET/HANDS) 15004 510 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538492 15005 Surg Prep FaceScapl Ea Add 100sq 15005 845.00 243.53 - 676.00 217.17 - - - - - 433.06 - 507.00 - - 559.31 - - - - - - - 676.00 - - 498.55 566.15 - 345.61 633.75 321.18 377.97 - 3537886 15050 Graft Skin Small Ulcer Except Face 15050 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542068 15100 Grft Skin Split Trk Arms Legs 15100 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538493 15101 Grf Split Trk Limb Add 100sqcm 15101 " 1,035.00 " 298.29 - 828.00 266.00 - - - - - 530.44 - 621.00 - - 685.07 - - - - - - - 828.00 - - 610.65 693.45 - 423.32 776.25 393.40 462.96 - 4413215 15110 Epiderm Autograft 1st 100 Cm 15110 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 4913293 15111 Epiderm Autograft Ea Addl 100 SqCm 15111 " 1,941.00 " 559.40 - " 1,552.80 " 498.84 - - - - - 994.76 - " 1,164.60 " - - " 1,284.75 " - - - - - - - " 1,552.80 " - - " 1,145.19 " " 1,300.47 " - 793.87 " 1,455.75 " 737.77 868.21 - 3538494 15115 Epidermal AutogrftFace 15115 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542069 15120 Grf Split Face Neck Gen 100sqc 15120 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538495 15121 Grf Split Face Neck Gen Ad 100 15121 " 1,112.00 " 320.48 - 889.60 285.78 - - - - - 569.90 - 667.20 - - 736.03 - - - - - - - 889.60 - - 656.08 745.04 - 454.81 834.00 422.67 497.40 - 3538496 15130 Drml Autogft Trk Arm Leg 15130 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542070 15135 Derm Autograft First 100 15135 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3542071 15200 Gft Full Free Trunk 20sqcm 15200 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538497 15201 Graft Full Free Trunk Add 20sq 15201 " 1,074.00 " 309.53 - 859.20 276.02 - - - - - 550.43 - 644.40 - - 710.88 - - - - - - - 859.20 - - 633.66 719.58 - 439.27 805.50 408.23 480.40 - 3542072 15220 Graft Full Scalp Limbs 20 sq cm 15220 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 48010453 FULL THICKNESS SKIN GRAFT 15220 510 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542073 15221 Graft Full Scalp Limbs Ad 20sq 15221 428.00 123.35 - 342.40 110.00 - - - - - 219.35 - 256.80 - - 283.29 - - - - - - - 342.40 - - 252.52 286.76 - 175.05 321.00 162.68 191.44 - 46835 FULL TH GRAFT FC NK GN HD 15240 450 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542074 15240 Grf Full Face Hd Ft Gen 20sqcm 15240 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542075 15241 Grf Full Face Hd Ft Gen Ad 20S 15241 540.00 155.63 - 432.00 138.78 - - - - - 276.75 - 324.00 - - 357.43 - - - - - - - 432.00 - - 318.60 361.80 - 220.86 405.00 205.25 241.54 - 3542076 15260 Grf Full Lid Ns Ear Lip 20sqcm 15260 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542078 15261 Grf Full Lid Ns Ear Lip Ad 20S 15261 759.00 218.74 - 607.20 195.06 - - - - - 388.99 - 455.40 - - 502.38 - - - - - - - 607.20 - - 447.81 508.53 - 310.43 569.25 288.50 339.50 - 3542079 15271 Skin Sub Trnk Arms Legs 100 sq cm 15271 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 48010349 LEG SKIN FIRST 25 SQ CM 15271 510 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542080 15272 Skin Sub Each Addl 25sqcm 15272 41.00 11.82 - 32.80 10.54 - - - - - 21.01 - 24.60 - - 27.14 - - - - - - - 32.80 - - 24.19 27.47 - 16.77 30.75 15.58 18.34 - 48010348 LEG SKIN ADD 25 SQ CM 15272 510 41.00 11.82 - 32.80 10.54 - - - - - 21.01 - 24.60 - - 27.14 - - - - - - - 32.80 - - 24.19 27.47 - 16.77 30.75 15.58 18.34 - 3542081 15273 Skin Sub Grft T/Arm/Lg Child 15273 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 48010545 APP SK SUB 1ST 20 SQ CM 15273 510 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3542082 15274 Skn Sub Grft T/A/L Child Add 15274 85.00 24.50 - 68.00 21.85 - - - - - 43.56 - 51.00 - - 56.26 - - - - - - - 68.00 - - 50.15 56.95 - 34.77 63.75 32.31 38.02 - 48070053 15274 APP SK SUB LEG EACH ADD 100 SQ CM 15274 510 85.00 24.50 - 68.00 21.85 - - - - - 43.56 - 51.00 - - 56.26 - - - - - - - 68.00 - - 50.15 56.95 - 34.77 63.75 32.31 38.02 - 3542083 15275 Skin Sub Graft Face/Nk/Hf/G 15275 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 48010487 FOOT SKIN FIRST 25 SQ CM 15275 510 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542084 15276 Skin Sub Graft F/N/Hf/G Addl 15276 42.00 12.10 - 33.60 10.79 - - - - - 21.53 - 25.20 - - 27.80 - - - - - - - 33.60 - - 24.78 28.14 - 17.18 31.50 15.96 18.79 - 48010488 FOOT SKIN ADD 25 SQ CM 15276 510 42.00 12.10 - 33.60 10.79 - - - - - 21.53 - 25.20 - - 27.80 - - - - - - - 33.60 - - 24.78 28.14 - 17.18 31.50 15.96 18.79 - 3542085 15277 Skn Sub Grft F/N/Hf/G Child 15277 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 48070040 15277 APP SK SUB FEET 1ST 100 SQ CM 15277 510 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542086 15278 Skn Sub Grft F/N/Hf/G Ch Add 15278 85.00 24.50 - 68.00 21.85 - - - - - 43.56 - 51.00 - - 56.26 - - - - - - - 68.00 - - 50.15 56.95 - 34.77 63.75 32.31 38.02 - 48070041 15278 APP SK SUB FEET EACH ADD 100 SQ CM 15278 510 85.00 24.50 - 68.00 21.85 - - - - - 43.56 - 51.00 - - 56.26 - - - - - - - 68.00 - - 50.15 56.95 - 34.77 63.75 32.31 38.02 - 3538498 15570 Form/Dir/Tub Ped/W/W/O Trnk 15570 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538499 15572 Form/Dir/Tub Ped SclArmLeg 15572 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538500 15574 Exc Def Place Flap Fc Nk Hd Ft 15574 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542087 15576 F/Dir/Tub Ped ElidsNsErsLps Intoraoral 15576 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538501 15600 Delay Flap (Div&Inset) Trnk 15600 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3542088 15610 Delay Pedicle Flap Scl Arm Leg 15610 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542089 15620 Delay Ped Flap Hd Nk Gen Hd Ft 15620 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542090 15630 Del Ped Flap Lid Nose Ear Lip 15630 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538123 15650 Tran Pedicle Flap Any Location 15650 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3619240 15730 Midface Flap W/ Vasc Pedicle 15730 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3542091 15731 Forehead Flap W/ Vas Pedicle 15731 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3619241 15733 Musc Myoq/Fscq Flap Hd&Nk W/Named Pedicle 15733 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538502 15734 Muscle Myocut/Fascio Flap Trunk 15734 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538503 15736 Muscle Myocut/Fascioc Flap Upper Extremity 15736 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538504 15738 Muscle Myocutaneous Lwr Extremity 15738 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3542093 15740 Flap; Island Pedicle 15740 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538505 15750 Flap; Neurovascular Ped 15750 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538506 15756 Free Muscle Flap Microva 15756 " 3,554.00 " " 1,024.26 " 913.38 " 2,843.20 " 913.38 N/A N/A N/A N/A N/A " 1,821.43 " N/A " 2,132.40 " N/A N/A " 2,352.39 " N/A N/A N/A N/A N/A N/A N/A " 2,843.20 " N/A N/A " 2,096.86 " " 2,381.18 " N/A " 1,453.59 " " 2,665.50 " " 1,350.88 " " 1,589.70 " N/A 3538507 15757 Free Skin FlapMicrovasc 15757 " 4,104.00 " " 1,182.77 " " 1,054.73 " " 3,283.20 " " 1,054.73 " N/A N/A N/A N/A N/A " 2,103.30 " N/A " 2,462.40 " N/A N/A " 2,716.44 " N/A N/A N/A N/A N/A N/A N/A " 3,283.20 " N/A N/A " 2,421.36 " " 2,749.68 " N/A " 1,678.54 " " 3,078.00 " " 1,559.93 " " 1,835.72 " N/A 3538508 15758 Free Fascial FlapMicrova 15758 " 20,896.00 " " 6,022.23 " " 5,370.27 " " 16,716.80 " " 5,370.27 " N/A N/A N/A N/A N/A " 10,709.20 " N/A " 12,537.60 " N/A N/A " 13,831.06 " N/A N/A N/A N/A N/A N/A N/A " 16,716.80 " N/A N/A " 12,328.64 " " 14,000.32 " N/A " 8,546.46 " " 15,672.00 " " 7,942.57 " " 9,346.78 " N/A 3538509 15760 Graft Composite Full Ear Nasal 15760 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 5044147 15769 Grfg Autol Soft Tiss Dir Exc 15769 761 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3542094 15770 Graft Derma-Fat-Fascia 15770 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 5044148 15771 Grft fat trk/brst/extrm15 15776 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538510 15777 Implnt Biologic Soft Tissue Reinforcement 15777 " 5,009.00 " " 1,443.59 " - " 4,007.20 " " 1,287.31 " - - - - - " 2,567.11 " - " 3,005.40 " - - " 3,315.46 " - - - - - - - " 4,007.20 " - - " 2,955.31 " " 3,356.03 " - " 2,048.68 " " 3,756.75 " " 1,903.92 " " 2,240.53 " - 3537799 15780 Dermabrasion Total Face 15780 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542096 15781 Dermabrasion Skin Segmental Face 15781 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542097 15782 Dermabrasion Regional Not Face 15782 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542098 15783 Superficial Derabrasion 15783 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537800 15786 Superficial Derabrasion 15786 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542099 15788 Chemical Peel Facial 15788 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542100 15789 Chemical Peel Dermal 15789 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542101 15792 Chemical PeelNon Facial 15792 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542102 15793 Chem Peel Nonfacial Dermal 15793 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542103 15820 Blepharoplasty Lower Eyelids 15820 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542104 15821 Blepharoplasty Ext Hern Fatpad 15821 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542105 15822 Blepharoplasty Upper Lids 15822 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542106 15823 Blepharoplasty W Exc Skin Lids 15823 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542107 15824 Rhytidectomy Forehead 15824 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542108 15825 Rhytidectomy Neck With P Tightening 15825 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3542109 15828 Rhytidectomy Cheek Chin & Neck 15828 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538511 15829 Rytidectomy Smas Flap 15829 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538512 15830 Excision Excess Skin Abdomen 15830 " 29,053.00 " " 8,373.07 " - " 27,020.64 " " 7,466.62 " " 25,994.29 " " 5,656.90 " " 26,884.27 " " 4,760.76 " " 5,600.89 " " 14,889.66 " " 5,600.89 " " 17,431.80 " " 4,760.76 " " 5,992.95 " " 19,230.18 " " 5,040.80 " " 5,600.89 " " 21,616.40 " " 27,020.64 " " 5,544.88 " " 5,712.91 " " 5,600.89 " " 23,242.40 " " 5,124.81 " - " 17,141.27 " " 19,465.51 " " 4,928.78 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,712.91 " 3538513 15832 Exc Excess Skin & Tiss Thighs 15832 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538124 15833 Exc Excess Skin & Tiss Legs 15833 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538125 15834 Exc Excess Skin And Tissue Hips 15834 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538514 15835 Exc Excess Skin & Tiss Buttock 15835 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538515 15836 Exc Excess Skin & Tiss Arms 15836 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538516 15837 Exc Excess Skin & Tiss Forearm 15837 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538517 15838 Exc Excess Skin & Tiss Subment 15838 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538518 15839 Exc Excess Skin & Tiss Other Area 15839 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538519 15840 Facial Paralysis Strips 15840 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538520 15842 Fac Paraly Strip Fr Mus Gr Mic 15842 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538521 15845 Fac Paraly Region Muscle Trans 15845 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538522 15847 Abdominoplasty 15847 " 4,711.00 " " 1,357.71 " - " 3,768.80 " " 1,210.73 " - - - - - " 2,414.39 " - " 2,826.60 " - - " 3,118.21 " - - - - - - - " 3,768.80 " - - " 2,779.49 " " 3,156.37 " - " 1,926.80 " " 3,533.25 " " 1,790.65 " " 2,107.23 " - 3538523 15850 Rem Of SuturesUnder Anes 15850 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538524 15851 Rem Sut W Anes Other Surgeon 15851 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542110 15852 Dressing Change 15852 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3538525 15860 Iv Inj To Test Vasc Flow In Flap Or Graft 15860 " 1,419.00 " 408.96 - " 1,319.43 " 364.68 " 1,274.77 " 277.42 " 1,318.42 " 233.47 274.67 727.24 274.67 851.40 233.47 293.90 939.24 247.20 274.67 " 1,055.54 " " 1,319.43 " 271.92 280.16 274.67 " 1,135.20 " 251.32 - 837.21 950.73 241.71 580.37 " 1,064.25 " 539.36 634.72 280.16 3542111 15876 Suct Assist Lipectomy Head And Neck 15876 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3542112 15877 Suct Assist Lipectomy Trunk 15877 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3542113 15878 Suct Assist Lipectomy Upper Extremity 15878 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542114 15879 Suct Assist Lipectomy Low Extrem 15879 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538526 15931 Exc Sac Decub Ulcer W Pri Sut 15931 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538527 15933 Exc Sac Press Ulc W Ost&Pr Sut 15933 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538528 15934 Exc Sac Press Ulc W Sk Fl Clos 15934 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538529 15935 Exc Sacral Press Ulcer W Ostectomy 15935 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538530 15936 Remove Sacrum Pres Sore 15936 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538531 15937 Exc Sac Pres Ulc W/O Stectomy 15937 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538532 15940 Exc Isc Press Ulcer W Pri Sut 15940 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538533 15941 Exc Isc Press Ulcer W Ostectom 15941 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538534 15944 Exc Isc Pres Ulc W Sk Fl Clos 15944 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538535 15945 Exc Isc Pres Ulcer W Ostectomy 15945 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538536 15946 Exc Isc Pres Ulcer W Ostect 15946 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 4449161 15950 Exc Tro Press Ulcer W Primary Suture 15950 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538537 15951 Exc Tro Press Ulcer W Ostectom 15951 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538538 15952 Exc Tro Press Ulc W Sk Fl Clos 15952 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538539 15956 Exc Tro Press Ulcer W Mus Myo Flap Clos 15956 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538540 15958 Exc Troch Pres Ulcer W/ Ostectomy 15958 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 46362 BURN TREAT 1ST DEG W/LOCA 16000 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542115 16000 Burn Treatment Local 16000 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46364 BURN DEBR W/O ANES SMALL 16020 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3538314 16020 Burn Treat Wo Anes Small 16020 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48010170 SMALL BURN CARE 16020 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 460922 BURN DEBR W/O ANES MEDIUM 16025 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542116 16025 Burn Treat Wo Anes Medium 16025 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48010171 MEDIUM BURN CARE 16025 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46964 BURN TREAT > 1 EXT LARGE 16030 450 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3537498 16030 Burn Treat Wo Anes Large 16030 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 48010172 LARGE BURN CARE 16030 510 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538542 16035 Escharotomy 16035 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3538543 16036 Escharotomy; Ea Addl 16036 " 1,113.00 " 320.77 286.04 890.40 286.04 N/A N/A N/A N/A N/A 570.41 N/A 667.80 N/A N/A 736.69 N/A N/A N/A N/A N/A N/A N/A 890.40 N/A N/A 656.67 745.71 N/A 455.22 834.75 423.05 497.84 N/A 3542117 17000 Destruct Premalg Lesion First Lesion 17000 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542118 17003 Des Any Meth 2-14 Les 17003 15.00 4.32 - 12.00 3.86 - - - - - 7.69 - 9.00 - - 9.93 - - - - - - - 12.00 - - 8.85 10.05 - 6.14 11.25 5.70 6.71 - 3542119 17004 Des Les Any Meth. 15 > 17004 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542120 17106 Des Cut Vas Pro Les<10sqc 17106 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542121 17107 Des Vas Pro Les 10.0-50.0 sq cm 17107 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542122 17108 Des Cut Vasc Pro Les>50 17108 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542123 17110 Des Any Meth Benign Lesion 1-14 17110 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48010470 WART DESTRUCTION <14 17110 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542124 17111 Des Any Meth Benign Lesion >= 15 17111 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3541916 17250 Chem Cauter Granula Tissue 17250 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 48070052 17250 CHEMICAL CAUTERIZATION 17250 510 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542125 17260 Les Mal Tr Ar Lg 0.5 cm 17260 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542126 17261 Les Mal Tr Ar Lg 0.6-1.0cm 17261 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542127 17262 Les Mal Tr Ar Lg 1.1-2.0 cm 17262 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542128 17263 Les Mal Tr Ar Lg 2.1-3.0 cm 17263 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542129 17264 Les Mal Tr Ar Lg 3.1-4.0 cm 17264 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542130 17266 Les Mal Tr Ar Lg 4.0 cm Lge 17266 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3541893 17270 Les Mal Scalp Nk Hd Ft Gent 0.5 cm 17270 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542131 17271 Les Mal Scalp Nk Hd Ft Gent .06-1.0 cm 17271 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3541894 17272 Les Mal Scalp Nk Hd Ft Gent 1.1-2.0 cm 17272 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542132 17273 Les Mal Scalp Nk Hd F1 Gent 2.1-3.0cm 17273 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542133 17274 Les Mal Scalp Nk Hd Ft Gent 3.1-4.0 cm 17274 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542134 17276 Les Mal Sc Hd Ft 4.0cm Lge 17276 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542135 17280 Les Mal Face Ear Lip Lid Nos 0.5cm 17280 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3542136 17281 Les Mal Face Ear Lip Lid Nos 0.6-1.0cm 17281 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542137 17282 Les Mal Face Ear Lip Lid Nos 1.1-2.0cm 17282 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542138 17283 Les Mal Face Ear Lip Lid Nos 2.1-3.0cm 17283 " 1,816.00 " 523.37 - " 1,688.64 " 466.71 " 1,623.46 " 353.30 " 1,679.04 " 297.33 349.80 930.70 349.80 " 1,089.60 " 297.33 374.29 " 1,202.01 " 314.82 349.80 " 1,350.91 " " 1,688.64 " 346.30 356.80 349.80 " 1,452.80 " 320.07 - " 1,071.44 " " 1,216.72 " 307.82 742.74 " 1,362.00 " 690.26 812.30 356.80 3542142 17284 Les Mal Face Ear Lip Lid Nos 3.1-4.0cm 17284 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542143 17286 Les Mal Face Ear Lip Lid Nos 4.0cm Lge 17286 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542144 17311 Mohs 1St Stage 17311 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542145 17312 Mohs Head/Neck Ea Add Stage 17312 265.00 76.37 - 212.00 68.11 - - - - - 135.81 - 159.00 - - 175.40 - - - - - - - 212.00 - - 156.35 177.55 - 108.39 198.75 100.73 118.53 - 3542146 17313 Mohs Trunk/Arms First Stage 17313 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542147 17314 Mohs Trunk/Arms Ea Additional 17314 242.00 69.74 - 193.60 62.19 - - - - - 124.03 - 145.20 - - 160.18 - - - - - - - 193.60 - - 142.78 162.14 - 98.98 181.50 91.98 108.25 - 3542148 17315 Mohs More Than 5 Sec Per Stage 17315 4.00 1.15 - 3.20 1.03 - - - - - 2.05 - 2.40 - - 2.65 - - - - - - - 3.20 - - 2.36 2.68 - 1.64 3.00 1.52 1.79 - 4457871 17999 Ablative fractionated laser resurfacing w/Ul 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4457872 17999 Ablative fractionated laser resurfacing w/Co 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4457864 17999 Ablative laser resurfacing 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619379 17999 Laser Genesis 1 treatment 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619380 17999 Laser Genesis 5 treatments 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619387 17999 Laser Hair Removal 120 min 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619388 17999 Laser Hair Removal 180 min 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619384 17999 Laser Hair Removal 30 min 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619385 17999 Laser Hair Removal 60 min 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619386 17999 Laser Hair Removal 90 min 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619389 17999 Rejuvenize Peel 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4457706 17999 Selective Photothermolysis with Q-switched l 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619381 17999 Solar Genesis - 1 treatment 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619382 17999 Solar Genesis - 5 treatments 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4457679 17999 Subcision 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 5226510 17999 Unl Exc Hidradinitis Other Area 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4593496 17999 Unl Micro-needling 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4629301 17999 Unl Midface Suspension Lift 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4789328 17999 Unl Mini Abdominoplasty 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 5266524T 17999 Unl NonAblative Laser Resurf Halo 17999 990 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4593493 17999 Unl Pulsed-Dye Laser/YAG <10 cm 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4593494 17999 Unl Pulsed-Dye Laser/YAG 10-50 cm 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4593495 17999 Unl Pulsed-Dye Laser/YAG over 50cm 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4593492 17999 Unl Subcut Inj Material 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4541544 17999 Unlisted Kybella Injection 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3619383 17999 Vascular Therapy 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 4457665 17999 Vicryl mesh 17999 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46998 BRST PUNCT 1ST CYST 19000 450 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46200043 US Breast Cyst Aspiration Left 19000 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46200043 US Breast Cyst Aspiration Right 19000 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3538318 19000 Aspiration Cyst Single 19000 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46200042 SJR US ASPIRAT BREAST CYST ADD 19001 761 76.00 21.90 - 60.80 19.53 - - - - - 38.95 - 45.60 - - 50.30 - - - - - - - 60.80 - - 44.84 50.92 - 31.08 57.00 28.89 33.99 - 3542152 19001 Aspiration Cyst Each Addition 19001 76.00 21.90 - 60.80 19.53 - - - - - 38.95 - 45.60 - - 50.30 - - - - - - - 60.80 - - 44.84 50.92 - 31.08 57.00 28.89 33.99 - 3541895 19020 Mastotomy Abscess Drain Deep 19020 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 71320020 SJR MG DUCT/GALACTO INJECT LT 19030 761 433.00 124.79 - 346.40 111.28 - - - - - 221.91 - 259.80 - - 286.60 - - - - - - - 346.40 - - 255.47 290.11 - 177.10 324.75 164.58 193.68 - 71320020 SJR MG DUCT/GALACTO INJECT RT 19030 761 433.00 124.79 - 346.40 111.28 - - - - - 221.91 - 259.80 - - 286.60 - - - - - - - 346.40 - - 255.47 290.11 - 177.10 324.75 164.58 193.68 - 46330009 MG Breast Biopsy w/ Stereo Guide Left 19081 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46330011 MG Breast Biopsy w/ Stereo Guide Right 19081 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542153 19081 Bx Breast Stereo 1St Les 19081 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46330008 SJR MG BX W STEREO GUID LT ADD 19082 761 375.00 108.08 - 300.00 96.38 - - - - - 192.19 - 225.00 - - 248.21 - - - - - - - 300.00 - - 221.25 251.25 - 153.38 281.25 142.54 167.74 - 46330010 SJR MG BX W STEREO GUID RT ADD 19082 761 375.00 108.08 - 300.00 96.38 - - - - - 192.19 - 225.00 - - 248.21 - - - - - - - 300.00 - - 221.25 251.25 - 153.38 281.25 142.54 167.74 - 3542154 19082 Bx Breast Stereo Each Add 19082 375.00 108.08 - 300.00 96.38 - - - - - 192.19 - 225.00 - - 248.21 - - - - - - - 300.00 - - 221.25 251.25 - 153.38 281.25 142.54 167.74 - 46200091 US Breast Biopsy w/ US Guide Left 19083 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46200093 US Breast Biopsy w/ US Guide Right 19083 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538545 19083 Bx Breast U/S 1St Les 19083 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46200092 SJR US BREAST BIOPSY LT ADDL 19084 761 375.00 108.08 - 300.00 96.38 - - - - - 192.19 - 225.00 - - 248.21 - - - - - - - 300.00 - - 221.25 251.25 - 153.38 281.25 142.54 167.74 - 46200094 SJR US BREAST BIOPSY RT ADDL 19084 761 375.00 108.08 - 300.00 96.38 - - - - - 192.19 - 225.00 - - 248.21 - - - - - - - 300.00 - - 221.25 251.25 - 153.38 281.25 142.54 167.74 - 3542155 19084 Bx Breast U/S Each Add 19084 375.00 108.08 - 300.00 96.38 - - - - - 192.19 - 225.00 - - 248.21 - - - - - - - 300.00 - - 221.25 251.25 - 153.38 281.25 142.54 167.74 - 46250115 MRI Breast Biopsy w/ MRI Guide Left 19085 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46250117 MRI Breast Biopsy w/ MRI Guide Right 19085 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46250116 SJR MRI BREAST BIOPSY LT EACH 19086 761 " 1,723.00 " 496.57 - " 1,378.40 " 442.81 - - - - - 883.04 - " 1,033.80 " - - " 1,140.45 " - - - - - - - " 1,378.40 " - - " 1,016.57 " " 1,154.41 " - 704.71 " 1,292.25 " 654.91 770.70 - 46250117 SJR MRI BREAST BIOPSY RT EACH 19086 761 " 1,723.00 " 496.57 - " 1,378.40 " 442.81 - - - - - 883.04 - " 1,033.80 " - - " 1,140.45 " - - - - - - - " 1,378.40 " - - " 1,016.57 " " 1,154.41 " - 704.71 " 1,292.25 " 654.91 770.70 - 3542156 19100 Biopsy Breast Needle 19100 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542157 19101 Bio Breast Incisinal 19101 761 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3538546 19105 AblationCryosurgOf Fibroadenoma 19105 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3542158 19110 Nipple Explor W/Wo Duct Excision 19110 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3542159 19112 Exc Of Lactiferous Duct Fistula 19112 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3541896 19120 Exc Cyst Bgn Tumor Breast 19120 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3542160 19125 Excision Of Breast Lesion 19125 761 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3542161 19126 Excis Of Brst Les/Ea Add 19126 398.00 114.70 - 318.40 102.29 - - - - - 203.98 - 238.80 - - 263.44 - - - - - - - 318.40 - - 234.82 266.66 - 162.78 298.50 151.28 178.03 - 183961 MG Device Plcmnt w/ Mammo Guide Left 19281 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 183961 MG Device Plcmnt w/ Mammo Guide Right 19281 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3541952 19281 Plcmnt Clip 1St Les Mammo Guidance 19281 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3541953 19282 Plcmnt Clip Each Add Les Mammo Guidance 19282 " 1,305.00 " 376.10 - " 1,044.00 " 335.39 - - - - - 668.81 - 783.00 - - 863.78 - - - - - - - " 1,044.00 " - - 769.95 874.35 - 533.75 978.75 496.03 583.73 - 46330014 MG Device Plcmnt w/ Stereo Guide Left 19283 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46330015 MG Device Plcmnt w/ Stereo Guide Right 19283 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542164 19283 Plcmnt Clip 1St Les Stereo Guidance 19283 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46330012 SJR MG DEV STER GUID LT EA ADD 19284 761 562.00 161.97 - 449.60 144.43 - - - - - 288.03 - 337.20 - - 371.99 - - - - - - - 449.60 - - 331.58 376.54 - 229.86 421.50 213.62 251.38 - 46330013 SJR MG DEV STER GUID RT EA ADD 19284 761 562.00 161.97 - 449.60 144.43 - - - - - 288.03 - 337.20 - - 371.99 - - - - - - - 449.60 - - 331.58 376.54 - 229.86 421.50 213.62 251.38 - 3542166 19284 Plcmnt Clip Each Add Les Stereo Guidance 19284 562.00 161.97 - 449.60 144.43 - - - - - 288.03 - 337.20 - - 371.99 - - - - - - - 449.60 - - 331.58 376.54 - 229.86 421.50 213.62 251.38 - 46200105 US Breast Device Plcmnt w/US Guide Left 19285 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46200106 US Breast Device Plcmnt w/US Guide Right 19285 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 5169904 US* BREAST DEVICE PLCMNT W/US GUIDE LEFT 19285 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 5169906 US* BREAST DEVICE PLCMNT W/US GUIDE RIGH 19285 761 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3541956 19285 Plcmnt Clip 1St Lesion U/S Guidance 19285 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 46200103 SJR US NEEDLE LOC ADDL LT 19286 761 " 1,317.00 " 379.56 - " 1,053.60 " 338.47 - - - - - 674.96 - 790.20 - - 871.72 - - - - - - - " 1,053.60 " - - 777.03 882.39 - 538.65 987.75 500.59 589.09 - 46200104 SJR US NEEDLE LOC ADDL RT 19286 761 " 1,317.00 " 379.56 - " 1,053.60 " 338.47 - - - - - 674.96 - 790.20 - - 871.72 - - - - - - - " 1,053.60 " - - 777.03 882.39 - 538.65 987.75 500.59 589.09 - 3541957 19286 Plcmnt Clip Each Add Lesion U/S Guidance 19286 " 1,317.00 " 379.56 - " 1,053.60 " 338.47 - - - - - 674.96 - 790.20 - - 871.72 - - - - - - - " 1,053.60 " - - 777.03 882.39 - 538.65 987.75 500.59 589.09 - 3542167 19296 Plcmt Of Radiotherapy Aft Load 19296 " 46,830.00 " " 13,496.41 " - " 43,554.00 " " 12,035.31 " " 41,880.87 " " 9,114.15 " " 43,314.77 " " 7,670.32 " " 9,023.91 " " 24,000.38 " " 9,023.91 " " 28,098.00 " " 7,670.32 " " 9,655.58 " " 30,996.78 " " 8,121.52 " " 9,023.91 " " 34,843.02 " " 43,554.00 " " 8,933.67 " " 9,204.39 " " 9,023.91 " " 37,464.00 " " 8,256.88 " - " 27,629.70 " " 31,376.10 " " 7,941.04 " " 19,153.47 " " 35,122.50 " " 17,800.08 " " 20,947.06 " " 9,204.39 " 3542168 19297 Plcm Of Radthpy Conc W/Par Masect 19297 " 4,680.00 " " 1,348.78 " - " 3,744.00 " " 1,202.76 " - - - - - " 2,398.50 " - " 2,808.00 " - - " 3,097.69 " - - - - - - - " 3,744.00 " - - " 2,761.20 " " 3,135.60 " - " 1,914.12 " " 3,510.00 " " 1,778.87 " " 2,093.36 " - 3542169 19300 Mastectomy For Gynecomast 19300 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3542170 19301 Mastectomy Partial 19301 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3542171 19302 Mastectomy Part W Axill Lymphadenectomy 19302 " 29,053.00 " " 8,373.07 " - " 27,020.64 " " 7,466.62 " " 25,994.29 " " 5,656.90 " " 26,884.27 " " 4,760.76 " " 5,600.89 " " 14,889.66 " " 5,600.89 " " 17,431.80 " " 4,760.76 " " 5,992.95 " " 19,230.18 " " 5,040.80 " " 5,600.89 " " 21,616.40 " " 27,020.64 " " 5,544.88 " " 5,712.91 " " 5,600.89 " " 23,242.40 " " 5,124.81 " - " 17,141.27 " " 19,465.51 " " 4,928.78 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,712.91 " 3538126 19303 Mastectomy Simple Complete 19303 " 29,053.00 " " 8,373.07 " - " 27,020.64 " " 7,466.62 " " 25,994.29 " " 5,656.90 " " 26,884.27 " " 4,760.76 " " 5,600.89 " " 14,889.66 " " 5,600.89 " " 17,431.80 " " 4,760.76 " " 5,992.95 " " 19,230.18 " " 5,040.80 " " 5,600.89 " " 21,616.40 " " 27,020.64 " " 5,544.88 " " 5,712.91 " " 5,600.89 " " 23,242.40 " " 5,124.81 " - " 17,141.27 " " 19,465.51 " " 4,928.78 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,712.91 " 3538551 19305 MastectomyRadical W/Lymp 19305 " 16,522.00 " " 4,761.64 " " 4,246.15 " " 13,217.60 " " 4,246.15 " N/A N/A N/A N/A N/A " 8,467.53 " N/A " 9,913.20 " N/A N/A " 10,935.91 " N/A N/A N/A N/A N/A N/A N/A " 13,217.60 " N/A N/A " 9,747.98 " " 11,069.74 " N/A " 6,757.50 " " 12,391.50 " " 6,280.01 " " 7,390.29 " N/A 3538552 19307 Mastectomy Modified Rad 19307 " 29,053.00 " " 8,373.07 " - " 27,020.64 " " 7,466.62 " " 25,994.29 " " 5,656.90 " " 26,884.27 " " 4,760.76 " " 5,600.89 " " 14,889.66 " " 5,600.89 " " 17,431.80 " " 4,760.76 " " 5,992.95 " " 19,230.18 " " 5,040.80 " " 5,600.89 " " 21,616.40 " " 27,020.64 " " 5,544.88 " " 5,712.91 " " 5,600.89 " " 23,242.40 " " 5,124.81 " - " 17,141.27 " " 19,465.51 " " 4,928.78 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,712.91 " 3538553 19316 Mastopexy 19316 " 29,053.00 " " 8,373.07 " - " 27,020.64 " " 7,466.62 " " 25,994.29 " " 5,656.90 " " 26,884.27 " " 4,760.76 " " 5,600.89 " " 14,889.66 " " 5,600.89 " " 17,431.80 " " 4,760.76 " " 5,992.95 " " 19,230.18 " " 5,040.80 " " 5,600.89 " " 21,616.40 " " 27,020.64 " " 5,544.88 " " 5,712.91 " " 5,600.89 " " 23,242.40 " " 5,124.81 " - " 17,141.27 " " 19,465.51 " " 4,928.78 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,712.91 " 3538554 19318 Reduction Mammaplasty 19318 " 29,053.00 " " 8,373.07 " - " 27,020.64 " " 7,466.62 " " 25,994.29 " " 5,656.90 " " 26,884.27 " " 4,760.76 " " 5,600.89 " " 14,889.66 " " 5,600.89 " " 17,431.80 " " 4,760.76 " " 5,992.95 " " 19,230.18 " " 5,040.80 " " 5,600.89 " " 21,616.40 " " 27,020.64 " " 5,544.88 " " 5,712.91 " " 5,600.89 " " 23,242.40 " " 5,124.81 " - " 17,141.27 " " 19,465.51 " " 4,928.78 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,712.91 " 3538127 19325 Mammaplasty Aug W Pros Implant 19325 " 46,830.00 " " 13,496.41 " - " 43,554.00 " " 12,035.31 " " 41,880.87 " " 9,114.15 " " 43,314.77 " " 7,670.32 " " 9,023.91 " " 24,000.38 " " 9,023.91 " " 28,098.00 " " 7,670.32 " " 9,655.58 " " 30,996.78 " " 8,121.52 " " 9,023.91 " " 34,843.02 " " 43,554.00 " " 8,933.67 " " 9,204.39 " " 9,023.91 " " 37,464.00 " " 8,256.88 " - " 27,629.70 " " 31,376.10 " " 7,941.04 " " 19,153.47 " " 35,122.50 " " 17,800.08 " " 20,947.06 " " 9,204.39 " 3541897 19328 Removal Of Intact Mammary Implant 19328 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3538555 19330 Removal Mammary Implant Material 19330 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3537892 19340 Immed Ins Breast Prost Fol Mas 19340 " 29,053.00 " " 8,373.07 " - " 27,020.64 " " 7,466.62 " " 25,994.29 " " 5,656.90 " " 26,884.27 " " 4,760.76 " " 5,600.89 " " 14,889.66 " " 5,600.89 " " 17,431.80 " " 4,760.76 " " 5,992.95 " " 19,230.18 " " 5,040.80 " " 5,600.89 " " 21,616.40 " " 27,020.64 " " 5,544.88 " " 5,712.91 " " 5,600.89 " " 23,242.40 " " 5,124.81 " - " 17,141.27 " " 19,465.51 " " 4,928.78 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,712.91 " 3538128 19342 Del Insert Breast Prothesis 19342 " 46,830.00 " " 13,496.41 " - " 43,554.00 " " 12,035.31 " " 41,880.87 " " 9,114.15 " " 43,314.77 " " 7,670.32 " " 9,023.91 " " 24,000.38 " " 9,023.91 " " 28,098.00 " " 7,670.32 " " 9,655.58 " " 30,996.78 " " 8,121.52 " " 9,023.91 " " 34,843.02 " " 43,554.00 " " 8,933.67 " " 9,204.39 " " 9,023.91 " " 37,464.00 " " 8,256.88 " - " 27,629.70 " " 31,376.10 " " 7,941.04 " " 19,153.47 " " 35,122.50 " " 17,800.08 " " 20,947.06 " " 9,204.39 " 3542172 19350 Nipple/Areola Reconstruction 19350 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3542173 19355 Correction Inverted Nippl 19355 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3538556 19357 Breast Recon W/Tis Expander 19357 " 78,376.00 " " 22,587.96 " - " 72,892.54 " " 20,142.63 " " 70,079.08 " " 15,250.67 " " 72,478.42 " " 12,834.72 " " 15,099.67 " " 40,167.70 " " 15,099.67 " " 47,025.60 " " 12,834.72 " " 16,156.65 " " 51,877.07 " " 13,589.70 " " 15,099.67 " " 58,313.74 " " 72,892.54 " " 14,948.67 " " 15,401.66 " " 15,099.67 " " 62,700.80 " " 13,816.20 " - " 46,241.84 " " 52,511.92 " " 13,287.71 " " 32,055.78 " " 58,782.00 " " 29,790.72 " " 35,057.58 " " 15,401.66 " 3538557 19361 Breast Recon W/Lattiss Dorsi Flap 19361 " 8,766.00 " " 2,526.36 " " 2,252.86 " " 7,012.80 " " 2,252.86 " N/A N/A N/A N/A N/A " 4,492.58 " N/A " 5,259.60 " N/A N/A " 5,802.22 " N/A N/A N/A N/A N/A N/A N/A " 7,012.80 " N/A N/A " 5,171.94 " " 5,873.22 " N/A " 3,585.29 " " 6,574.50 " " 3,331.96 " " 3,921.03 " N/A 3538558 19364 Breast Recon W/Free Flap 19364 " 16,238.00 " " 4,679.79 " " 4,173.17 " " 12,990.40 " " 4,173.17 " N/A N/A N/A N/A N/A " 8,321.98 " N/A " 9,742.80 " N/A N/A " 10,747.93 " N/A N/A N/A N/A N/A N/A N/A " 12,990.40 " N/A N/A " 9,580.42 " " 10,879.46 " N/A " 6,641.34 " " 12,178.50 " " 6,172.06 " " 7,263.26 " N/A 3538559 19367 Breast Recon W Tram Sing 19367 " 33,792.00 " " 9,738.85 " " 8,684.54 " " 27,033.60 " " 8,684.54 " N/A N/A N/A N/A N/A " 17,318.40 " N/A " 20,275.20 " N/A N/A " 22,366.92 " N/A N/A N/A N/A N/A N/A N/A " 27,033.60 " N/A N/A " 19,937.28 " " 22,640.64 " N/A " 13,820.93 " " 25,344.00 " " 12,844.34 " " 15,115.16 " N/A 3538560 19368 W Micro Vascu Anastomo 19368 " 48,141.00 " " 13,874.24 " " 12,372.24 " " 38,512.80 " " 12,372.24 " N/A N/A N/A N/A N/A " 24,672.26 " N/A " 28,884.60 " N/A N/A " 31,864.53 " N/A N/A N/A N/A N/A N/A N/A " 38,512.80 " N/A N/A " 28,403.19 " " 32,254.47 " N/A " 19,689.67 " " 36,105.75 " " 18,298.39 " " 21,533.47 " N/A 3538561 19369 Breast Recon W Tram Doubl 19369 " 36,803.00 " " 10,606.62 " " 9,458.37 " " 29,442.40 " " 9,458.37 " N/A N/A N/A N/A N/A " 18,861.54 " N/A " 22,081.80 " N/A N/A " 24,359.91 " N/A N/A N/A N/A N/A N/A N/A " 29,442.40 " N/A N/A " 21,713.77 " " 24,658.01 " N/A " 15,052.43 " " 27,602.25 " " 13,988.82 " " 16,461.98 " N/A 3538562 19370 Open Periprosthetic Cap Breast 19370 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3538563 19371 Periprosthetic Capsulec Breast 19371 " 16,578.00 " " 4,777.78 " - " 15,418.35 " " 4,260.55 " " 14,831.93 " " 3,227.74 " " 15,339.74 " " 2,716.41 " " 3,195.78 " " 8,496.23 " " 3,195.78 " " 9,946.80 " " 2,716.41 " " 3,419.48 " " 10,972.98 " " 2,876.20 " " 3,195.78 " " 12,334.62 " " 15,418.35 " " 3,163.82 " " 3,259.70 " " 3,195.78 " " 13,262.40 " " 2,924.14 " - " 9,781.02 " " 11,107.26 " " 2,812.29 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,259.70 " 3538564 19380 Revis Recon Breast 19380 " 29,053.00 " " 8,373.07 " - " 27,020.64 " " 7,466.62 " " 25,994.29 " " 5,656.90 " " 26,884.27 " " 4,760.76 " " 5,600.89 " " 14,889.66 " " 5,600.89 " " 17,431.80 " " 4,760.76 " " 5,992.95 " " 19,230.18 " " 5,040.80 " " 5,600.89 " " 21,616.40 " " 27,020.64 " " 5,544.88 " " 5,712.91 " " 5,600.89 " " 23,242.40 " " 5,124.81 " - " 17,141.27 " " 19,465.51 " " 4,928.78 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,712.91 " 3538566 20100 Expl Of Penet Wound Nk 20100 " 2,375.00 " 684.48 - " 2,208.75 " 610.38 " 2,124.32 " 462.30 " 2,197.06 " 389.06 457.72 " 1,217.19 " 457.72 " 1,425.00 " 389.06 489.76 " 1,572.01 " 411.95 457.72 " 1,766.99 " " 2,208.75 " 453.14 466.87 457.72 " 1,900.00 " 418.81 - " 1,401.25 " " 1,591.25 " 402.79 971.38 " 1,781.25 " 902.74 " 1,062.34 " 466.87 3538567 20101 Explore Wound Chest 20101 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 46988 EXPLOR PENETRAT WND ABD 20102 450 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3542175 20102 Explore Wound Abdomen 20102 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 46930 EXPLOR PENETRATING WOUND 20103 450 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3542176 20103 Explore Wound Extremity 20103 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3538568 20150 Excise Epiphyseal Bar 20150 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3541898 20200 Biopsy Muscle Superficial 20200 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542177 20205 Biopsy Muscle Deep 20205 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 4221270 BIOPSY MUSCLE PERC NDLE 20206 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46150145 CT Biopsy Muscle 20206 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46200070 US Biopsy Muscle 20206 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541899 20206 Biopsy Muscle Percut Needle 20206 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46150146 CT Biopsy Bone Superficial 20220 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542178 20220 Biopsy Bone Trochar Superificial 20220 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 48010553 BX BONE TROCAR/NEEDLE SUPER 20220 510 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 45000471 20225 Percutaneous bone biopsy 20225 490 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46150147 CT Biopsy Bone Deep 20225 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 307613 IR Biopsy Bone Deep Percutaneous 20225 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 46000286 XR Bone Bx Deep Percut 20225 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538569 20225 Biopsy Bone Trochar Deep 20225 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 48010552 BX BONE TROCAR/NEEDLE DEEP 20225 510 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542179 20240 Biopsy Bone Excision Superf 20240 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538570 20245 Biopsy Bone Excision Deep 20245 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3537499 20250 Open Bx Vertebral Body Thoracic 20250 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538571 20251 Open Bone Biopsy 20251 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46000266 XR Inj Sinus Tract Diag. 20500 761 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3538572 20500 Inject Sinus Tract Therap 20500 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3537405 20501 Injection Sinus Tract Diagnostic 20501 195.00 56.20 - 156.00 50.12 - - - - - 99.94 - 117.00 - - 129.07 - - - - - - - 156.00 - - 115.05 130.65 - 79.76 146.25 74.12 87.22 - 3541900 20520 Rem. Foreign Body Muscle Simple 20520 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542180 20525 Rem. Foreign Body Muscle Deep/Compl 20525 761 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542181 20526 Inj Thera Carpal Tunnel 20526 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3542182 20527 Injection Dupuytren Cord W/Enzyme 20527 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 460928 INJ TENDON SHEATH 20550 450 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3515507T US Inj Ligament or Tendon Sheath 20550 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46200049 US Injection Tendon Sheath Ligament 20550 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3538347 20550 Inject Tendon Lig 20550 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 4593498 Us Ortho 20550 Inj Tendon/Ligament POC 20550 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 48010476 PLANTAR FASCIAL STEROID INJECT 20550 510 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46838 INJ TENDON ORIGIN/INSERT 20551 450 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3542183 20551 Inj Tendon Origin/Inserti 20551 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 4593499 Us Ortho 20551 Inj Tendon Origin/Ins POC 20551 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46834 INJ 1 OR 1+TRGR 1 2 MUSCL 20552 450 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3538348 20552 Inj 1 Or 1+ Trgr Pt 1 Or 2 Muscl 20552 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 460909 INJ 1/1+ TRGR PT 3 > MUSC 20553 450 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3542184 20553 Trigger Point Inj-3+Mscl 20553 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3538573 20555 Radioelement Application 20555 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 5044152 20560 Ndl Insj W/O Njx 1 Or 2 Musc 20560 761 130.00 37.47 - 120.47 33.41 116.03 25.25 120.00 21.25 25.00 66.63 25.00 78.00 21.25 26.75 86.05 22.50 25.00 96.38 120.47 24.75 25.50 25.00 104.00 22.88 - 76.70 87.10 22.00 53.17 97.50 49.41 58.15 25.50 5044153 20561 Ndl Insj W/O Njx 3+ Musc 20561 761 130.00 37.47 - 120.47 33.41 116.03 25.25 120.00 21.25 25.00 66.63 25.00 78.00 21.25 26.75 86.05 22.50 25.00 96.38 120.47 24.75 25.50 25.00 104.00 22.88 - 76.70 87.10 22.00 53.17 97.50 49.41 58.15 25.50 46962 ARTHROCENTESIS SM JOINT 20600 450 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3516053 "XR Aspiration Small Joint ( Finger, Toe)" 20600 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 307127 "XR Joint Injection Small Finger, Toe" 20600 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3542185 20600 Arthrocentesis Small Joint 20600 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46200150 "IR Joint, Small LT Drain or Inj w/US" 20604 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46200150 "IR Joint, Small RT Drain or Inj w/US" 20604 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3515555 US Joint/Bursa Up Sm Arth/Asp/Inj Right 20604 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3542186 20604 Arthrocentesis Small Joint Or Bursa; W/ Us 20604 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 4295161 US Ortho 20604 Arthrocentesis Small Inj POC 20604 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 4943299 US 20604 Arthrocentesis Small Inj POC 20604 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46817 ARTHROCENTESIS INTRMED JT 20605 450 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3512552T "IR Joint, Intermed LT Drain or Inj w/oUS" 20605 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46200055 US Asp/Inj Intermediate Joint 20605 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3516440 XR Joint Inj Inter TMJ Ankle Elbow Wrist 20605 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3516440 XR Joint Inj Inter TMJ Ankle Elbow Wrist 20605 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3542188 20605 Arthrocentesis Int Joint 20605 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 460946 DRAIN/INJ JOINT/BURSA U/S 20606 450 " 3,332.00 " 960.28 - " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 2,478.80 " " 3,098.51 " 636.21 655.49 642.64 " 2,665.60 " 588.02 - " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 46200151 "IR Joint, Intermed LT Drain or Inj w/US" 20606 761 " 3,332.00 " 960.28 - " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 2,478.80 " " 3,098.51 " 636.21 655.49 642.64 " 2,665.60 " 588.02 - " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 46200152 "IR Joint, Intermed RT Drain or Inj w/US" 20606 761 " 3,332.00 " 960.28 - " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 2,478.80 " " 3,098.51 " 636.21 655.49 642.64 " 2,665.60 " 588.02 - " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 46200055 US Joint/Bursa Lw Int Arth/Asp/Inj Left 20606 761 " 3,332.00 " 960.28 - " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 2,478.80 " " 3,098.51 " 636.21 655.49 642.64 " 2,665.60 " 588.02 - " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 46200055 US Joint/Bursa Lw Int Arth/Asp/Inj Right 20606 761 " 3,332.00 " 960.28 - " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 2,478.80 " " 3,098.51 " 636.21 655.49 642.64 " 2,665.60 " 588.02 - " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 46200055 US Joint/Bursa Up Int Arth/Asp/Inj Left 20606 761 " 3,332.00 " 960.28 - " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 2,478.80 " " 3,098.51 " 636.21 655.49 642.64 " 2,665.60 " 588.02 - " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 46200055 US Joint/Bursa Up Int Arth/Asp/Inj Right 20606 761 " 3,332.00 " 960.28 - " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 2,478.80 " " 3,098.51 " 636.21 655.49 642.64 " 2,665.60 " 588.02 - " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 3542189 20606 Arthrocentesis Inter Joint Or Bursa; W/ Us 20606 " 3,332.00 " 960.28 - " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 2,478.80 " " 3,098.51 " 636.21 655.49 642.64 " 2,665.60 " 588.02 - " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 4295162 US Ortho 20606 Arthrocentesis Inter Joint POC 20606 " 3,332.00 " 960.28 - " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 2,478.80 " " 3,098.51 " 636.21 655.49 642.64 " 2,665.60 " 588.02 - " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 4943298 US 20606 Arthrocentesis Inter Joint POC 20606 " 3,332.00 " 960.28 - " 3,098.51 " 856.32 " 2,982.56 " 649.07 " 3,084.67 " 546.24 642.64 " 1,707.65 " 642.64 " 1,999.20 " 546.24 687.62 " 2,205.45 " 578.38 642.64 " 2,478.80 " " 3,098.51 " 636.21 655.49 642.64 " 2,665.60 " 588.02 - " 1,965.88 " " 2,232.44 " 565.52 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 655.49 46818 ARTHROCENTESIS MAJOR JT 20610 450 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3512570T "IR Joint, Major RT Drain or Inj w/oUS" 20610 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 307129 INJ MAJ JT HIP KNEE SHOUL 20610 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 307129 INJ MAJ JT HIP KNEE SHOUL 20610 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3542190 20610 Arthrocentesis Maj Joint 20610 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46001395 "IR Joint, Major LT Drain or Inj w/US" 20611 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46001397 "IR Joint, Major RT Drain or Inj w/US" 20611 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46200056 US Asp/Inj Major Joint 20611 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46200056 US Joint/Bursa Lw Maj Arth/Asp/Inj Left 20611 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46200056 US Joint/Bursa Lw Maj Arth/Asp/Inj Right 20611 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46200056 US Joint/Bursa Up Maj Arth/Asp/Inj Left 20611 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 46200056 US Joint/Bursa Up Maj Arth/Asp/Inj Right 20611 761 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3542191 20611 Arthrocentesis Major Joint Or Bursa; W/ Us 20611 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 4295163 US Ortho 20611 Arthrocentesis Major Joint POC 20611 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 5280894T US 20611 Arthrocentesis Major Joint POC 20611 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3542192 20612 Ganglion Cyst InjAny Site 20612 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 4593497 Us Ortho 20612 Gang Cyst Any Site POC 20612 " 1,371.00 " 395.12 - " 1,275.21 " 352.35 " 1,227.15 " 267.05 " 1,269.17 " 224.75 264.41 702.64 264.41 822.60 224.75 282.92 907.46 237.97 264.41 " 1,020.16 " " 1,275.21 " 261.77 269.70 264.41 " 1,096.80 " 241.94 - 808.89 918.57 232.68 560.74 " 1,028.25 " 521.12 613.25 269.70 3538350 20615 Aspiration & Inj Treatment Bone Cyst 20615 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 460916 INSERT/REMOVE WIRE PIN 20650 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538574 20650 Insert/Rem Wire/ Pin 20650 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538129 20660 Application Removal Caliper/Tongs Ip 20660 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538130 20661 Application Removal Halo Cranial 20661 " 14,860.00 " " 4,282.65 " " 3,819.02 " " 13,820.05 " " 3,819.02 " N/A N/A N/A N/A N/A " 7,615.75 " N/A " 8,916.00 " N/A N/A " 9,835.83 " N/A N/A " 11,055.99 " " 13,820.05 " N/A N/A N/A " 11,888.00 " N/A N/A " 8,767.40 " " 9,956.20 " N/A " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " N/A 3538575 20663 Application Halo Incl Rem Femoral 20663 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538576 20664 Halo Brace Application 20664 " 14,860.00 " " 4,282.65 " " 3,819.02 " " 13,820.05 " " 3,819.02 " N/A N/A N/A N/A N/A " 7,615.75 " N/A " 8,916.00 " N/A N/A " 9,835.83 " N/A N/A " 11,055.99 " " 13,820.05 " N/A N/A N/A " 11,888.00 " N/A N/A " 8,767.40 " " 9,956.20 " N/A " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " N/A 3538577 20665 Remove Caliper/Tongs 2Nd Physn 20665 " 1,419.00 " 408.96 - " 1,319.43 " 364.68 " 1,274.77 " 277.42 " 1,318.42 " 233.47 274.67 727.24 274.67 851.40 233.47 293.90 939.24 247.20 274.67 " 1,055.54 " " 1,319.43 " 271.92 280.16 274.67 " 1,135.20 " 251.32 - 837.21 950.73 241.71 580.37 " 1,064.25 " 539.36 634.72 280.16 3541901 20670 Removal Implant Superficial 20670 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542193 20680 Removal Implant Deep 20680 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538578 20690 Appl Uniplane Uni Ext Fixation System 20690 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538131 20692 Appl Multiplane Uni Ext Fix System 20692 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538579 20693 Adj/Rev Ext Fix Sys W Anes 20693 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538580 20694 Rem Under Anes Exter Fixation System 20694 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538581 20696 App Multiplane W Stereota 20696 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 3542194 20697 App Multiplane Unilater External Fixation 20697 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 5044154 20700 Mnl Prep&Insj Dp Rx Dlvr Dev 20700 761 353.00 101.73 - 282.40 90.72 - - - - - 180.91 - 211.80 - - 233.65 - - - - - - - 282.40 - - 208.27 236.51 - 144.38 264.75 134.18 157.90 - 5044155 20701 Rmvl Deep Rx Delivery Device 20701 761 263.00 75.80 - 210.40 67.59 - - - - - 134.79 - 157.80 - - 174.08 - - - - - - - 210.40 - - 155.17 176.21 - 107.57 197.25 99.97 117.64 - 5044156 20702 Mnl Prep&Insj Imed Rx Dev 20702 587.00 169.17 - 469.60 150.86 - - - - - 300.84 - 352.20 - - 388.54 - - - - - - - 469.60 - - 346.33 393.29 - 240.08 440.25 223.12 262.57 - 5044157 20703 Rmvl Imed Rx Delivery Device 20703 420.00 121.04 - 336.00 107.94 - - - - - 215.25 - 252.00 - - 278.00 - - - - - - - 336.00 - - 247.80 281.40 - 171.78 315.00 159.64 187.87 - 5044158 20704 Mnl Prep&Insj I-Artic Rx Dev 20704 611.00 176.09 - 488.80 157.03 - - - - - 313.14 - 366.60 - - 404.42 - - - - - - - 488.80 - - 360.49 409.37 - 249.90 458.25 232.24 273.30 - 5044159 20705 Rmvl I-Artic Rx Delivery Dev 20705 503.00 144.96 - 402.40 129.27 - - - - - 257.79 - 301.80 - - 332.94 - - - - - - - 402.40 - - 296.77 337.01 - 205.73 377.25 191.19 224.99 - 3538582 20805 Reimplant Forearm Complete Amputation 20805 " 83,308.00 " " 24,009.37 " " 21,410.16 " " 77,479.52 " " 21,410.16 " N/A N/A N/A N/A N/A " 42,695.35 " N/A " 49,984.80 " N/A N/A " 55,141.57 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 66,646.40 " N/A N/A " 49,151.72 " " 55,816.36 " N/A " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " N/A 3538583 20808 Reimplantation Hand Complete 20808 " 83,308.00 " " 24,009.37 " " 21,410.16 " " 77,479.52 " " 21,410.16 " N/A N/A N/A N/A N/A " 42,695.35 " N/A " 49,984.80 " N/A N/A " 55,141.57 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 66,646.40 " N/A N/A " 49,151.72 " " 55,816.36 " N/A " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " N/A 3538584 20816 Reimplantation Digit Complete 20816 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538585 20822 Reimplantation Digit Excl Thumb Comp Amp 20822 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538586 20824 Replantation Thumb; Complete Amputation 20824 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538587 20827 Replantation Thumb 20827 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538588 20838 Replantation;Foot Complete Amputation 20838 " 83,308.00 " " 24,009.37 " " 21,410.16 " " 77,479.52 " " 21,410.16 " N/A N/A N/A N/A N/A " 42,695.35 " N/A " 49,984.80 " N/A N/A " 55,141.57 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 66,646.40 " N/A N/A " 49,151.72 " " 55,816.36 " N/A " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " N/A 3538589 20900 Graft Bone Minor 20900 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538590 20902 Graft Bone Major 20902 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537500 20910 Graft Cartilage Costochondral 20910 " 2,752.00 " 793.13 - " 2,559.39 " 707.26 " 2,459.97 " 535.34 " 2,544.19 " 450.53 530.04 " 1,410.40 " 530.04 " 1,651.20 " 450.53 567.14 " 1,821.55 " 477.04 530.04 " 2,047.50 " " 2,559.39 " 524.74 540.64 530.04 " 2,201.60 " 484.99 - " 1,623.68 " " 1,843.84 " 466.44 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 540.64 3542195 20912 Bone Graft Nasal Septum 20912 " 18,491.00 " " 5,329.11 " - " 17,197.63 " " 4,752.19 " " 16,539.21 " " 3,599.28 " " 17,105.47 " " 3,029.09 " " 3,563.64 " " 9,476.64 " " 3,563.64 " " 11,094.60 " " 3,029.09 " " 3,813.09 " " 12,239.19 " " 3,207.28 " " 3,563.64 " " 13,758.04 " " 17,197.63 " " 3,528.00 " " 3,634.91 " " 3,563.64 " " 14,792.80 " " 3,260.73 " - " 10,909.69 " " 12,388.97 " " 3,136.00 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,634.91 " 3538591 20920 Graft Fascia Lata 20920 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538592 20922 Graft Fascia Lata Complex 20922 " 9,006.00 " " 2,595.53 " - " 8,375.60 " " 2,314.54 " " 8,044.93 " " 1,750.74 " " 8,320.37 " " 1,473.40 " " 1,733.41 " " 4,615.58 " " 1,733.41 " " 5,403.60 " " 1,473.40 " " 1,854.75 " " 5,961.07 " " 1,560.07 " " 1,733.41 " " 6,700.44 " " 8,375.60 " " 1,716.08 " " 1,768.08 " " 1,733.41 " " 7,204.80 " " 1,586.07 " - " 5,313.54 " " 6,034.02 " " 1,525.40 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,768.08 " 3538593 20924 Tendon Graft From A Distance 20924 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538594 20930 Spinal Bone Allograft 20930 " 1,190.00 " 342.96 - 952.00 305.83 - - - - - 609.88 - 714.00 - - 787.66 - - - - - - - 952.00 - - 702.10 797.30 - 486.71 892.50 452.32 532.29 - 3538595 20931 Allograft/Spine Sur Struc 20931 " 1,400.00 " 403.48 - " 1,120.00 " 359.80 - - - - - 717.50 - 840.00 - - 926.66 - - - - - - - " 1,120.00 " - - 826.00 938.00 - 572.60 " 1,050.00 " 532.14 626.22 - 4407191 20932 Osteoart Algrft W/surf & Bone 20932 " 10,727.00 " " 3,091.52 " - " 8,581.60 " " 2,756.84 " - - - - - " 5,497.59 " - " 6,436.20 " - - " 7,100.20 " - - - - - - - " 8,581.60 " - - " 6,328.93 " " 7,187.09 " - " 4,387.34 " " 8,045.25 " " 4,077.33 " " 4,798.19 " - 4423199 20933 Hemicrt Intrclry Algrft Prtl 20933 " 9,841.00 " " 2,836.18 " - " 7,872.80 " " 2,529.14 " - - - - - " 5,043.51 " - " 5,904.60 " - - " 6,513.76 " - - - - - - - " 7,872.80 " - - " 5,806.19 " " 6,593.47 " - " 4,024.97 " " 7,380.75 " " 3,740.56 " " 4,401.88 " - 4423200 20934 Intercalary Allograft Compl 20934 " 10,722.00 " " 3,090.08 " - " 8,577.60 " " 2,755.55 " - - - - - " 5,495.03 " - " 6,433.20 " - - " 7,096.89 " - - - - - - - " 8,577.60 " - - " 6,325.98 " " 7,183.74 " - " 4,385.30 " " 8,041.50 " " 4,075.43 " " 4,795.95 " - 3538596 20936 Spinal Bone Autograft 20936 " 1,227.00 " 353.62 - 981.60 315.34 - - - - - 628.84 - 736.20 - - 812.15 - - - - - - - 981.60 - - 723.93 822.09 - 501.84 920.25 466.38 548.84 - 3538597 20937 Autogrft/Spn Surg Morseli 20937 " 1,080.00 " 311.26 - 864.00 277.56 - - - - - 553.50 - 648.00 - - 714.85 - - - - - - - 864.00 - - 637.20 723.60 - 441.72 810.00 410.51 483.08 - 3538598 20938 Autogrft/Spn Sur Structur 20938 " 1,470.00 " 423.65 - " 1,176.00 " 377.79 - - - - - 753.38 - 882.00 - - 972.99 - - - - - - - " 1,176.00 " - - 867.30 984.90 - 601.23 " 1,102.50 " 558.75 657.53 - 4841295 20939 Bone Marrow Aspir Bone Grfg 20939 " 6,036.00 " " 1,739.58 " - " 4,828.80 " " 1,551.25 " - - - - - " 3,093.45 " - " 3,621.60 " - - " 3,995.23 " - - - - - - - " 4,828.80 " - - " 3,561.24 " " 4,044.12 " - " 2,468.72 " " 4,527.00 " " 2,294.28 " " 2,699.90 " - 3542197 20950 Monitor Interstitial Fluid Pressure 20950 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3538599 20955 Fibula Graft W Micro Anastomos 20955 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538600 20962 Bne Graf W/Mic Anas Other Bone Graft 20962 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538601 20969 Free Osteocut Flp W/Microvas. Anaston 20969 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538602 20970 Osteocutaneous Grf W Micro Ana 20970 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3541902 20974 Elec Stim Aid Bone Healing Noninvasive 20974 260.00 74.93 - 231.46 66.82 223.79 48.70 231.46 40.99 48.22 133.25 48.22 156.00 40.99 51.60 172.09 43.40 48.22 134.33 167.92 47.74 49.18 48.22 208.00 44.12 - 153.40 174.20 42.43 106.34 195.00 98.83 116.30 49.18 3538132 20975 Elec Stim Aid Bone Healing Invasive 20975 " 2,486.00 " 716.47 - " 1,988.80 " 638.90 - - - - - " 1,274.08 " - " 1,491.60 " - - " 1,645.48 " - - - - - - - " 1,988.80 " - - " 1,466.74 " " 1,665.62 " - " 1,016.77 " " 1,864.50 " 944.93 " 1,111.99 " - 3538603 20982 Ablation Bone Tumors W/Ct 20982 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 4913294 20999 Unl BAHA Magnet Implant 20999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4865388 20999 Unl BAHA Magnet Removal 20999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 5948743T 20999 Unl Exploration Facial Wounds 20999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 5197565 20999 Unl Fascial Mesh Removal; No Inf 20999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4617332 20999 Unl Lap Component Separation 20999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4457859 20999 cadaveric costal graft 20999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542198 21011 ExcTumor Face Or Scalp Subq;< Than 2 cm 21011 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542199 21012 Exc Tumor Face Or Scalp Subq; 2 cm Or > 21012 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542200 21013 ExcTumorFace & Scalp <2 cm 21013 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542201 21014 ExcTumorFace & Scalp >2 cm 21014 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542202 21015 Rad Resec/Tumor Sof Tiss Fc/Scalp 21015 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538605 21016 Resect TumorFace Or Scalp >2cm 21016 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542203 21025 Excision Of Bone Mandible 21025 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538606 21026 Exc Of Bone Facial Bones 21026 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3542204 21029 Rem By Cont Beg Tum Fac/B 21029 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538607 21030 Exc Ben Tum Fac Bone Not Mandi 21030 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 4873302 21032 Exc Maxillary Torus Palatinus 21032 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538608 21034 Exc Mal Tum Fac Bone Not Mandi 21034 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538609 21040 Exc Ben Cyst Tumor Mandib Sim 21040 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538610 21044 Exc Malignant Tumor Mandible 21044 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538611 21045 Exc Mal Tumor Mandible 21045 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538133 21046 Exc Mal Tumor Mand Rad Res 21046 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538612 21047 Exc Benign Tumor Manible 21047 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538613 21048 Exc Benign Tum/Cyst Of Maxilla 21048 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538614 21050 Condylectomy Temporomand Joint 21050 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538615 21070 Coronoidectomy 21070 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538616 21073 Manipulation Tmj Theraputic 21073 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3538617 21085 Impress & Custm Prep Oral Surg Splint 21085 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 3538618 21110 Appl Interdental Fixation Dev 21110 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3538619 21120 Genioplasty Augmentation 21120 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538620 21121 Genioplsty/Sldng Osteotomy Sin Piece 21121 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538621 21122 Genioplasty Sliding 2 21122 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538622 21123 Genioplsty/Sldng W/Bone Graft 21123 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538623 21137 Reduction ForeheadContou 21137 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538624 21138 Cont&App/Prost Mat/Bne Gf 21138 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538625 21141 Reconstruct MidfaceLefort Single Piece 21141 " 10,172.00 " " 2,931.57 " " 2,614.20 " " 24,833.73 " " 2,614.20 " N/A N/A N/A N/A N/A " 5,213.15 " N/A " 6,103.20 " N/A N/A " 6,732.85 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 8,137.60 " N/A N/A " 6,001.48 " " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 3538626 21142 Reconstruct MidfaceLefort 2 Pieces 21142 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538627 21143 Recon MidfcLefort 3 Or M 21143 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538628 21145 Recons Midface Lefort 21145 " 10,172.00 " " 2,931.57 " " 2,614.20 " " 24,833.73 " " 2,614.20 " N/A N/A N/A N/A N/A " 5,213.15 " N/A " 6,103.20 " N/A N/A " 6,732.85 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 8,137.60 " N/A N/A " 6,001.48 " " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 3538629 21146 Recons Midface Lefort 21146 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538630 21147 Recons Midface Lefort 3 Or > 21147 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538631 21150 Recon Midfce Anterior Intrusion 21150 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538632 21154 ReconMidface Lefort Iii 21154 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538633 21172 Recon Super-Lateral Orbital Rim 21172 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538634 21175 Recon Bifront W/Wo Grafts 21175 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538635 21179 Recons Ent/Maj Forehead 21179 " 10,172.00 " " 2,931.57 " " 2,614.20 " " 24,833.73 " " 2,614.20 " N/A N/A N/A N/A N/A " 5,213.15 " N/A " 6,103.20 " N/A N/A " 6,732.85 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 8,137.60 " N/A N/A " 6,001.48 " " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 3538636 21180 Reconst Forehead W Grafts 21180 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538637 21181 Recon Contour/Begn Tumor/Cranial Bones 21181 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538638 21182 Reconstruction Orbital Walls 21182 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538640 21183 Recon Bone Graft 40-80 sq 21183 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538641 21188 Recon Midfce Osteotomies 21188 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538643 21193 Reconst Lower Jaw Bone 21193 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538645 21194 Reconst Lower Jaw Bone 21194 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538646 21196 Reconst Lower Jaw Bone 21196 " 10,172.00 " " 2,931.57 " " 2,614.20 " " 24,833.73 " " 2,614.20 " N/A N/A N/A N/A N/A " 5,213.15 " N/A " 6,103.20 " N/A N/A " 6,732.85 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 8,137.60 " N/A N/A " 6,001.48 " " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 3538647 21198 Osteotomy Mandible Segmental 21198 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538134 21206 Osteotomy Maxilla Segmental 21206 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538648 21208 Osteoplasty Facial Bns Augment 21208 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538649 21209 Osteoplasty Facial Bones Reduct 21209 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538650 21210 Graft Bone Nasal Maxilla Malar 21210 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538651 21215 Graft Bone Mandible 21215 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538652 21230 Graft Rib Cart Autogen Face 21230 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3542205 21235 Graft Ear Cart To Nose Or Ear 21235 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 5161321 21240 Arthroplasty TMJ W/WO Autograft 21240 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538653 21244 Arthroplasty Mandible Extr W Bone Plate 21244 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538654 21245 Recon Mandible Max Subper 21245 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538655 21246 Recon Mandible Max Subper Complete 21246 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538656 21247 Reconstruct Lowr Jaw Bone 21247 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538657 21248 Reconstruction Of Jaw Partial 21248 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538658 21249 Reconstruction Of Jaw 21249 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538659 21255 Recon/Zygomatic Arch & Glenoid Fossa 21255 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538660 21256 Recon Orbit/W/Osteotomies 21256 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538661 21267 Orbital Repos W Bn Gr Extr App 21267 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538662 21268 Orbital Repos W Bn Gr Int/Ext 21268 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538663 21270 Malar Augmentation Prosthetic Mat 21270 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538664 21275 Second Rev Orbitocraniof Recon 21275 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538665 21280 Medial Canthopexy 21280 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3542206 21282 Lateral Canthopexy 21282 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538666 21295 Revision Of Jaw Muscle/Bone 21295 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 4789329 21299 Unl Placemt Internal Distractn Dev 21299 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 6340802T 21299 Unl Resection Deep Muscle Lip 21299 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 46373 CLSD TR NOSE FX W/O MANIP 21310 450 " 1,082.00 " 311.83 278.07 " 1,006.77 " 278.07 N/A N/A N/A N/A N/A 554.53 N/A 649.20 N/A N/A 716.18 N/A N/A 805.41 " 1,006.77 " N/A N/A N/A 865.60 N/A N/A 638.38 724.94 N/A 442.54 811.50 411.27 483.98 N/A 3538442 21310 Frac Nasal Open/Clo Wo Manipulation 21310 " 1,082.00 " 311.83 278.07 " 1,006.77 " 278.07 N/A N/A N/A N/A N/A 554.53 N/A 649.20 N/A N/A 716.18 N/A N/A 805.41 " 1,006.77 " N/A N/A N/A 865.60 N/A N/A 638.38 724.94 N/A 442.54 811.50 411.27 483.98 N/A 46374 CLSD TR NOSE FX W/O STABI 21315 450 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3538668 21315 Frac Nasal Manip Wo Stabilazat 21315 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 46759 CLSD TX NOSE FX W/STABIL 21320 450 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3537900 21320 Frac Nasal Manip W Stabilization 21320 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 46375 OPEN TREAT NOSE FX;UNCOMP 21325 450 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3537501 21325 Frac Nasal Open Red Uncomplic 21325 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538669 21330 Frac Nasal Open Red Complicate 21330 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538670 21335 Frac Nasal Open Red Frac Sept 21335 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538671 21336 Opn Trtmnt/Nasal Septum Fracture 21336 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 460941 FRAC NASAL SEPTAL CLOSED 21337 450 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538135 21337 Frac Nasal Septal Closed 21337 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538672 21338 Frac Nasoeth Open Wo Ext Fix 21338 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538673 21339 Frac Nasoeth Open W Ext Fix 21339 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538674 21340 Frac Nasoeth Clos Open Complex 21340 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538675 21343 Frac Depress Frontal Sinus 21343 " 10,172.00 " " 2,931.57 " " 2,614.20 " " 24,833.73 " " 2,614.20 " N/A N/A N/A N/A N/A " 5,213.15 " N/A " 6,103.20 " N/A N/A " 6,732.85 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 8,137.60 " N/A N/A " 6,001.48 " " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 3538676 21344 Opn Trtmnt/Comp/Invol Frontal Sins Frac 21344 " 10,172.00 " " 2,931.57 " " 2,614.20 " " 24,833.73 " " 2,614.20 " N/A N/A N/A N/A N/A " 5,213.15 " N/A " 6,103.20 " N/A N/A " 6,732.85 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 8,137.60 " N/A N/A " 6,001.48 " " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 3538136 21345 Frac Nasomaxillary Complex 21345 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3538677 21346 Frac Nasomaxillary Open Compl 21346 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538678 21347 Frac Nasomax Complex W Mul App 21347 " 10,172.00 " " 2,931.57 " " 2,614.20 " " 24,833.73 " " 2,614.20 " N/A N/A N/A N/A N/A " 5,213.15 " N/A " 6,103.20 " N/A N/A " 6,732.85 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 8,137.60 " N/A N/A " 6,001.48 " " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 3538679 21348 Opn Trtmnt/Comp/Inv Frnt Sns W/Bne Grft 21348 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538680 21355 Frac Malar Zygomatic Manipulative 21355 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538681 21356 Opn Trt/Depres Zygo Arch Fracture 21356 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538682 21360 Frac Malar Zygomatic Open Red 21360 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538683 21365 Frac Malar Zygomatic Comp 21365 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538684 21366 Opn Trtmnt Com/Inv Frac Malar Area 21366 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538685 21385 Frac Orbital Floor Transantral 21385 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538686 21386 Frac Orbital Floor Periorbital 21386 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3542207 21390 Frac Orbit Fl Periob W Allop 21390 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538687 21395 Frac Orbit Fl Perior W Bone Gr 21395 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3542208 21400 Frac Orbit Wo Manipulation 21400 " 2,375.00 " 684.48 - " 2,208.75 " 610.38 " 2,124.32 " 462.30 " 2,197.06 " 389.06 457.72 " 1,217.19 " 457.72 " 1,425.00 " 389.06 489.76 " 1,572.01 " 411.95 457.72 " 1,766.99 " " 2,208.75 " 453.14 466.87 457.72 " 1,900.00 " 418.81 - " 1,401.25 " " 1,591.25 " 402.79 971.38 " 1,781.25 " 902.74 " 1,062.34 " 466.87 3538688 21406 Frac Orbit Open Wo Implant 21406 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538689 21407 Frac Orbit Open W Implant 21407 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538690 21408 Opn Trtmnt Frac Of Orbit W/Bne Graft 21408 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538691 21421 Frac Palatal Alv Rdg Clos Mani 21421 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538692 21422 Frac Palatal Alv Rdg Op Treat 21422 " 10,172.00 " " 2,931.57 " " 2,614.20 " " 24,833.73 " " 2,614.20 " N/A N/A N/A N/A N/A " 5,213.15 " N/A " 6,103.20 " N/A N/A " 6,732.85 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 8,137.60 " N/A N/A " 6,001.48 " " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 3538693 21423 Opn Trtmnt/Pal/Max Frac /Complicated 21423 " 10,172.00 " " 2,931.57 " " 2,614.20 " " 24,833.73 " " 2,614.20 " N/A N/A N/A N/A N/A " 5,213.15 " N/A " 6,103.20 " N/A N/A " 6,732.85 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 8,137.60 " N/A N/A " 6,001.48 " " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 3538694 21432 Xpen Treat Craniofacial Separ 21432 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538695 21433 Open Treat Craniofac Sep Compl 21433 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538696 21435 Frac Maxillary Comp 21435 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538697 21436 Opn Trtmnt/Craniofacial Sept; Complicated 21436 " 26,702.00 " " 7,695.52 " " 6,862.41 " " 24,833.73 " " 6,862.41 " N/A N/A N/A N/A N/A " 13,684.78 " N/A " 16,021.20 " N/A N/A " 17,674.05 " N/A N/A " 19,866.88 " " 24,833.73 " N/A N/A N/A " 21,361.60 " N/A N/A " 15,754.18 " " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 3538698 21440 Frac Alveolar Ridge Manipul 21440 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538699 21445 Frac Alveolar Ridge Open Treat 21445 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538700 21450 Frac Mandibular W/O Reduction 21450 " 2,375.00 " 684.48 - " 2,208.75 " 610.38 " 2,124.32 " 462.30 " 2,197.06 " 389.06 457.72 " 1,217.19 " 457.72 " 1,425.00 " 389.06 489.76 " 1,572.01 " 411.95 457.72 " 1,766.99 " " 2,208.75 " 453.14 466.87 457.72 " 1,900.00 " 418.81 - " 1,401.25 " " 1,591.25 " 402.79 971.38 " 1,781.25 " 902.74 " 1,062.34 " 466.87 3538701 21451 Frac Mandibular W Manipulation 21451 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3538702 21452 Perc Tx Mandib Fx W/Ext Fixation 21452 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538703 21453 Closed Treatmnt Mandib Fracture W/Fixation 21453 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538704 21454 Frac Mand Open Treat W Ext Fix 21454 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538705 21461 Frac Mand Open Wo Inter Fixat 21461 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3537502 21462 Frac Mand Open W Inter Fixat 21462 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538706 21465 Opn Trtment Manib Cond Fr 21465 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538707 21470 Frac Mandibular Comp Open Red 21470 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 46379 CLSD TX TM DISLOCATION 21480 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538708 21480 Temporamandibular Closed Reduction 21480 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538710 21485 Temporomandibular Dislocation; Complicated 21485 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3538711 21490 Temporamandibular Comp Open Re 21490 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3538712 21497 Interdental Wiring Not Fracture 21497 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 5037320 21499 Transcervical Styloidectomy 21499 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 45000374 21501 Hematoma evacuation 21501 361 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 45000374 21501 Hematoma evacuation 21501 361 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 45000374 "21501 Incision and drainage, deep abscess or hematoma, soft tissue" 21501 361 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538715 21501 Drain Abscess Thorax Deep 21501 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538716 21502 Drain Absc Thorax Part Ost Rib 21502 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538718 21510 Inc Deep W Opening Bone Cortex Thorax 21510 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 6340795T US Biopsy Neck and Thorax Soft Tissue 21550 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542209 21550 Biopsy Soft Tissue Neck Thorax 21550 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542210 21552 ExcTumorNeck Or Thorax Subq;3cm Or > 21552 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542211 21554 ExcTumor Neck Or Thorax >5cm 21554 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542212 21555 Exc Tumor Soft Tissue Neck/Thorax Suq<3 cm 21555 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542213 21556 Exc Tumor Soft Tissue Neck/Thorax Sub<5cm 21556 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3541903 21557 Radical Resec Tumor Soft Tis Nk Thorax 21557 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538719 21558 Resec TumorNeck Or Thorx>5cm 21558 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538720 21600 Excision Rib Partial 21600 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 5044160 21601 Exc Chest Wall Tumor W/Ribs 21601 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 5044161 21602 Exc Ch Wal Tum W/O Lymphadec 21602 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 5044162 21603 Exc Ch Wal Tum W/Lymphadec 21603 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3537406 21615 Exc 1St &/Or Cervical Rib 21615 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538137 21620 Ostectomy Sternum Partial 21620 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538721 21627 Sternal Debridement 21627 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3537503 21630 Rad Resection Sternum Tumor 21630 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538722 21685 Hyoid Myotomy And Suspension 21685 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538723 21700 Division Scalenus Anterior 21700 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538724 21705 Div Scal Ant W Resc Cerv Rib 21705 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3537504 21720 Torticollis Open Operation Wo Cast 21720 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538725 21740 Pectus Excav/Carinat Plas Rep 21740 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538726 21742 Lap Pectus Excavatum W/O Scope 21742 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538728 21743 Lap Pectus Excavatum W/Scope 21743 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538729 21750 Clsr/Sternot Sep W/Wo Debrid 21750 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538731 21811 Open Treatmnt Rib Fracture; 1-3 Ribs 21811 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538732 21812 Open Treatmnt Rib Fracture; 4-6 Ribs 21812 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538733 21813 Open Treatmnt Rib Fracture; 7 Or More Ribs 21813 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538734 21825 Treatment Of Sternal Fracture Open 21825 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 4457707 21899 Robotic rib resection 21899 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 4789333 21899 Unl Adjust Substernal Pectus Bar 21899 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 4935298 21899 Unl Vats Thoracic Duct Ligation 21899 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 4457668 21899 VATS chest wall resection 21899 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 4457666 21899 VATS rib plating 21899 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 3541904 21920 Bx-Soft Tissue Back Flank Superficial 21920 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538736 21925 Bx Soft Tissue Back Flank Deep 21925 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542215 21930 Exc Tumor Soft Tiss Back/Flank 21930 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542216 21931 Exc Tumor Back Or Flank Subq; 3 cm Or > 21931 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538737 21932 ExcTumorBack Or Flank Subfascial 21932 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542217 21933 Exc TumorBack Or Flank >5cm 21933 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538738 21935 Rad Resec/Tum Bck Or Flnk 21935 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538739 21936 Radical Resec Tumor Back/Flank 5cm > 21936 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538740 22010 I&D Post Spine Cerv Thoracic Cervicothorac 22010 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538741 22015 Inc&Drn Lmb Sac Lumbos 22015 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538138 22100 Partial Resection Vertebral Spinous Proc 22100 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538139 22101 Partial Resection Vertebral Spinous Proc 22101 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538742 22102 Excision Post Veterb Lumb 22102 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538743 22103 Pt Exc Post Vert Com Spin 22103 713.00 205.49 - 570.40 183.24 - - - - - 365.41 - 427.80 - - 471.93 - - - - - - - 570.40 - - 420.67 477.71 - 291.62 534.75 271.01 318.92 - 3538744 22110 Partial Excision Vertebral Body; Cervical 22110 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538745 22116 Partial Excision Vertebral Body; Each Addt 22116 " 6,864.00 " " 1,978.20 " " 1,764.05 " " 5,491.20 " " 1,764.05 " N/A N/A N/A N/A N/A " 3,517.80 " N/A " 4,118.40 " N/A N/A " 4,543.28 " N/A N/A N/A N/A N/A N/A N/A " 5,491.20 " N/A N/A " 4,049.76 " " 4,598.88 " N/A " 2,807.38 " " 5,148.00 " " 2,609.01 " " 3,070.27 " N/A 3538746 22207 Osteotomy Of Spine;Lumbar 22207 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538747 22210 Osteo SpinePost Ap 1 Segment Cervical 22210 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538748 22212 Osteo SpinePost Ap 1 Segment Thoracic 22212 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538749 22214 Osteo SpinePost Ap1 Segment Lumbar 22214 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538750 22216 Revise Extra Spine Segmen 22216 838.00 241.51 215.37 670.40 215.37 N/A N/A N/A N/A N/A 429.48 N/A 502.80 N/A N/A 554.67 N/A N/A N/A N/A N/A N/A N/A 670.40 N/A N/A 494.42 561.46 N/A 342.74 628.50 318.52 374.84 N/A 3538751 22220 Osteo SpineAnt Ap I Segment Cervicial 22220 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538752 22224 Osteotomy Spine Fix Deformity Lumbar 22224 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538753 22226 Osteotomy Spine Incld Disketmy 22226 " 8,463.00 " " 2,439.04 " " 2,174.99 " " 6,770.40 " " 2,174.99 " N/A N/A N/A N/A N/A " 4,337.29 " N/A " 5,077.80 " N/A N/A " 5,601.66 " N/A N/A N/A N/A N/A N/A N/A " 6,770.40 " N/A N/A " 4,993.17 " " 5,670.21 " N/A " 3,461.37 " " 6,347.25 " " 3,216.79 " " 3,785.50 " N/A 3541905 22310 Fx/Dsl Vertebral Body Wo Manipulation 22310 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537505 22315 Fx/Dsl Vertebral Body W Manip 22315 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538754 22318 Repair Odontoid Fracture 22318 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538755 22319 Repr Odontoid Fracture W/Grafting 22319 " 64,652.00 " " 18,632.71 " " 16,615.56 " " 60,129.43 " " 16,615.56 " N/A N/A N/A N/A N/A " 33,134.15 " N/A " 38,791.20 " N/A N/A " 42,793.16 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 51,721.60 " N/A N/A " 38,144.68 " " 43,316.84 " N/A " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " N/A 3538756 22325 Fx/Dsl Vert Body Op Red Lumbar 22325 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538140 22326 Fx/Dsl Vert Body Op Red Cervic 22326 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538757 22327 Fx/Dsl Vert Body Op Red Thorac 22327 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538758 22328 Opn Trtmnt Or Red/Vert Fr 22328 664.00 191.36 170.65 531.20 170.65 N/A N/A N/A N/A N/A 340.30 N/A 398.40 N/A N/A 439.50 N/A N/A N/A N/A N/A N/A N/A 531.20 N/A N/A 391.76 444.88 N/A 271.58 498.00 252.39 297.01 N/A 3538759 22505 Manipulation Of Spine Req Anesthesia 22505 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 45000218 22510 Perc Vertebroplasty; Cervicothorac 22510 361 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 310682 PERQ VERTEBROPLASTY CERVI 22510 761 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538760 22510 Percutaneous Vertebroplasty; Cervicothorac 22510 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 45000266 22511 Perc Vertebroplasty; Lumbosacral 22511 361 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3512888 IR Vertebroplasty Lumbar 1 Region 22511 761 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538761 22511 Percutaneous Vertebroplasty; Lumbosacral 22511 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 45000267 22512 PercVertebroplasty Each Addl 22512 361 " 2,958.00 " 852.50 - " 2,366.40 " 760.21 - - - - - " 1,515.98 " - " 1,774.80 " - - " 1,957.90 " - - - - - - - " 2,366.40 " - - " 1,745.22 " " 1,981.86 " - " 1,209.82 " " 2,218.50 " " 1,124.34 " " 1,323.11 " - 46001355 SJR IR VERTEBROPLASTY EA ADD 22512 761 " 2,958.00 " 852.50 - " 2,366.40 " 760.21 - - - - - " 1,515.98 " - " 1,774.80 " - - " 1,957.90 " - - - - - - - " 2,366.40 " - - " 1,745.22 " " 1,981.86 " - " 1,209.82 " " 2,218.50 " " 1,124.34 " " 1,323.11 " - 3538762 22512 Perq Vertebroplasty Each Additional 22512 " 2,958.00 " 852.50 - " 2,366.40 " 760.21 - - - - - " 1,515.98 " - " 1,774.80 " - - " 1,957.90 " - - - - - - - " 2,366.40 " - - " 1,745.22 " " 1,981.86 " - " 1,209.82 " " 2,218.50 " " 1,124.34 " " 1,323.11 " - 3512588 IR Kyphoplasty Thoracic 1 Region 22513 761 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538763 22513 Perq Vertebral Augmentation; Thoracic 22513 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 380295 IR Kyphoplasty Lumbar 1 Region 22514 761 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538764 22514 Perq Vertebral Augmentation; Lumbar 22514 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46001358 SJR IR KYPHOPLASTY EA ADD 22515 761 " 3,044.00 " 877.28 - " 2,435.20 " 782.31 - - - - - " 1,560.05 " - " 1,826.40 " - - " 2,014.82 " - - - - - - - " 2,435.20 " - - " 1,795.96 " " 2,039.48 " - " 1,245.00 " " 2,283.00 " " 1,157.02 " " 1,361.58 " - 3538765 22515 Perq Vertebral Aug Each Addtl Thora/Lumbar 22515 " 3,044.00 " 877.28 - " 2,435.20 " 782.31 - - - - - " 1,560.05 " - " 1,826.40 " - - " 2,014.82 " - - - - - - - " 2,435.20 " - - " 1,795.96 " " 2,039.48 " - " 1,245.00 " " 2,283.00 " " 1,157.02 " " 1,361.58 " - 3538772 22526 Prc Intradsc Annuloplasty 22526 " 4,606.00 " " 1,327.45 " 962.02 " 3,684.80 " " 1,183.74 " N/A N/A N/A N/A N/A " 2,360.58 " N/A " 2,763.60 " N/A N/A " 3,048.71 " N/A N/A 962.02 " 1,202.53 " N/A N/A N/A " 3,684.80 " N/A N/A " 2,717.54 " " 3,086.02 " N/A " 1,883.85 " " 3,454.50 " " 1,750.74 " " 2,060.26 " N/A 3537506 22527 Prc Annuloplsty Addtl Level 22527 " 2,163.00 " 623.38 451.77 " 1,730.40 " 555.89 N/A N/A N/A N/A N/A " 1,108.54 " N/A " 1,297.80 " N/A N/A " 1,431.69 " N/A N/A 451.77 564.71 N/A N/A N/A " 1,730.40 " N/A N/A " 1,276.17 " " 1,449.21 " N/A 884.67 " 1,622.25 " 822.16 967.51 N/A 3538773 22532 Arthrodesis Lateral Extracavitary; Thorac 22532 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538774 22533 Art Lat Extac Tech Lumbar 22533 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538775 22534 Art Lat Extca Tech Thor/Lum 22534 538.00 155.05 138.27 430.40 138.27 N/A N/A N/A N/A N/A 275.73 N/A 322.80 N/A N/A 356.10 N/A N/A N/A N/A N/A N/A N/A 430.40 N/A N/A 317.42 360.46 N/A 220.04 403.50 204.49 240.65 N/A 5211288 22548 Arthrod Ant Trans/Xtraoral C1-C2 22548 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538776 22551 Arthrodesis;Cervical Below C2 22551 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538777 22552 Arthrodesis;Cervical Below C2 Ea Addtl 22552 " 1,426.00 " 410.97 - " 1,140.80 " 366.48 - - - - - 730.83 - 855.60 - - 943.87 - - - - - - - " 1,140.80 " - - 841.34 955.42 - 583.23 " 1,069.50 " 542.02 637.85 - 3538778 22554 Arthrod Ant/Inter Cervcl W Bone Grft 22554 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538779 22556 Arthrod Ant/Inter Thoracic W Bone Grft 22556 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538780 22558 Lumbar Spine Fusion 22558 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538781 22585 Arthrod Ant/Antlat Add Intsp 22585 " 1,173.00 " 338.06 - 938.40 301.46 - - - - - 601.16 - 703.80 - - 776.41 - - - - - - - 938.40 - - 692.07 785.91 - 479.76 879.75 445.86 524.68 - 3538782 22590 ArthrodPostCraniocer Bn Grft 22590 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538783 22595 ArthroPostAtlasaxis/Bn Graft 22595 " 83,308.00 " " 24,009.37 " " 21,410.16 " " 77,479.52 " " 21,410.16 " N/A N/A N/A N/A N/A " 42,695.35 " N/A " 49,984.80 " N/A N/A " 55,141.57 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 66,646.40 " N/A N/A " 49,151.72 " " 55,816.36 " N/A " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " N/A 3538784 22600 Arthrodes Cerv Pstapp Lcl Grft 22600 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538141 22610 ArthroPost/Postla Bn Grft Thor 22610 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538785 22612 Arthrod Post/Postlat Bngft Lum 22612 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538786 22614 Spine FusionExtra Segmen 22614 926.00 266.87 - 740.80 237.98 - - - - - 474.58 - 555.60 - - 612.92 - - - - - - - 740.80 - - 546.34 620.42 - 378.73 694.50 351.97 414.20 - 3538787 22630 Arthrod Post Intbdy Bn Gft Lum 22630 " 31,736.00 " " 9,146.32 " - " 78,546.00 " " 8,156.15 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 16,264.70 " " 16,363.75 " " 19,041.60 " " 13,909.19 " " 17,509.21 " " 21,006.06 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 25,388.80 " " 14,972.83 " - " 18,724.24 " " 21,263.12 " " 14,400.10 " " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " " 16,691.03 " 3538788 22632 Spine Fusion Extra Segmnt 22632 740.00 213.27 190.18 592.00 190.18 N/A N/A N/A N/A N/A 379.25 N/A 444.00 N/A N/A 489.81 N/A N/A N/A N/A N/A N/A N/A 592.00 N/A N/A 436.60 495.80 N/A 302.66 555.00 281.27 331.00 N/A 3538789 22633 Lumbar Spine Fusion Combined 22633 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538790 22634 Lumbar Spine Fusion Ea Addl 22634 555.00 159.95 - 444.00 142.64 - - - - - 284.44 - 333.00 - - 367.35 - - - - - - - 444.00 - - 327.45 371.85 - 227.00 416.25 210.96 248.25 - 3538142 22800 Arthrod Ant W Bone Grf <6 Vert 22800 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538143 22802 Arthrod Post W Bn Grft >7 Vert 22802 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538791 22804 Fusion Of Spine 13> Vert 22804 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538792 22808 Fusion Of Spine/2-3 Vert 22808 " 83,308.00 " " 24,009.37 " " 21,410.16 " " 77,479.52 " " 21,410.16 " N/A N/A N/A N/A N/A " 42,695.35 " N/A " 49,984.80 " N/A N/A " 55,141.57 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 66,646.40 " N/A N/A " 49,151.72 " " 55,816.36 " N/A " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " N/A 3538144 22810 ArthroAntInc Bn Gft 4-7 Vert 22810 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538145 22812 ArthroAntInc Bn Gft >8 Vert 22812 " 83,308.00 " " 24,009.37 " " 21,410.16 " " 77,479.52 " " 21,410.16 " N/A N/A N/A N/A N/A " 42,695.35 " N/A " 49,984.80 " N/A N/A " 55,141.57 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 66,646.40 " N/A N/A " 49,151.72 " " 55,816.36 " N/A " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " N/A 3538793 22818 Kyphectomy Circumfer Exposure 22818 " 83,308.00 " " 24,009.37 " " 21,410.16 " " 77,479.52 " " 21,410.16 " N/A N/A N/A N/A N/A " 42,695.35 " N/A " 49,984.80 " N/A N/A " 55,141.57 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 66,646.40 " N/A N/A " 49,151.72 " " 55,816.36 " N/A " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " N/A 3538794 22830 Exp Of Spinal Fusion 22830 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538795 22840 Pst Instr Harrington Rod Tech 22840 " 1,389.00 " 400.31 - " 1,111.20 " 356.97 - - - - - 711.86 - 833.40 - - 919.38 - - - - - - - " 1,111.20 " - - 819.51 930.63 - 568.10 " 1,041.75 " 527.96 621.30 - 3538796 22841 Insert Spine Fixation Dev 22841 " 2,609.00 " 751.91 670.51 " 2,087.20 " 670.51 N/A N/A N/A N/A N/A " 1,337.11 " N/A " 1,565.40 " N/A N/A " 1,726.90 " N/A N/A N/A N/A N/A N/A N/A " 2,087.20 " N/A N/A " 1,539.31 " " 1,748.03 " N/A " 1,067.08 " " 1,956.75 " 991.68 " 1,167.01 " N/A 3538797 22842 Posterior Instr Segmental Fix 22842 " 1,103.00 " 317.88 - 882.40 283.47 - - - - - 565.29 - 661.80 - - 730.08 - - - - - - - 882.40 - - 650.77 739.01 - 451.13 827.25 419.25 493.37 - 3538798 22843 Post Seg Inst Fix 7-12 Se 22843 441.00 127.10 113.34 352.80 113.34 N/A N/A N/A N/A N/A 226.01 N/A 264.60 N/A N/A 291.90 N/A N/A N/A N/A N/A N/A N/A 352.80 N/A N/A 260.19 295.47 N/A 180.37 330.75 167.62 197.26 N/A 3538799 22844 Ins Spine Fix Dev 13> Ver 22844 " 1,535.00 " 442.39 394.50 " 1,228.00 " 394.50 N/A N/A N/A N/A N/A 786.69 N/A 921.00 N/A N/A " 1,016.02 " N/A N/A N/A N/A N/A N/A N/A " 1,228.00 " N/A N/A 905.65 " 1,028.45 " N/A 627.82 " 1,151.25 " 583.45 686.61 N/A 3538800 22845 Anterior Instrumentation 22845 " 1,563.00 " 450.46 - " 1,250.40 " 401.69 - - - - - 801.04 - 937.80 - - " 1,034.55 " - - - - - - - " 1,250.40 " - - 922.17 " 1,047.21 " - 639.27 " 1,172.25 " 594.10 699.13 - 3538801 22846 Ant Instrument 4-7 Vert 22846 " 1,441.00 " 415.30 370.34 " 1,152.80 " 370.34 N/A N/A N/A N/A N/A 738.51 N/A 864.60 N/A N/A 953.80 N/A N/A N/A N/A N/A N/A N/A " 1,152.80 " N/A N/A 850.19 965.47 N/A 589.37 " 1,080.75 " 547.72 644.56 N/A 3538802 22847 Ant Instrument > 8 Vert 22847 " 11,363.00 " " 3,274.82 " " 2,920.29 " " 9,090.40 " " 2,920.29 " N/A N/A N/A N/A N/A " 5,823.54 " N/A " 6,817.80 " N/A N/A " 7,521.17 " N/A N/A N/A N/A N/A N/A N/A " 9,090.40 " N/A N/A " 6,704.17 " " 7,613.21 " N/A " 4,647.47 " " 8,522.25 " " 4,319.08 " " 5,082.67 " N/A 3538803 22848 Pelv Fix Other /Sacrum 22848 779.00 224.51 200.20 623.20 200.20 N/A N/A N/A N/A N/A 399.24 N/A 467.40 N/A N/A 515.62 N/A N/A N/A N/A N/A N/A N/A 623.20 N/A N/A 459.61 521.93 N/A 318.61 584.25 296.10 348.45 N/A 3538804 22849 Rein Of Spinal Fixation Device 22849 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538805 22850 Removal Harrington Rod 22850 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538807 22852 Rem Posterior Seg Instruments 22852 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538808 22853 Ins Biomchn Dev Intervertebral Dsc Spc W/ 22853 " 1,296.00 " 373.51 - " 1,036.80 " 333.07 - - - - - 664.20 - 777.60 - - 857.82 - - - - - - - " 1,036.80 " - - 764.64 868.32 - 530.06 972.00 492.61 579.70 - 3538809 22854 Ins Biomchn Dev Vrt Corpectomy Defect W/A 22854 " 1,228.00 " 353.91 - 982.40 315.60 - - - - - 629.35 - 736.80 - - 812.81 - - - - - - - 982.40 - - 724.52 822.76 - 502.25 921.00 466.76 549.28 - 3538810 22855 Removal Anterior Instrumentation 22855 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538811 22856 Total Dis ArthroplastySi 22856 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 3538812 22857 Totl Disc Arthroplsty Lmb 22857 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3538813 22858 Totl Disc Arthroplsty Cervical 22858 " 3,671.00 " " 1,057.98 " - " 2,936.80 " 943.45 - - - - - " 1,881.39 " - " 2,202.60 " - - " 2,429.83 " - - - - - - - " 2,936.80 " - - " 2,165.89 " " 2,459.57 " - " 1,501.44 " " 2,753.25 " " 1,395.35 " " 1,642.04 " - 3538814 22859 Ins Biomchn Dev Ntrvrt Disc Space W/O Art 22859 " 3,089.00 " 890.25 - " 2,471.20 " 793.87 - - - - - " 1,583.11 " - " 1,853.40 " - - " 2,044.61 " - - - - - - - " 2,471.20 " - - " 1,822.51 " " 2,069.63 " - " 1,263.40 " " 2,316.75 " " 1,174.13 " " 1,381.71 " - 3538815 22861 RevReplTotal Disc Arthr 22861 " 83,308.00 " " 24,009.37 " " 21,410.16 " " 77,479.52 " " 21,410.16 " N/A N/A N/A N/A N/A " 42,695.35 " N/A " 49,984.80 " N/A N/A " 55,141.57 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 66,646.40 " N/A N/A " 49,151.72 " " 55,816.36 " N/A " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " N/A 3538816 22862 Revs/Rplcmnt Totl Arthpls 22862 " 83,308.00 " " 24,009.37 " " 21,410.16 " " 77,479.52 " " 21,410.16 " N/A N/A N/A N/A N/A " 42,695.35 " N/A " 49,984.80 " N/A N/A " 55,141.57 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 66,646.40 " N/A N/A " 49,151.72 " " 55,816.36 " N/A " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " N/A 3538817 22864 Rem Total Disc Arthroplst 22864 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538818 22865 Removal Disc Arthroplasty 22865 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538821 22867 Insj Stablj Dev W/DCmprn Lumbar Single Lev 22867 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 3619244 22868 Insj Stablj Dev W/DCmprn Lumbar Second Lev 22868 " 2,245.00 " 647.01 - " 1,796.00 " 576.97 - - - - - " 1,150.56 " - " 1,347.00 " - - " 1,485.97 " - - - - - - - " 1,796.00 " - - " 1,324.55 " " 1,504.15 " - 918.21 " 1,683.75 " 853.32 " 1,004.19 " - 3538822 22869 Insj Stablj Dev W/O DCmprn Lumbar Single L 22869 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538823 22870 Insj Stablj Dev W/O DCmprn Lumbar Single L 22870 " 1,709.00 " 492.53 - " 1,367.20 " 439.21 - - - - - 875.86 - " 1,025.40 " - - " 1,131.19 " - - - - - - - " 1,367.20 " - - " 1,008.31 " " 1,145.03 " - 698.98 " 1,281.75 " 649.59 764.44 - 5441060T 22899 Unl Tot Disc Arthropla Cer 3rd Lvl 22899 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542218 22900 Exc Abdominal Wall Tumor Subfascial 22900 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538825 22901 Exc Tumor Of Abd Wall 5cm > 22901 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542219 22902 ExcTumorAbdominal WallSubq;< Than 3 cm 22902 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542220 22903 ExcTumor Abdominal Wall Subq; 3 cm Or > 22903 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538827 22904 Rad Resec Tumr Abd Wall <5cm 22904 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538829 22905 Rad Resec Tumr Abd Wall 5cm > 22905 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 5390680T 22999 Unl Mesh Placement Deep Than SubQ 22999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538831 23000 Excision Deposits Subdeltoid 23000 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538832 23020 Capsular Contracture Release 23020 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538834 23030 Inc & Drain Deep Abshematoma 23030 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538836 23031 I&D Shldr Infect Bursa 23031 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538837 23035 Drain Shoulder Bone Les 23035 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538838 23040 Arthro W Exploration 23040 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538839 23044 Arth Sternoclavicular Jnt 23044 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538840 23065 Biopsy Soft Tissue Superficial 23065 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538842 23066 Biopsy Soft Tissue Deep 23066 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542221 23071 Exc Tumor Shoulder Area Subq; 3 cm Or > 23071 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538843 23073 Exc TumorShoulder Subfascial >5cm 23073 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542222 23075 Exc Tumor Shoulder Subcutaneous 23075 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538844 23076 Exc Tumor Shoulder Deep Sub/Intr 23076 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538845 23077 Remove Tumor Of Shoulder 23077 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538846 23078 Resect Shoulder Tumor >5 cm 23078 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538847 23105 Arthrt W Synvect Gelnohum 23105 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538848 23107 Explore Treat Should Jnt 23107 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538849 23120 Claviculectomy Partial 23120 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538850 23125 Claviculectomy; Total 23125 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538851 23130 Acromiectomy Total 23130 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538852 23140 Excision Cyst Scapula 23140 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538853 23146 Excision Cyst Scapula W Allograft 23146 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538854 23150 Exc/Curet Bone Syst/Benig 23150 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538855 23156 Esc Bone Cyst Prox Humerus 23156 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538856 23170 Sequestrectomy Clavicle 23170 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538857 23174 Sequestrectomy Hum Head-Sur Nk 23174 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537507 23180 Exc Bone Partial Osteomyelitis Clavicle 23180 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537508 23182 Partial Excision Bone Scapula 23182 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537509 23184 Partial Excision Bone Proxmial Humerus 23184 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537510 23190 Ostectomy Scapula Partial 23190 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538858 23195 Resection Humeral Head 23195 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538146 23200 Radical Resection Tumor Clavicle 23200 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3537511 23210 Radical Resection Tumor Scapula 23210 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538861 23220 Partial Remov Of Humerous 23220 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538147 23330 Remove Foreign Body Shoulder Subcu 23330 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3538862 23333 Removal Foreign Body Deep 23333 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538863 23334 Removal Prostesis Shoulder Humeral Or Glen 23334 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538864 23335 Removal Prostesis Total Shoulder 23335 " 4,740.00 " " 1,366.07 " " 1,218.18 " " 11,572.10 " " 1,218.18 " N/A N/A N/A N/A N/A " 2,429.25 " N/A " 2,844.00 " N/A N/A " 3,137.41 " N/A N/A " 9,257.64 " " 11,572.10 " N/A N/A N/A " 3,792.00 " N/A N/A " 2,796.60 " " 3,175.80 " N/A " 1,938.66 " " 3,555.00 " " 1,801.67 " " 2,120.20 " N/A 46000267 SJR XR ARTHRO INJ SHOULDER LT 23350 761 140.00 40.35 - 112.00 35.98 - - - - - 71.75 - 84.00 - - 92.67 - - - - - - - 112.00 - - 82.60 93.80 - 57.26 105.00 53.21 62.62 - 46000267 SJR XR ARTHRO INJ SHOULDER RT 23350 761 140.00 40.35 - 112.00 35.98 - - - - - 71.75 - 84.00 - - 92.67 - - - - - - - 112.00 - - 82.60 93.80 - 57.26 105.00 53.21 62.62 - 3538865 23395 Muscle Tran Shoulder Upper Arm Single 23395 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538866 23397 Muscle Tran Any Shoul/Up Arm 23397 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538867 23400 Scapulopexy 23400 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538868 23405 Tenotomy Shoulder Area Single Tendon 23405 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3619245 23406 Tenotomy Shoulder Area Multiple Tendons 23406 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538869 23410 Rep Musculoten Cuff Acute 23410 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3542223 23412 Rep Musculoten Cuff Chron 23412 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538870 23415 Coracocromial Ligament Release 23415 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538148 23420 Rep Shoulder Cuff Avuls Complete 23420 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3542224 23430 Tenodesis Rupt Long Biceps Tendon 23430 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538871 23440 Resection Transplant Long Biceps Tendon 23440 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538149 23450 Capsulorrhaphy Rec Disloc Ant Putti-Plat 23450 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538150 23455 Capsulorrhaphy Rec Disc Ant Bankhart Proc 23455 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538151 23460 Capsulorrhaphy Rec Discl Ant/Bone Block 23460 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538872 23462 Capsulor W Caracoid Process Trasfer 23462 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538152 23465 Capsulor Recur Dsl Shoulder Posterior 23465 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538873 23466 Capsulor W Mult Dir Instb 23466 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538874 23470 Arthroplasty Shlder W Prosthesis 23470 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538153 23472 Arthroplasty Total Shoulder 23472 " 24,630.00 " " 7,098.37 " - " 60,129.43 " " 6,329.91 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 12,622.88 " " 12,479.19 " " 14,778.00 " " 10,607.31 " " 13,352.73 " " 16,302.60 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 19,704.00 " " 11,418.46 " - " 14,531.70 " " 16,502.10 " " 10,981.69 " " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " " 12,728.77 " 3538875 23473 Revis Reconst Shoulder Joint Hum Or Glenoi 23473 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538876 23474 Revis Reconst Shoulder Joint Hum & Glenoid 23474 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538154 23480 Osteotomy Clavicl W/Wo Internal Fixation 23480 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538156 23485 Osteotomy Clavicle W Bone Graft 23485 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 4799296 23490 Prophylac Trtmnt Clavicle 23490 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538877 23491 Phrophylac Trtmnt Prox HumHum Hd 23491 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 46385 CLSD TX CLAV FX W/O MANIP 23500 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538639 23500 Fract Clavicular W/O Manipulation 23500 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46386 CLSD TX CLAV FX W MANIPUL 23505 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537407 23505 Fract Clavicular W Manipulation 23505 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538157 23515 Fracture Clavicle Simple/Compound Open 23515 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46797 TX STERNOCLAV DIS W/O MAN 23520 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537512 23520 Dsl Sternoclavcular Wo Manipulation 23520 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538878 23525 Dsl Sternoclavcl Simp W Manipulation 23525 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537513 23530 Dsl Sternclavical Simp/Comp Open 23530 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538879 23532 Dsl Sternoclavical W Fascial Graft 23532 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46799 TX ACROMIOCLV DIS W/O MAN 23540 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537923 23540 Dsl Acromioclavicul Disc Wo Manipulation 23540 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3541906 23550 Dsl Acromclavicular Simple/Compound Open 23550 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538158 23552 Dsl Acromclavicular W Fascial Graft 23552 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46391 CLSD TX SCAPULA FX WO MAN 23570 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538642 23570 Fx-Scapula Closed Wo Manipulation 23570 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538880 23585 Fx-Scapula Smpl/Comp Open 23585 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46394 CL TX PROX HUM FX WO MANI 23600 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538644 23600 Fracture Humeral Neck W/O Manipulation 23600 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46395 CL TX PROX HUM FX W MANIP 23605 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537514 23605 Fracture Humeral Neck W Manipulation 23605 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538881 23615 Fx-Surg Neck Simple Coumpound Open 23615 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538882 23616 Opn Trt Prox.Hum Frc W/ Prosthetic 23616 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 46802 TX GR HUMRL TB FX W/O MAN 23620 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538883 23620 Fx Tuberosity C/S W/O Man 23620 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542225 23625 Cl Tx Gr Hum Tbrsty Fx W/ 23625 761 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538884 23630 Fx Tuberosity Op/Cl W/Wo Fixation 23630 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46398 CL TX SHLDR DISLOC WO ANE 23650 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538885 23650 Dislocation Shoulder W/O Anesthesia 23650 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46399 CL TX SHLDR DISLOC W ANES 23655 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538886 23655 Dislocation Shoulder W Anesesthesia 23655 761 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538887 23660 Dsl Shouldr Smp/Cmp Open 23660 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46814 CL TX SHLDR DISLOC W/MANI 23665 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3542226 23665 Dsl Shouldr Fx Tubros Manp 23665 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537408 23670 Dsl Shoulder Fx Tubros Open 23670 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538888 23680 Dsl Shouldr Fx Surg Nck Op 23680 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538889 23700 Manip Shoulder Gen Anes 23700 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538890 23800 Arthro Shld Jnt Wwo Loc Bn Grf 23800 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538891 23802 Arthrodesis Glenohumeral Joint; With Auto 23802 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538892 23900 Amputate Interthosacoscapular 23900 " 64,652.00 " " 18,632.71 " " 16,615.56 " " 60,129.43 " " 16,615.56 " N/A N/A N/A N/A N/A " 33,134.15 " N/A " 38,791.20 " N/A N/A " 42,793.16 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 51,721.60 " N/A N/A " 38,144.68 " " 43,316.84 " N/A " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " N/A 3538893 23920 Disarticulation Of Shoulder 23920 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 4865387 23929 Unl Open Humeral Head Core Decompr 23929 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538894 23930 Inc & Drain Deep Abs Or Hemat 23930 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538895 23931 Inc & Drain Inf Bursa Arm 23931 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538896 23935 Inc Deep W Open Cortex Humerus/Elbow 23935 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537515 24000 Arthrotomy Elbow W Exploration 24000 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538897 24006 Arthrotomy Of Elbow 24006 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538898 24065 Biopsy Soft Tissue Super Arm 24065 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538899 24066 Biopsy Soft Tissue Deep Arm 24066 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542227 24071 ExcTumorUpper Arm/ElbowSubq; 3 cm Or > 24071 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538900 24073 Ex Arm Elbow Tum Deep >5cm 24073 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542228 24075 Exc Tumor Subcutaneous Upper Arm/Elbow 24075 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538901 24076 Exc Tumor Deep Subf/Int Upp Arm/Elbow 24076 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538902 24077 Rad Resec Tumor Soft Tis Upp Arm/Elbow 24077 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538903 24079 Resect Arm/Elbow Tum >5cm 24079 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538904 24101 Arthrotomy Elbow W Joint Explo 24101 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538905 24102 Arthrotomy Elbow Synovectomy 24102 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537409 24105 Excision Bursa Olecranon 24105 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538906 24110 Exc Cyst Benign Tumor Humerus 24110 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538907 24115 Exc Cyst Humerus W Autog Graft 24115 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538160 24116 Exc Cyst Humerus W Allograft 24116 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538908 24120 Exc Cyst Benign Tumor Radius 24120 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538909 24126 Exc/Cur Bone Cyst Or Bgn Tumor 24126 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538910 24130 Excision Radial Head 24130 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538911 24134 Sequestrectomy Shaft Dist Hum 24134 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538912 24140 Excision Bone Partial Humerus 24140 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538913 24145 Exc Bone Partial Rad Head Neck 24145 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538914 24147 Exc Bone Part Olecranon Proc 24147 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538915 24149 Radical Resection Elbow 24149 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538916 24150 Rad Res Tumor Shaft Dist Humer 24150 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538917 24160 Implant Removal Elbow Joint 24160 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538918 24164 Implant Removal Radial H 24164 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542019 24200 Removal Foreign Body Subcutan 24200 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538919 24201 Removal Foreign Body Deep 24201 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 46000277 SJR XR ARTHROGRAM INJ ELBOW LT 24220 761 248.00 71.47 - 198.40 63.74 - - - - - 127.10 - 148.80 - - 164.15 - - - - - - - 198.40 - - 146.32 166.16 - 101.43 186.00 94.26 110.93 - 46000277 SJR XR ARTHROGRAM INJ ELBOW RT 24220 761 248.00 71.47 - 198.40 63.74 - - - - - 127.10 - 148.80 - - 164.15 - - - - - - - 198.40 - - 146.32 166.16 - 101.43 186.00 94.26 110.93 - 3538920 24220 Inj Proc For Elbow Arthrograph 24220 248.00 71.47 - 198.40 63.74 - - - - - 127.10 - 148.80 - - 164.15 - - - - - - - 198.40 - - 146.32 166.16 - 101.43 186.00 94.26 110.93 - 3538921 24300 Manip. Elbow Under Anesth 24300 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538922 24301 Muscle Tendon Trans Any Ty Sin 24301 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538923 24305 Tendon Lengthening Single Each 24305 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538924 24310 Tenotomy Elbow To Shoulder 24310 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538925 24332 Tenolysis Triceps 24332 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538926 24340 Tenodesis Bicep At Elbow 24340 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538927 24341 Rpr Tendon/Muscle;Arm/Elb 24341 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538928 24342 Reinsert Rup Bic Ten W/Wo Grf 24342 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538929 24343 Rpr Lateral Col Lig Elbow 24343 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538930 24344 Recon Lat Coll LigElb W/Tendon Grf 24344 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538931 24345 Rpr Medial Coll Lig Elb W/Graft 24345 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538932 24346 Recon Med/Coll Lig Elbow W/Grft 24346 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538933 24358 Tenotomy Elbow W/Debridement Open 24358 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538934 24359 Tenotomy Elbow W/Debridement Open 24359 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538935 24360 Arthroplasty Elbow W Membrane 24360 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538936 24363 Arthroplasty (Total Elbow) 24363 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 3538937 24366 Arthroplasty Rad Head W Implan 24366 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538938 24370 Revise Reconst Elbow Joint 24370 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538939 24371 Revise Reconst Elbow Joint Humeral & Ulnar 24371 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 3538161 24400 Osteotomy Humerus W/W Int Fixa 24400 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538940 24420 Osteoplas Humerus Short Or Lng 24420 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538941 24430 Rep Non/Malunion Humers Wo Gft 24430 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538942 24435 Rep Non/Malunion Humerus W Gft 24435 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538943 24495 Decomp Fasc Forearm W Brac Art 24495 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538944 24498 Prophylact Tx W/Wo Mwthyl Humr 24498 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 46400 TX HUMERAL SHAFT FX 24500 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538709 24500 Fx-Humer Shaft Clsd Wo Manip 24500 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46401 TX HUMERL SHFT FX W/MANIP 24505 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538945 24505 Fx-Humer Shaft Clsd Manip 24505 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538946 24515 Fx-Humer Shaft Clsd Open Fixat 24515 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538947 24516 Opn Trtmnt Hum Shft Fracture 24516 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 46402 TX SUPRA/TRANS HUMERAL FX 24530 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538713 24530 Fx-Sup/Trnscond Clsd Wo Manip 24530 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46804 TX DISTAL HUMERL FX W/MAN 24535 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538948 24535 Fx-Sup/Trnscond Clsd Manip 24535 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538162 24538 Fx Sup/Trnscond W Perc Sk Fix 24538 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538949 24545 Fx-Sup/Trnscond Clsd Open Fixa 24545 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538950 24546 Op Trt Hum STcond W/Icond Exten 24546 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 46404 TX HUMERAL EPICONDYLAR FX 24560 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538717 24560 Fx-Epicondyl Closed Wo Manip 24560 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46405 TX HUMERAL EPI FX W/MANIP 24565 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538951 24565 Fx-Epicondyl Closed Manip 24565 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538952 24566 Perc Skel Fix Hum Epicon 24566 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538953 24575 Fx-Epicondyl Cls Open W/Wo Fix 24575 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 46807 TX HUMERAL CONDYLAR FX 24576 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3541690 24576 Fx Condylar Cl Med/ Lat Wo Manip 24576 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 460935 CLOSED TX HUMERUS FRACTUR 24577 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538163 24577 Fx Condylar Cl Med/ Lat W Manip 24577 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538954 24579 Fx-Condylar Cl Open W/Wo Fixat 24579 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538956 24582 Treatment Of Fracture 24582 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538957 24586 Op Tx Periart Fx/Osl Elbo 24586 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538958 24587 Op Tx Periart Fx Elb W Imp Arthro 24587 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 46408 TX CLSD ELBOW DISLOCATION 24600 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537930 24600 Dsl Elbow Clsd Wo Anestheisa 24600 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46409 TX CLSD ELBOW DISL W/ANES 24605 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537410 24605 Dsl Elbow Clsd W Anesthesia 24605 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538164 24615 Dsl Elbow Smp/Cmp Open Reduc 24615 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46990 CLSD TMT MONTEGGIA FX/DSL 24620 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538959 24620 Fx/Dsl Montegia Smp 24620 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538960 24635 Fx/Dsl Montegia Cmp W/Wo Fixation 24635 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46410 RADIAL HEAD SUB CHLD MANI 24640 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3541907 24640 Dsl Radial Head Child Manipulation 24640 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46411 TX RADIAL HEAD/NECK FX 24650 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538727 24650 Fx-Radial Head/Neck Smp Wo Man 24650 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46808 CLSD TX RAD HD/NK FX MANI 24655 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3542020 24655 Fx-Radial Hd/Nk Clsd Manip 24655 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538961 24665 Fx-Radial Hd/Nk Smp/Cmp Open 24665 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538963 24666 Open Rx Rad Head/Neck Fx 24666 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 46413 TX ULNAR FX PROXIMAL END 24670 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538730 24670 Fract Ulnar W/O Manipulation 24670 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46414 TX ULNAR FX PROX W/MANIP 24675 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538966 24675 Fract Ulnar Closed W Manipulation 24675 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537516 24685 Fract Ulnar Open W/Wo Fixation 24685 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538967 24800 Arthrod Elbow Jt W/Wo Bone Graft 24800 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538969 24802 Arthrod Elbow Jt W Pri Auto Gr 24802 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538970 24900 Amputate Arm/Humer Prim Clos 24900 " 64,652.00 " " 18,632.71 " " 16,615.56 " " 60,129.43 " " 16,615.56 " N/A N/A N/A N/A N/A " 33,134.15 " N/A " 38,791.20 " N/A N/A " 42,793.16 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 51,721.60 " N/A N/A " 38,144.68 " " 43,316.84 " N/A " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " N/A 3538971 24920 Amputate Arm/Humer Guillotine 24920 " 64,652.00 " " 18,632.71 " " 16,615.56 " " 60,129.43 " " 16,615.56 " N/A N/A N/A N/A N/A " 33,134.15 " N/A " 38,791.20 " N/A N/A " 42,793.16 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 51,721.60 " N/A N/A " 38,144.68 " " 43,316.84 " N/A " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " N/A 3538972 24925 Amputate Arm/Humer 2Ndry Close 24925 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538973 24930 Amputate Arm/Humer Reamputate 24930 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538974 24935 Stump Elongation Upper Extremity 24935 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 5235071T 24999 Unl Fasciotomy of Upper Arm 24999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542229 25000 Tend Sheath Inc Rad Styld 25000 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538976 25001 Incision Flexor Tend SheathWrist 25001 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538977 25020 Decomp Fasciot Flex & Exten 25020 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538978 25023 Decomp Fasc W Debr Nonvia Musc 25023 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538979 25024 Decomp Fasc Forearm/Wrist 25024 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538980 25025 Decomp Fasio Fore/Wrst W/Debrid 25025 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538981 25028 Inc & Drain Deep Absc Hematoma 25028 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538982 25031 Inc & Drain Infected Bursa 25031 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538983 25035 Inc Deep W Open Cortex Osteomy 25035 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538984 25040 Arthrotomy W Exploration 25040 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538985 25065 Biopsy Soft Tissue Superficial 25065 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538986 25066 Biopsy Soft Tissue Deep 25066 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542230 25071 ExcTumor Forearm/Wrist Area Subq; 3 cm 25071 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538987 25073 Exc Forearm Tumor >=3cm 25073 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542231 25075 Exc Tumor Forearm/Wrist Subcutaneous 25075 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538988 25076 Exc Tumor Forearm Wrist Deep 25076 761 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538989 25077 Rad Resc Tumor Forearm/Wrist Area 25077 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538990 25078 Resect Forearm/Wrist Tumor >=3cm 25078 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538991 25085 Capsulotomy Wrist 25085 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538992 25100 Arthrotomy Wrist Joint Biopsy 25100 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538993 25101 Arthrotomy W Jt Expl W/Wo Bio 25101 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538994 25105 Arthrotomy Wrist Joint Synovec 25105 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538995 25107 Arthrotomy Distal Radio Joint 25107 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538996 25109 Exc TendonForearmWrstF 25109 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538997 25110 Excision Lesion Tendon Sheath 25110 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538998 25111 Excision Ganglion Wrist Primar 25111 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538999 25112 Excision Ganglion Wrist Recur 25112 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539000 25115 Excision Bursa Flexors 25115 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539001 25116 Excision Bursa Extensors 25116 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537411 25118 Synovectomy Ext Wrist 25118 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539002 25119 Synovectomy Wrist W Res Dis Ul 25119 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539003 25120 Excision Cyst Radius Ulna 25120 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539004 25126 Ex/Cut Bone Cyt Bein W Allgrft 25126 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539005 25130 Exc Cyst Tumor Carpal Bones 25130 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539006 25135 Exc Tumor Carpal Bone W Graft 25135 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539007 25145 Sequestrectomy 25145 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537517 25150 Exc Bone Partial Osteomy Ulna 25150 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539008 25151 Exc Bone Part Osteomy Radius 25151 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539009 25170 Rad Res Tumor Radius Ulna 25170 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539010 25210 Carpectomy One Bone 25210 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539011 25215 Carpectomy All Bones 25215 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539012 25230 Radial Styloidectomy 25230 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539013 25240 Exc Distal Ulna Darrach Type 25240 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46000305 SJR XR ARTHROGRAM INJ WRIST LT 25246 761 184.00 53.03 - 147.20 47.29 - - - - - 94.30 - 110.40 - - 121.79 - - - - - - - 147.20 - - 108.56 123.28 - 75.26 138.00 69.94 82.30 - 46000305 SJR XR ARTHROGRAM INJ WRIST RT 25246 761 184.00 53.03 - 147.20 47.29 - - - - - 94.30 - 110.40 - - 121.79 - - - - - - - 147.20 - - 108.56 123.28 - 75.26 138.00 69.94 82.30 - 3539014 25248 Explor W Rem Deep For Bod 25248 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539015 25250 Removal Wrist Prosthesis 25250 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539016 25251 Removal Of Wrist Prosthesis 25251 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542232 25259 ManipulationWrist/Anesth 25259 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537518 25260 Rep Flexor Muscle Laceration 25260 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539017 25263 Rep Flexor Forarm Second 25263 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539018 25265 Rep Tend Musc Flexor Secon W Free Graft 25265 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538165 25270 Rep Extensor Muscle Laceration 25270 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539019 25272 Rep Tend Musc Exten Prim Secon 25272 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539020 25274 Repair Forearm/Tendon Mus 25274 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539021 25275 Repair Tend SheathExtensor 25275 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539022 25280 Length Flex/Ten Frarm/Wrst Ea Ten 25280 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539023 25290 Teno Op Flex/Ext Endon For Wrist 25290 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538166 25295 Tenolysis Flex Ext Tend Each 25295 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542233 25300 Tenodesis Wrist Flex Of Finger 25300 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539024 25301 Tenodesis At Wrist-Extens 25301 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539025 25310 Tendon Transfer Flex/Exten 25310 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539026 25312 Tendon Transfer W Grf Ea Tend 25312 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539027 25315 Flexor Origin Slide Forearm And/Or Wrist 25315 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537519 25316 Flex Origin Slide Forearm Tend Trans 25316 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539028 25320 Capsulr Wrist Carpl Instb 25320 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539029 25332 Arthrpolasty Wrist W Int Fixation 25332 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539030 25335 Centrilization Of Wrist On Ulna 25335 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539031 25337 Rec Stabl Druj W/W/O Orif 25337 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539032 25350 Osteotomy Radius Distal Third 25350 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539033 25355 Osteotomy Radius Mid/Prox Thrd 25355 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539034 25360 Osteotomy Ulna 25360 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539035 25365 Osteotomy Radius And Ulna 25365 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539036 25390 Osteoplasty Radius/Ulna Short 25390 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538167 25391 Osteoplasty Radius Ulna Length Autogrf 25391 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539038 25392 Osteoplasty Radius/Ulna Short 25392 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539039 25394 Carpal Bone Shortening 25394 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539040 25400 Rep Radius Or Ulna Comp Tech 25400 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538168 25405 Rep Radius Or Ulna Auto Bonegr 25405 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539041 25415 Rep N-Union Rad & Uln Wo Graft 25415 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539042 25420 Rep Radius & Ulna Auto Bone Gr 25420 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539043 25425 Rep Def W/Autogft Rad/Uln 25425 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539044 25430 Insertion Vascular Pedicle 25430 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539045 25431 Repair Nonuion Carpal Bone 25431 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539046 25440 Rep N-Union Navic Bone W Graft 25440 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539047 25441 Arthroplasty W Prost Repl 25441 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539048 25442 Arthroplasty W Pro Repl Distal Ulna 25442 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 3539049 25444 Arthroplasty W Pro Repl Wrist Joint 25444 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539050 25446 Arthroplasty Total Wrist 25446 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 3539051 25447 Interposition Arthrop Inter Or Carp Jts 25447 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539052 25449 Rev Arthroplasty W Rem Implant 25449 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539053 25450 Epiphyseal Arrest Rad Or Ulna 25450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539054 25490 Prophylac Trtmnt; Radius 25490 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539055 25491 Prophylac Trtmnt ; Ulna 25491 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 46415 TX RADIAL SHAFT FX 25500 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538819 25500 Fx Radial Shaft W/O Reduction 25500 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46416 TX RADIAL SHAFT FX W/MAN 25505 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538820 25505 Fx Radial Shaft Man Reduction 25505 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539056 25515 Fx Radial Shaft Smp/Cmp Op Red 25515 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539057 25520 Clsd Trtmnt Rad Shft Frac 25520 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539058 25525 Op Trt Rd Shft Frc/Int/Ext Fix Cls Trt 25525 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539059 25526 Op Trt/Rad Shft Frc/W/Int Ex Fx Op Trt 25526 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46418 TX ULNAR SHAFT FX 25530 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3541908 25530 Fx Ulnar Shaft Simple Wo Red 25530 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46419 TX ULNAR SHFT FX W/MANIP 25535 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539060 25535 Fx Ulnar Shaft Simp Manip Red 25535 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537412 25545 Fx Ulnar Shaft Smp/Cmp Op Red 25545 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46420 TX RADIAL&ULNAR SHAFT FX 25560 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538826 25560 Fx Rad & Uln Shaft Smp Wo Red 25560 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46421 TX RAD&ULN SHFT FX W/MAN 25565 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537936 25565 Fx Rad & Uln Shaft Manip Red 25565 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539061 25574 Opn Trtmnt Rad & Ulnar Shaft Frac 25574 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537520 25575 Fx Rad&Uln Shaft Smp/Cmp Op Reduction 25575 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46422 FX DISTAL RADIUS W/O RED 25600 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3541909 25600 Fx Distal Radius Colles Wo Reduction 25600 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46423 FX DISTAL RADIUS MANIP/RE 25605 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538828 25605 Fx Dstl Radius Simp Manip Red 25605 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539062 25606 Perc Skeletal Fix Of Dist 25606 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539063 25607 Orif Of Distal Radius 25607 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539064 25608 Orif Of Distal Radial Int 25608 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539065 25609 Orif Of Distal Radial >=3 25609 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46424 TX CARPAL SCAPHOID FX 25622 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538833 25622 Fx Navicular Closed Wo Manip 25622 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 5178167 25624 Fx Navicular Closed With Manip 25624 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538169 25628 Fx Navicular Op/Cl W/Wo Sk Fix 25628 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46426 TX CARPAL BONE FX EA BONE 25630 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3541910 25630 Fx Carpal W/O Reduction 25630 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46427 TX CARP BONE FX W/MAN EA 25635 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3541911 25635 Fx Carpal Manip Reduct 25635 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539066 25645 Fx Carpal Open Reduction 25645 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46428 TX ULNAR STYLOID FX 25650 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538835 25650 Fx Closed Ulnar Styloid 25650 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539067 25651 Perc Skel Fix Unia Styloid 25651 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539068 25652 Open Trtmt Ulnar Styloid Fx 25652 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539069 25660 Radiocarpal Manipulative Red 25660 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539070 25670 Radiocarpal Open Reduction 25670 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539071 25671 Perc Skel Fix Of Dist Radio Disloc 25671 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 460918 RADIOULNAR DSL W MANIPULA 25675 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538841 25675 Radioulnar Dsl W Manip 25675 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539072 25676 Radioulnar Disloc Acute Chron 25676 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539073 25680 Fx-Dislo Trans-Scaphoperilunar W Manip 25680 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539074 25685 Fx-Dislo Trans-Scaphoperil Open Red 25685 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46432 TX LUNATE DISLOCAT W/MAN 25690 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537521 25690 Lunate Disloc W Manipulation 25690 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539075 25695 Lunate Disloc Open Treatment 25695 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539076 25800 Arthrodesis Wrist W/O Bone Graft 25800 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539077 25805 Arthrodesis Wrist W Sliding Graft 25805 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539078 25810 Arthrodesis Wrist Auto Bone Graft 25810 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539079 25820 Intercarpal Fusion W/O Bone Graft 25820 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539080 25825 Intracarp Inf W/Autograft 25825 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539081 25830 Arthod Druj W/W/O Bn Gft 25830 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539082 25900 Amputation Forearm Thru Radius & Ulna 25900 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539083 25905 Amputation Radius & Ulna Open 25905 " 64,652.00 " " 18,632.71 " " 16,615.56 " " 60,129.43 " " 16,615.56 " N/A N/A N/A N/A N/A " 33,134.15 " N/A " 38,791.20 " N/A N/A " 42,793.16 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 51,721.60 " N/A N/A " 38,144.68 " " 43,316.84 " N/A " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " N/A 3539084 25907 Amputation Secondary Closure 25907 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539085 25909 Re-Amputation Forearm 25909 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539086 25920 Disarticulation Thru Wrist 25920 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539087 25927 Amputate Transmetacarpal 25927 " 14,860.00 " " 4,282.65 " " 3,819.02 " " 13,820.05 " " 3,819.02 " N/A N/A N/A N/A N/A " 7,615.75 " N/A " 8,916.00 " N/A N/A " 9,835.83 " N/A N/A " 11,055.99 " " 13,820.05 " N/A N/A N/A " 11,888.00 " N/A N/A " 8,767.40 " " 9,956.20 " N/A " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " N/A 46433 DRAIN FINGER ABSCESS SIMP 26010 450 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 3538859 26010 Drainage Abscess Finger Simple 26010 943.00 271.77 - 876.69 242.35 843.47 183.56 872.35 154.48 181.74 483.29 181.74 565.80 154.48 194.46 624.17 163.57 181.74 701.35 876.69 179.92 185.37 181.74 754.40 166.29 - 556.37 631.81 159.93 385.69 707.25 358.43 421.80 185.37 46980 DRAIN FINGER ABSCESS COMP 26011 450 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3538860 26011 Drainage Abscess Finger Comp 26011 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539089 26020 Drainage Tendon Sheath 1 Digit 26020 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539090 26025 Drain Palmar Bursa Ul/Rad Sing 26025 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539091 26030 Drain Palmar Bursa Ul/Rad Mult 26030 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539092 26034 Inc Deep W Opening Cortex Hand Finger 26034 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539093 26035 Decomp Finger/Hand Inj Injury 26035 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539094 26037 Decompressive Fasciot Hand 26037 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542234 26040 Fasciotomy Palmer Subcutaneous 26040 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538170 26045 Fasciotomy Palmar Op Partial 26045 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542235 26055 Tendon Sheath Inc For Trigger Finger 26055 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 5356913T 26060 Tenotomy Percut Single Each Digit 26060 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539095 26070 Arthrotomy Carpometacar W Expl 26070 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539096 26075 Arthrotomy Metacar- Popha W Expl 26075 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 460947 ARTHROTOMY INTERPHALANG 26080 761 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537522 26080 Arthrotomy Inter Phalang W Expl 26080 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539097 26100 Arthrotomy Carpomet Synov Biop 26100 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539098 26105 Arthrotomy Metacarp Synov Biop 26105 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539099 26110 Arthrotomy Interpha Synov Biop 26110 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3542236 26111 ExcTumorHand Or FingerSubq;1.5 cm Or > 26111 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539100 26113 Exc Tumor Or Vasc Malformation 26113 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542237 26115 Exc Tumor Vasc Malfor Subcutaneous 26115 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539101 26116 Excision Tumor Hand Finger Deep 26116 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539102 26117 Remove Tumor Hand/Finger 26117 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539103 26118 Rad Res Tumor Finger Hand >=3Mc 26118 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539104 26121 Fasciectomy Palmar 26121 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538171 26123 Fasciectomy Palmar Part Exc Finger 26123 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538172 26125 Fasciectomy Palmar Each Add Finger 26125 " 3,483.00 " " 1,003.80 " - " 2,786.40 " 895.13 - - - - - " 1,785.04 " - " 2,089.80 " - - " 2,305.40 " - - - - - - - " 2,786.40 " - - " 2,054.97 " " 2,333.61 " - " 1,424.55 " " 2,612.25 " " 1,323.89 " " 1,557.95 " - 3619246 26130 Synovectomy Carpometacarp Jnt 26130 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539105 26135 Synovectomy Metacarpophal Jnt 26135 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539106 26145 Tenosynovectomy Flexor Single 26145 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3542238 26160 Exc Cyst Ganglion Tend Sheath 26160 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539107 26170 Exc Tendon Palm Flexor Single 26170 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539108 26180 Excision Tendon Finger Flexor 26180 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 4865498 "26185 Sesamoidectomy, Thumb Or Finger" 26185 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539109 26200 Exc Cyst Benign Tumor Metacarpal 26200 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539110 26205 Exc Cyst Metacarpal W Auto Gft 26205 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538173 26210 Excsn Bone Cyst/Ben Tumor Finger 26210 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539111 26215 Exc Cyst Benign Tumor Finger W Grf 26215 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539112 26230 Excision Bone Partial Metacarp 26230 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539113 26235 Excision Bone Partial Finger 26235 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539114 26236 Excision Bone Partial Distal Phalanx 26236 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539115 26320 Removal Implant Fng Or Hand 26320 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539116 26340 Manip Finger Joint Under/Anes 26340 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3542239 26341 Manipulation Palm Cord Post Injection 26341 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537523 26350 Rep Tendon Flexor Single Prim 26350 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538174 26352 Rep Flex Tend Scnd W Grf Eac 26352 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537524 26356 Rep Flex Tend In Nomansland Pr 26356 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537525 26357 Rep Flex Tend In Nomansland Sec 26357 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539117 26358 Rep Flex Ten Nomansland Sec Gr 26358 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539118 26370 Profundus Tendon Rep Primary 26370 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539119 26372 Repair/Graft Hand Tend 26372 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539120 26373 Profundus Tend Rep Sec Wo Graft 26373 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539121 26390 Flex Tend Exc Imp Plas Tube 26390 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539122 26392 Rem Tube/Rod Insert Tend Graft 26392 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46929 REP TEND EXT HND SING PRM 26410 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539123 26410 Rep Tendon Ext Hand Sing Prim 26410 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539124 26412 Rep Tendon Ext Hand W Grf Ea 26412 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539125 26415 Excision Hand/Finger Tendon 26415 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539126 26416 Rem Synth Rod/Insert Extensor 26416 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538175 26418 Rep Tendn Ext Figr Sin Prin 26418 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539127 26420 Rep Tendon Ext Finger W Grf 26420 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539128 26426 Rep Tendon Ext Sec Local Tissu 26426 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539129 26428 Rep Tendon Ext Sec Local Tissu 26428 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542240 26432 Rep Tend Ext Dist Clo W/Wo Pin 26432 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3542241 26433 Rep Tend Open Prim Sec Wo Grf 26433 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539130 26434 Repair Of Extensor Tendon 26434 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539131 26437 Ext Tendon Realigment Hand 26437 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539132 26440 Tenolysis Palm Single 26440 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537526 26442 Tenolysis Palm & Finger 26442 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539133 26445 Tenolysis Finger Single 26445 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539134 26449 Tenolysis Finger Complex 26449 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539135 26450 Tenotomy Flexor Palm Open Sing 26450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539136 26455 Tenotomy Flexor Finger Single 26455 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539137 26460 Tenotomy Extensor Hand/Finger 26460 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539139 26471 Tenodesis Interphalangeal 26471 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539140 26476 Lengthening Tendon Extensor Hand Or Fing 26476 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539141 26477 Tendon Shorten Exten Sing Each 26477 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539142 26478 Tendon Length Flexor Sing Each 26478 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539143 26479 Tran Tendon Carpom Dorsum Sing 26479 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539146 26480 Tran Tendon Carpom Dorsum Sing 26480 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539147 26483 Tran Tendon Carp Dorsum W Grft 26483 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539148 26485 Tran Tendon Palmar Single 26485 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 4309627 26489 Camitz Tendon Transfer/Transplant Palmar 26489 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539149 26490 Opponensplasty W/O Graft 26490 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 5795701T "26492 Opponensplasty; W/Graft, Ea Tendon" 26492 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539150 26494 Opponensplasty Muscle Transfer 26494 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539151 26496 Opponensplasty Other Methods 26496 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539152 26497 Tendon Trans/Restr Intrin 26497 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539153 26498 Tendon Transfer/ 4 Fingers 26498 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539154 26499 Correc Claw Finger Other Method 26499 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539155 26500 Tendon Puley Recon- Struction 26500 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539156 26502 Tendon Pulley Rec W/Graft 26502 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539157 26508 Thenar Muscle Rel Thumb Contr 26508 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539158 26516 Capsul M-P Jnt Stab Sing Digit 26516 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539159 26518 Capsul M-P Jnt Stab 3 Or 4 Dig 26518 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539160 26520 Capsulectomy Metacarpopha Sing 26520 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539161 26525 Capsulectomy Interphalangeal 26525 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539162 26530 Arthroplasty Metacrp-Phal Sngl 26530 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539163 26531 Arthroplasty W/Prosthesis Impl 26531 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539164 26535 Arthroplasty Finger Interph Jt 26535 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539165 26536 Arthroplasty Fing Inter W Impl 26536 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539166 26540 Reconstr Colltrl Ligament Thum 26540 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539167 26541 Recon Coll Lig Thum W Tend/Grf 26541 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539168 26542 Recon Coll Lig W/Loc Tiss 26542 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539169 26545 Recon Coll Lig Inter Fing Sing 26545 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539170 26546 Rpr Non-Union Metcr W Grf 26546 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539171 26548 Rep/Reco Fing Volar Plate 26548 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539172 26550 Pollicization Of Finger 26550 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539173 26560 Repair Syndactyly W Skin Flaps 26560 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539174 26561 Rep Syndactyly W Sk Flap Graft 26561 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539175 26562 Repair Syndactyly Complex 26562 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539176 26565 Osteotomy Metacarpal Deformity 26565 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539177 26567 Osteotomy Phalanx Deformity 26567 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539178 26568 Osteoplsty/Length Met/Pha 26568 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539179 26580 Repair Cleft Hand 26580 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542242 26587 Recon Supernumerary Digit 26587 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 4543388 26590 Repair Macrodactylia Ea Digit 26590 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539180 26591 Repair Intrinsic Muscles Hand 26591 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539181 26593 Rel Intrinsic Muscle Hand 26593 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46434 CL TX METCRP FX SINGLE EA 26600 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537944 26600 Fx Metacarpal Smpl W/O Reduct 26600 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46435 CL TX MTCP FX SN W/MAN EA 26605 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537945 26605 Fx Metacarpal Smpl Manip Reduc 26605 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46760 CL TX MTCP FX MANIP/FIXAT 26607 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542243 26607 Fx Metacarpal Manip W Fix 26607 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539182 26608 Perc Skel Fix/Metacar Fra 26608 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538176 26615 Fx-Metacarpal Smp/ Cmp W/Wo Fix 26615 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46437 CL TX CRPMT DIS THB W/MAN 26641 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3619247 26641 Bennett Frac W/O Red Dsl Thumb 26641 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539183 26645 Bennett Frac Man Red Dsl Thumb 26645 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539184 26650 Bennett Frac Mani Red Skel Fix 26650 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539185 26665 Bennett Frac Simp/Comp Op Red 26665 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46440 CL TX CRPMT DIS SIN W/MAN 26670 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538955 26670 Dsl Crp-Metcrp Smp Red Wo Anes 26670 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46441 CL TX CRPMT DIS W/MAN/ANE 26675 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537527 26675 Dsl Crp-Metcrp Smp Red W Anes 26675 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539186 26676 Dsl Crp-Metcrp Smp Red W Perc Pinning 26676 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539187 26685 Dsl Crp-Metcrp Smp/Cmp Op Red 26685 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539188 26686 Dsl Crp Metcrp Smp/Cmp Complex 26686 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46442 CL TX METCRPHL DIS W/MAN 26700 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4789427 26700 Cl Tx Metacarpophalangeal Dislc 26700 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 5200733 26705 Dsl Metcrp-Phal Smp Reduct W Anes 26705 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539189 26705 Dsl Metcrp-Phal Smp Red W Anes 26705 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539190 26706 Perc Skeletal Fixation Of Metacarpophalang 26706 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539191 26715 Dsl Metcrp-Phal Smp/Cmp Op Red 26715 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46444 CL TX PHAL SHFT FX EA 26720 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537947 26720 Fx Prx-Mid Phalang Smp Wo Red 26720 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46445 CL TX PHAL FX W/MAN EA 26725 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538962 26725 Fx Prx-Mid Phal Smp Manip Red 26725 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538177 26727 Fx Prx-Mid Phal W Manip/Trac 26727 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538178 26735 Fx Phal Prox Open Red W/Wo Fix 26735 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539192 26740 Fx Articular Wo Manip Each 26740 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542244 26742 Fx Articular W Manip Each 26742 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538179 26746 Fx Articular Op/Cl Met Prox In 26746 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46446 CL TX DIS PHAL FX EA 26750 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538964 26750 Fx Phal Distal Simp W/O Red 26750 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46447 CL TX DIS PHL FX W/MAN EA 26755 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538965 26755 Fx Phal Distal Simp Manip Red 26755 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539193 26756 Fx Phal Distal Perc Pinning 26756 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46761 OP TX PHALANG FX EACH 26765 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539194 26765 Fx Phal Distal Open Red 26765 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46448 CL TX INTPH JT DIS W/MAN 26770 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538968 26770 Dsl Interphal Smp Red Wo Anes 26770 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46449 CL TX INTPH JT W/MAN/ANES 26775 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3538180 26776 Dsl Interphal W Perc Pinning 26776 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538181 26785 Dsl Interphal Smp/ Cmp Open Red 26785 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539195 26841 Arthrodesis Carpometacarpal 26841 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539196 26842 Arthrodesis Crp-Metacrpl/Graft 26842 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539197 26843 Arthrod Carp Jnt Dig Not Thumb 26843 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539198 26844 Arthrod Carp Jnt No Thumb W Gr 26844 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539199 26850 Arthrodesis Metcrp-Phalang Jnt 26850 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539200 26852 Arthrodes Metcrp-Phal W Graft 26852 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539201 26860 Arthrodes Interpha- Langeal Jnt 26860 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538182 26861 Arthrodes Interphal Joint Each Add 26861 798.00 229.98 - 638.40 205.09 - - - - - 408.98 - 478.80 - - 528.20 - - - - - - - 638.40 - - 470.82 534.66 - 326.38 598.50 303.32 356.95 - 3539202 26862 Arthrodes Interphal W Graft 26862 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539203 26910 Amputate Metacarp W Phal Sngl 26910 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46826 AMPUTATION FGR/TMB DIR CL 26951 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539204 26951 Amputation Finger Single 26951 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 5441065T AMPUTATION FINGER OR THUMB WITH FLAPS 26952 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3541912 26952 Amputation Finger Sing With Flaps 26952 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 5123529 26989 Unl Capsulodesis Carpometa Joint 26989 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4791389 26989 Unl Open Tx Hand Fx Dsloc Not Thmb 26989 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539206 26990 Inc & Drain Deep Abs Or Hemat 26990 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539207 26991 Inc & Drain Infected Bursa Hip 26991 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539208 26992 Inc Deep W Open Cortex Osteomy 26992 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539209 27000 Tenotomy Adductor Closed 27000 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539210 27001 Tenotomy Adductor Open 27001 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539211 27003 Tenotomy Adductor Sub Open W Obtur Neurec 27003 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538183 27005 Tenotomy Iliopsoas Open Ip 27005 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538184 27006 Tenotomy Abductors Hip Open 27006 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539212 27025 Fasciotomy Hip/Thigh Any Type 27025 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539213 27027 Fasciotomy PelvicUnilate 27027 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538185 27030 Arthrotomy Hip For Drainge 27030 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539214 27033 Arthrotomy Hip For Exploration 27033 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539215 27036 Capsul(Ectomy Or Otomy)Hi 27036 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539216 27040 Biopsy Soft Tissue Superficial 27040 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539217 27041 Biopsy Soft Tissue Deep 27041 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3542245 27043 Exc Hip Pelvis Les Sc >3 cm 27043 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539218 27045 Exc Tumor Pelvis Hip >=5C 27045 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542246 27047 Remove Hip/Pelvis Lesion 27047 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539220 27048 Excis Deep Suprf Intramuscular 27048 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539221 27049 Radical Resect Of Tumor 27049 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3619248 27050 Arthrot Sacroiliac For Biopsy 27050 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539223 27054 Arthrot Hip Jnt For Synovectom 27054 " 14,860.00 " " 4,282.65 " " 3,819.02 " " 13,820.05 " " 3,819.02 " N/A N/A N/A N/A N/A " 7,615.75 " N/A " 8,916.00 " N/A N/A " 9,835.83 " N/A N/A " 11,055.99 " " 13,820.05 " N/A N/A N/A " 11,888.00 " N/A N/A " 8,767.40 " " 9,956.20 " N/A " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " N/A 3539225 27057 Decomp FascPelvicDebrid 27057 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539226 27059 Rad Resec Tumor Pelvis Hip>=5cm 27059 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539228 27060 Excision Ischial Bursa 27060 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539229 27062 Excision Bursa Trochanteric 27062 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539231 27065 Exc Cyst Tumor Ilium Etc Spfic 27065 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539232 27066 Exc Cyst Tumor Ilium Etc Deep 27066 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539234 27070 Excision Bone Partial Super 27070 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539235 27071 Excision Bone Partial Deep 27071 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539236 27075 Res Tumor Rad Pelvis & Hip Jnt 27075 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539237 27076 Ilium Including Acetabulum 27076 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539238 27078 Extensive Hip Surgery 27078 " 64,652.00 " " 18,632.71 " " 16,615.56 " " 60,129.43 " " 16,615.56 " N/A N/A N/A N/A N/A " 33,134.15 " N/A " 38,791.20 " N/A N/A " 42,793.16 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 51,721.60 " N/A N/A " 38,144.68 " " 43,316.84 " N/A " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " N/A 3539239 27080 Coccygectomy 27080 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539240 27086 Rem Forgn Body Pel/Hip 27086 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539241 27087 Rem For Bod Pel/Hip Deep 27087 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537528 27090 Removal Hip Pro- Thesis Ind Pro 27090 " 12,443.00 " " 3,586.07 " " 3,197.85 " " 11,572.10 " " 3,197.85 " N/A N/A N/A N/A N/A " 6,377.04 " N/A " 7,465.80 " N/A N/A " 8,236.02 " N/A N/A " 9,257.64 " " 11,572.10 " N/A N/A N/A " 9,954.40 " N/A N/A " 7,341.37 " " 8,336.81 " N/A " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " N/A 3539242 27091 Rem Hip Prosthesis Insert 27091 " 4,740.00 " " 1,366.07 " " 1,218.18 " " 11,572.10 " " 1,218.18 " N/A N/A N/A N/A N/A " 2,429.25 " N/A " 2,844.00 " N/A N/A " 3,137.41 " N/A N/A " 9,257.64 " " 11,572.10 " N/A N/A N/A " 3,792.00 " N/A N/A " 2,796.60 " " 3,175.80 " N/A " 1,938.66 " " 3,555.00 " " 1,801.67 " " 2,120.20 " N/A 46000278 SJR XR ARTHROGRAM INJ HIP LT 27093 761 116.00 33.43 - 92.80 29.81 - - - - - 59.45 - 69.60 - - 76.78 - - - - - - - 92.80 - - 68.44 77.72 - 47.44 87.00 44.09 51.89 - 46000278 SJR XR ARTHROGRAM INJ HIP RT 27093 761 116.00 33.43 - 92.80 29.81 - - - - - 59.45 - 69.60 - - 76.78 - - - - - - - 92.80 - - 68.44 77.72 - 47.44 87.00 44.09 51.89 - 3538186 27095 Inj Proc For Hip Arthrog W Anes 27095 " 3,648.00 " " 1,051.35 " - " 2,918.40 " 937.54 - - - - - " 1,869.60 " - " 2,188.80 " - - " 2,414.61 " - - - - - - - " 2,918.40 " - - " 2,152.32 " " 2,444.16 " - " 1,492.03 " " 2,736.00 " " 1,386.60 " " 1,631.75 " - 3509349 NV STEROID INJECTION SI JOINT 27096 761 " 3,332.00 " 960.28 856.32 " 2,665.60 " 856.32 N/A N/A N/A N/A N/A " 1,707.65 " N/A " 1,999.20 " N/A N/A " 2,205.45 " N/A N/A N/A N/A N/A N/A N/A " 2,665.60 " N/A N/A " 1,965.88 " " 2,232.44 " N/A " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " N/A 3542247 27096 Inj Sacroiliac Joint 27096 " 3,332.00 " 960.28 856.32 " 2,665.60 " 856.32 N/A N/A N/A N/A N/A " 1,707.65 " N/A " 1,999.20 " N/A N/A " 2,205.45 " N/A N/A N/A N/A N/A N/A N/A " 2,665.60 " N/A N/A " 1,965.88 " " 2,232.44 " N/A " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " N/A 4593501 Us Ortho 27096 Inj Sacroiliac Joint POC 27096 " 3,332.00 " 960.28 856.32 " 2,665.60 " 856.32 N/A N/A N/A N/A N/A " 1,707.65 " N/A " 1,999.20 " N/A N/A " 2,205.45 " N/A N/A N/A N/A N/A N/A N/A " 2,665.60 " N/A N/A " 1,965.88 " " 2,232.44 " N/A " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " N/A 3539243 27097 Release Or RecessionHamstring Proximal 27097 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539244 27100 Trnsfer Ext Obliq To Grt Troch 27100 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539245 27120 Acetabuloplasty 27120 " 64,652.00 " " 18,632.71 " " 16,615.56 " " 60,129.43 " " 16,615.56 " N/A N/A N/A N/A N/A " 33,134.15 " N/A " 38,791.20 " N/A N/A " 42,793.16 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 51,721.60 " N/A N/A " 38,144.68 " " 43,316.84 " N/A " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " N/A 3538187 27122 Hip Reconstruction Girdlestone 27122 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539246 27125 Partial Hip Replacement Prosth 27125 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539247 27130 Total Hip Replacemnt 27130 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538188 27132 Revision Total Hip Replacement 27132 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539248 27134 Rev Total Hip Arthroplasty 27134 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539249 27137 Rev Tot Hip Arthro Acetabular 27137 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539250 27138 Rev Tot Hip Arthrp Femoral 27138 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538189 27140 Osteot&Trnsference Grtr Troch 27140 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539251 27146 Osteotomy Innominate Bone 27146 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539252 27147 Osteotomy Inno Bone Op Red Hip 27147 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539253 27151 Osteotomy Innom Bone & Femur 27151 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539254 27156 Osteot Innom & Fem Op Red Hip 27156 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539255 27158 Osteotomy Pelvis Bil Cong Malform 27158 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539256 27161 Osteotomy Femoral Neck 27161 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539257 27165 Osteotomy Intertroch/Subtroch 27165 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539258 27170 Bone Graft Femoral Hd Nk 27170 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539259 27176 Slippd Femrl Epiphs Sin/Mul Pi 27176 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539260 27177 Slippd Femrl Epiphys Open Red 27177 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539261 27178 Open Tx Slipped Femoral 27178 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539262 27179 Slippd Femrl Epiphys Osteoplas 27179 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539263 27181 Slippd Femrl Epip Oste Int Fix 27181 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539264 27185 Epiphyseal Arrest Grtr Trochan 27185 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539265 27187 Phrophylactic Trtmnt W/W/O Methylmeth 27187 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 46501 CLOSED TX PELVIC RING FX 27197 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542248 27197 Clsd Tx Pelvic Ring Fx W/Manip W/An 27197 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539268 27198 Clsd Tx Pelvic Ring Fx W/Manipulation W/An 27198 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46503 TX COCCYGEAL FX (CLOSED) 27200 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539037 27200 Fx-Closed Coccygeal 27200 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539269 27202 Open Treatment Of Coccyge 27202 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539270 27215 Opn Trtmnt Of Iliac Spine 27215 " 6,202.00 " " 1,787.42 " " 1,295.37 " " 4,961.60 " " 1,593.91 " N/A N/A N/A N/A N/A " 3,178.53 " N/A " 3,721.20 " N/A N/A " 4,105.10 " N/A N/A " 1,295.37 " " 1,619.21 " N/A N/A N/A " 4,961.60 " N/A N/A " 3,659.18 " " 4,155.34 " N/A " 2,536.62 " " 4,651.50 " " 2,357.38 " " 2,774.15 " N/A 3539271 27216 Perc Skel Fx/Pos Pl R Frc 27216 " 4,600.00 " " 1,325.72 " 960.77 " 3,680.00 " " 1,182.20 " N/A N/A N/A N/A N/A " 2,357.50 " N/A " 2,760.00 " N/A N/A " 3,044.74 " N/A N/A 960.77 " 1,200.96 " N/A N/A N/A " 3,680.00 " N/A N/A " 2,714.00 " " 3,082.00 " N/A " 1,881.40 " " 3,450.00 " " 1,748.46 " " 2,057.58 " N/A 3539272 27217 Op Trt/Ant Rng F/Dis W/Fx 27217 " 7,766.00 " " 2,238.16 " " 1,622.03 " " 6,212.80 " " 1,995.86 " N/A N/A N/A N/A N/A " 3,980.08 " N/A " 4,659.60 " N/A N/A " 5,140.32 " N/A N/A " 1,622.03 " " 2,027.54 " N/A N/A N/A " 6,212.80 " N/A N/A " 4,581.94 " " 5,203.22 " N/A " 3,176.29 " " 5,824.50 " " 2,951.86 " " 3,473.73 " N/A 3539273 27218 Opn Trt/Pst R Frc W/Int F 27218 " 10,627.00 " " 3,062.70 " " 2,219.59 " " 8,501.60 " " 2,731.14 " N/A N/A N/A N/A N/A " 5,446.34 " N/A " 6,376.20 " N/A N/A " 7,034.01 " N/A N/A " 2,219.59 " " 2,774.49 " N/A N/A N/A " 8,501.60 " N/A N/A " 6,269.93 " " 7,120.09 " N/A " 4,346.44 " " 7,970.25 " " 4,039.32 " " 4,753.46 " N/A 46504 TX HIP SOCKET FX (CLOSED) 27220 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 5115518 27220 Fx Acetabulum Smp Without Reduct 27220 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46505 TX HIP SOCK FX W/MANIP 27222 450 " 1,082.00 " 311.83 278.07 " 1,006.77 " 278.07 N/A N/A N/A N/A N/A 554.53 N/A 649.20 N/A N/A 716.18 N/A N/A 805.41 " 1,006.77 " N/A N/A N/A 865.60 N/A N/A 638.38 724.94 N/A 442.54 811.50 411.27 483.98 N/A 4799293 27222 Treat Hip Socket Fracture 27222 " 1,082.00 " 311.83 278.07 " 1,006.77 " 278.07 N/A N/A N/A N/A N/A 554.53 N/A 649.20 N/A N/A 716.18 N/A N/A 805.41 " 1,006.77 " N/A N/A N/A 865.60 N/A N/A 638.38 724.94 N/A 442.54 811.50 411.27 483.98 N/A 3539274 27226 Opn Trtmnt Post/Anter Acetabular Wal Fract 27226 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539275 27227 Op Trt/Acetab Frc Ant/Pst 1 Column 27227 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539276 27228 Op Trt Acteb Frc Ant/Pst 2 Columns 27228 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 46506 TX FEMORAL FX (CLOSED) 27230 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539277 27230 Fx Femur Neck Smp Wo Reduction 27230 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46507 TX FEMORAL FX W/MANIPULAT 27232 450 " 7,310.00 " " 2,106.74 " " 1,878.67 " " 6,798.45 " " 1,878.67 " N/A N/A N/A N/A N/A " 3,746.38 " N/A " 4,386.00 " N/A N/A " 4,838.49 " N/A N/A " 5,438.73 " " 6,798.45 " N/A N/A N/A " 5,848.00 " N/A N/A " 4,312.90 " " 4,897.70 " N/A " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " N/A 3537529 27232 Fx Femur Neck Smp Manip Reduc 27232 " 7,310.00 " " 2,106.74 " " 1,878.67 " " 6,798.45 " " 1,878.67 " N/A N/A N/A N/A N/A " 3,746.38 " N/A " 4,386.00 " N/A N/A " 4,838.49 " N/A N/A " 5,438.73 " " 6,798.45 " N/A N/A N/A " 5,848.00 " N/A N/A " 4,312.90 " " 4,897.70 " N/A " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " N/A 3539278 27235 Fx Femor Neck Cl Op Pinn Frac 27235 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539279 27236 Fx Femur Neck Smp/Cmp Open Reduc 27236 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3542249 27238 Fx-Femur Intr/Pertr Smp Wo Red 27238 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539280 27240 Fx Femur Intr Closed Manip Red 27240 " 2,785.00 " 802.64 715.75 " 6,798.45 " 715.75 N/A N/A N/A N/A N/A " 1,427.31 " N/A " 1,671.00 " N/A N/A " 1,843.39 " N/A N/A " 5,438.73 " " 6,798.45 " N/A N/A N/A " 2,228.00 " N/A N/A " 1,643.15 " " 1,865.95 " N/A " 1,139.07 " " 2,088.75 " " 1,058.58 " " 1,245.73 " N/A 3539281 27244 Fx-Femur Intr/Pert W Int Fix 27244 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539282 27245 Op Trt/IPStroch Frc W/ Intra Implnt 27245 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3542250 27246 Fx Great Trochan Smp Wo Reduc 27246 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539283 27248 Fx Great Trochan Smp/Cmp Open 27248 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 46512 TX HIP DISLOCATION CLOSED 27250 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539284 27250 Dsl Hip Trauma Manip Wo Anes 27250 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46513 TX HIP DISLOC W/ANESTHES 27252 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539285 27252 Dsl Hip Trauma Manip Req Anes 27252 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539286 27253 Dsl Hip Open Clos Wo Int Fix 27253 " 5,661.00 " " 1,631.50 " " 1,454.88 " " 13,820.05 " " 1,454.88 " N/A N/A N/A N/A N/A " 2,901.26 " N/A " 3,396.60 " N/A N/A " 3,747.02 " N/A N/A " 11,055.99 " " 13,820.05 " N/A N/A N/A " 4,528.80 " N/A N/A " 3,339.99 " " 3,792.87 " N/A " 2,315.35 " " 4,245.75 " " 2,151.75 " " 2,532.17 " N/A 3539287 27254 Dsl Hip Trauma Smp/Cmp Open Re 27254 " 5,661.00 " " 1,631.50 " " 1,454.88 " " 13,820.05 " " 1,454.88 " N/A N/A N/A N/A N/A " 2,901.26 " N/A " 3,396.60 " N/A N/A " 3,747.02 " N/A N/A " 11,055.99 " " 13,820.05 " N/A N/A N/A " 4,528.80 " N/A N/A " 3,339.99 " " 3,792.87 " N/A " 2,315.35 " " 4,245.75 " " 2,151.75 " " 2,532.17 " N/A 3539288 27256 Dsl Hip Congenital Splnt Trac 27256 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46515 TX HIP DISLOCAT W/ANESTH 27257 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539289 27257 Dsl Hip Congential W Man& Anes 27257 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539290 27258 Dsl Hip Congenital Open Reduc 27258 " 5,661.00 " " 1,631.50 " " 1,454.88 " " 13,820.05 " " 1,454.88 " N/A N/A N/A N/A N/A " 2,901.26 " N/A " 3,396.60 " N/A N/A " 3,747.02 " N/A N/A " 11,055.99 " " 13,820.05 " N/A N/A N/A " 4,528.80 " N/A N/A " 3,339.99 " " 3,792.87 " N/A " 2,315.35 " " 4,245.75 " " 2,151.75 " " 2,532.17 " N/A 3539291 27259 Dis Hip Congenital W Fem Short 27259 " 14,860.00 " " 4,282.65 " " 3,819.02 " " 13,820.05 " " 3,819.02 " N/A N/A N/A N/A N/A " 7,615.75 " N/A " 8,916.00 " N/A N/A " 9,835.83 " N/A N/A " 11,055.99 " " 13,820.05 " N/A N/A N/A " 11,888.00 " N/A N/A " 8,767.40 " " 9,956.20 " N/A " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " N/A 46516 TX POST HIP ARTHRO DISLOC 27265 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46762 TX POST HIP ARTHRO W/ANES 27266 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3542251 27266 Trtmnt/Atraumatic Hip Disloca Gen Anes 27266 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3542252 27267 Closed Tx Fem FxProx W/O 27267 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539292 27268 Closed Treatmen Femoral Fx W Manipulation 27268 " 14,860.00 " " 4,282.65 " " 3,819.02 " " 13,820.05 " " 3,819.02 " N/A N/A N/A N/A N/A " 7,615.75 " N/A " 8,916.00 " N/A N/A " 9,835.83 " N/A N/A " 11,055.99 " " 13,820.05 " N/A N/A N/A " 11,888.00 " N/A N/A " 8,767.40 " " 9,956.20 " N/A " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " N/A 3539293 27269 Open Treatment Femoral Fx 27269 " 7,310.00 " " 2,106.74 " " 1,878.67 " " 6,798.45 " " 1,878.67 " N/A N/A N/A N/A N/A " 3,746.38 " N/A " 4,386.00 " N/A N/A " 4,838.49 " N/A N/A " 5,438.73 " " 6,798.45 " N/A N/A N/A " 5,848.00 " N/A N/A " 4,312.90 " " 4,897.70 " N/A " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " N/A 3539294 27275 Manip Hip Joint Req Gen Anes 27275 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539295 27279 ArthrodesisSacroiliac Joint W/Image Guida 27279 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 3539296 27280 Arthrodesis Open Sacroiliac Joint 27280 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3539297 27282 Arthrodesis Symphysis Pubis 27282 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539298 27284 Arthrodesis Fusion Hip Joint 27284 " 83,308.00 " " 24,009.37 " " 21,410.16 " " 77,479.52 " " 21,410.16 " N/A N/A N/A N/A N/A " 42,695.35 " N/A " 49,984.80 " N/A N/A " 55,141.57 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 66,646.40 " N/A N/A " 49,151.72 " " 55,816.36 " N/A " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " N/A 3539299 27290 Amputation Interpelviabdominal 27290 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3539300 27295 Disarticulation Hip 27295 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 5462692T 27299 Bernese Periacetabular Osteotomy 27299 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4457736 27299 Open right gluteus medius repair 27299 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4457735 27299 Open right hip anterior arthrotomy hipcam 27299 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 5887260T 27299 Unl Hip Capsule Repair 27299 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539301 27299 Unl Hip Core Decompression 27299 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 6007338T 27299 Unl IT Band Repair 27299 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4917292 27999 Unl Perc Pin Acetabular Fracture 27299 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538190 27301 Incision & Drainage Deep Abscess 27301 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539302 27303 Incision Deep Open Bone Cortex 27303 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3538191 27305 Fasciotomy Iliotibia Tenotom 27305 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539304 27306 Tenotomy Sub Cl Add Hamst Sing 27306 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539305 27307 Tenotomy Sub Closed Adductor Hamst Multi 27307 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 4309635T 27310 Arthro Knee Removal Fb 27310 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539306 27310 Arthrotomy Knee Expldrain Removl Forin Bdy 27310 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538192 27323 Biopsy Soft Tissue Knee Thigh Superfic 27323 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539307 27324 Biopsy Soft Tiss T/Kn Dep 27324 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539308 27325 NeurectomyHamstring Musc 27325 " 9,211.00 " " 2,654.61 " - " 8,566.18 " " 2,367.23 " " 8,247.51 " " 1,794.83 " " 8,529.89 " " 1,510.50 " " 1,777.06 " " 4,720.64 " " 1,777.06 " " 5,526.60 " " 1,510.50 " " 1,901.45 " " 6,096.76 " " 1,599.35 " " 1,777.06 " " 6,852.91 " " 8,566.18 " " 1,759.29 " " 1,812.60 " " 1,777.06 " " 7,368.80 " " 1,626.01 " - " 5,434.49 " " 6,171.37 " " 1,563.81 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,812.60 " 3539309 27326 NeurectomyPopliteal 27326 " 9,211.00 " " 2,654.61 " - " 8,566.18 " " 2,367.23 " " 8,247.51 " " 1,794.83 " " 8,529.89 " " 1,510.50 " " 1,777.06 " " 4,720.64 " " 1,777.06 " " 5,526.60 " " 1,510.50 " " 1,901.45 " " 6,096.76 " " 1,599.35 " " 1,777.06 " " 6,852.91 " " 8,566.18 " " 1,759.29 " " 1,812.60 " " 1,777.06 " " 7,368.80 " " 1,626.01 " - " 5,434.49 " " 6,171.37 " " 1,563.81 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,812.60 " 3541913 27327 Exc Tumor Thigh/Knee Subcutaneous 27327 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539310 27328 Exc Tumor Thigh Knee Deep 27328 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538193 27329 Rad Resection Tumor Soft Tis Thigh Knee 27329 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539311 27330 Arthrotomy Knee For Synovial Biopsy Only 27330 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538194 27331 Arthro Knee W Joint Exploration 27331 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 5342699T 27332 Arthro Meniscectomy Knee Med/Lat 27332 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538196 27334 Arthrot Knee Synov Anterior Or Posterior 27334 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539312 27335 Atrhrot Knee Synovec Ant & Pos 27335 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3542253 27337 Exc TumorThigh Or Knee 27337 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539313 27339 Exc TumorThigh Or Knee >=5cm 27339 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539314 27340 Excision Prepatelar Bursa 27340 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538197 27345 Excision Synovial Cyst BakerS Cyst 27345 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539315 27347 Ex Of Lesion Meniscus CapKnee 27347 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537413 27350 Patellectomy Or Hemipatellectomy 27350 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539316 27355 Excis Or Curtage Of Cyst Beng Tumr Of Femr 27355 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539317 27356 Exc Cyst Tumfemur W/Allograft 27356 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539318 27357 Exc Cyst Tumor Femur W Graft 27357 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539319 27358 Exc Cyst Tumor Femur W Int Fix 27358 " 5,208.00 " " 1,500.95 " - " 4,166.40 " " 1,338.46 " - - - - - " 2,669.10 " - " 3,124.80 " - - " 3,447.18 " - - - - - - - " 4,166.40 " - - " 3,072.72 " " 3,489.36 " - " 2,130.07 " " 3,906.00 " " 1,979.56 " " 2,329.54 " - 3539320 27360 Part Exc Femur Prox Tibi Osteo 27360 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539321 27364 Rad Resect Tumor Thigh Or Knee 27364 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3538198 27365 Radical Resection For Tumr Of Femr / Kne 27365 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 46000306 SJR XR ARTHROGRAM INJ KNEE LT 27369 761 787.00 226.81 - 629.60 202.26 - - - - - 403.34 - 472.20 - - 520.92 - - - - - - - 629.60 - - 464.33 527.29 - 321.88 590.25 299.14 352.03 - 46000306 SJR XR ARTHROGRAM INJ KNEE RT 27369 761 787.00 226.81 - 629.60 202.26 - - - - - 403.34 - 472.20 - - 520.92 - - - - - - - 629.60 - - 464.33 527.29 - 321.88 590.25 299.14 352.03 - 4407190 27369 Inj Cntrst Knee Arthg/Ct/Mri 27369 787.00 226.81 - 629.60 202.26 - - - - - 403.34 - 472.20 - - 520.92 - - - - - - - 629.60 - - 464.33 527.29 - 321.88 590.25 299.14 352.03 - 3538199 27372 Remvl Forgin Body Deep Thigh Or Knee 27372 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539322 27380 Sutur Infrapatellar Tendon Primary 27380 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539323 27381 Sutr Infrapat Tend Second Recon 27381 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539324 27385 Sut Quadcep/Hamstrg Muscle Rupture Primary 27385 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3542254 27386 Sut/Quaricep/H/S Musc Rup 27386 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539325 27390 Tenotomy Op Hamstr Kn/Hip Sing 27390 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539326 27391 Tenotomy Op Hamstr Kn/Hip Mult 27391 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539327 27392 Tenotomy Op Hamst Kn/Hip Mu Bi 27392 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539328 27393 Lengthening Hamstring Ten Sing 27393 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539329 27394 Lengthening Hamstring Tend Mul 27394 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539330 27395 Lengthening Hamstr Ten Mul Bil 27395 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539331 27396 Trans Hamstr Tend To Pat Sing 27396 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539332 27400 Tansfer Hamsrings To Femur 27400 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537414 27403 Arthrotomy W Open Meniscus Repair 27403 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539333 27405 Rep Collateral Lig Knee Prim 27405 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539334 27407 Rep Cruciate Lig Kne Primary 27407 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539335 27409 Rep Coll & Cruci Lig Knee Prim 27409 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539336 27412 Autologous Chondroc Implt Knee 27412 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539337 27415 Osteochond Allogrft Knee Opn 27415 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539338 27416 Osteochond Autogrft Knee Open 27416 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539339 27418 Ant Tibial Tub Plasty Chond Pa 27418 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539340 27420 Recur Dsl Patella Hauser Type 27420 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539341 27422 Recur Dsl Patella W Extn Align 27422 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539342 27424 Recur Dsl Patella W Patellectm 27424 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539343 27425 Lateral Retinacular Release 27425 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539344 27427 Lig ReconstKneeEx-Articular 27427 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539345 27428 Lig ReconsKneeIntr-Articular 27428 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539346 27429 Lig RecKneeInt/Ext-Articular 27429 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539347 27430 Quadricepsplasty Thompson Type 27430 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539348 27435 Capsulotomy Knee 27435 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539349 27437 ArthroplastPatel W/O Pro 27437 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539351 27438 Arthroplasty Patella W/Prosth 27438 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538200 27445 Arhtroplasty Knee Constrained Prosthesis 27445 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539352 27446 Arth Knee Med Or Lat Compartment 27446 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3538201 27447 Arth Knee Med & Lat Comp Total Knee 27447 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539353 27448 Osteot Femur Shaft W/O Fx 27448 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538202 27450 Osteot Femur Shaft Supracondylar W\Fixati 27450 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538203 27454 Osteotomy Multiple Femoral Shaft 27454 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539354 27455 Osteot Prox Tib Bf Epip Clo 27455 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539355 27457 Osteot Prox Tib Af Epip Clo 27457 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539356 27465 Osteoplasty Femur Shortening 27465 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539357 27466 Osteoplasty Femur Lengthening 27466 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539359 27468 Osteoplasty Femur Lengthening & Shortening 27468 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539360 27470 Rep Non-Union Femur Wo Graft 27470 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539361 27472 Rep Non-Union Femur W Graft 27472 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539363 27475 Epiphyseal Arrest Distal Femur 27475 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539364 27477 Epiphysl Arst Tib & Fib Proxml 27477 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539365 27479 Epiphysl Arst Comb Femur Knee 27479 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539367 27485 Hemiepiphysl Arst Distal Femur 27485 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538204 27486 Revision Total Knee Arthroplasty 27486 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539369 27487 Rev Total Knee Artho All Components 27487 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3538205 27488 Remov Knee Prosthes Inc Tot Knee Ins Spac 27488 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539370 27495 Prophylact Tx W/Wo Methyl Femur 27495 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539371 27496 Decompress Fasciotomy 1 Compartment 27496 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539372 27497 Decom Fasciotomy W/Debr Nvia Msc/Nrv 27497 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539373 27498 Decompres Fasciotomy Mult Compartmnts 27498 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 5169348 27499 Decomp Fasc Thigh/Knee W/Debride 27499 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46517 TX FEMORAL SHAFT FX 27500 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3541914 27500 Fx Femur Shaft Smp Wo Reduction 27500 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542255 27501 Closed Tx Supracondylar Fracture 27501 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 460930 FX FEMUR SHAFT SMP MANIP 27502 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538206 27502 Fx Femur Shaft Smp Manip Reduction 27502 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 46926 TX SUPRA/TRA FEM FX;W/MAN 27503 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537530 27503 Trt Thigh Frc W/Man/W/W/O Skel Tract 27503 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538207 27506 Fx Femur Shaft Smp/ Cmp Opn Reduction 27506 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539374 27507 Trt Thigh Frc W/PlateScrw/W/W/O Cerclage 27507 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 46520 TX FEMORAL FX DISTAL END 27508 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539138 27508 Fx Femur Distal End Smp Wo Red 27508 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539375 27509 Trt Thigh Fr/W/W/O Intercon Extension 27509 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539376 27510 Fx Femur Distal End Smp W Red 27510 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539377 27511 Trt Thigh Fr W/W/O Int/Ext Fix 27511 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539378 27513 Opn Trtmnt Femor Supracon/Transcon 27513 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3538208 27514 Fx Femur Dstl End Smp/Cmp Op Reduction 27514 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3542256 27516 Fx-Distal Femor Clos Wo Manip 27516 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539379 27517 Fx Distal Femoral W Manipulation 27517 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538209 27519 Fx Distal Femor Cl Op W/Wo Fix 27519 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 46524 FX PATELLAR SIMP W/O REDU 27520 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539144 27520 Fx Patella Simple Wo Reduc 27520 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538210 27524 Fx Patella Smp/Cmp Open Reduction 27524 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46525 TX TIBIAL FX PROXIMAL 27530 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539145 27530 Fx Tibia Proxml Smp Wo Reduc 27530 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 460911 CLOSED TX TIBIAL FX 27532 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539380 27532 Fx Tibia Proxml Smp Manip Red 27532 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539381 27535 Opn Trtmnt Of Tibial Frac 27535 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539382 27536 Fx Tibia Proxml Smp/Cmp Op Red 27536 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3537531 27538 Fx Intercondylar Spine Closed 27538 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537415 27540 Fx-Intercondylar Spine W Int Fixation 27540 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 460937 TREAT KNEE DISLOCATION 27550 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537532 27550 Dsl Knee Smp Manip Red Wo Anes 27550 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539384 27552 Dsl Knee Smp Manip Red W Anes 27552 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539385 27556 Dsl Knee Smp/Cmp Open Reduc 27556 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539386 27557 Dsl Knee Smp/Cmp Open Red W Gr 27557 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539387 27558 Repair Of Knee Dislocation 27558 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 46530 TX PATELLAR DISLOCATION 27560 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542257 27560 Dsl Patela Smp Man Red W/O Ans 27560 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46531 TX PATELLAR DISLOC W/ANES 27562 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539388 27566 Dsl Patela Smp/Cmp Open Reduc 27566 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3542258 27570 Manip Knee Under Gen Anes 27570 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538211 27580 Fusion Of Knee Any Technique 27580 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539389 27590 Amputate Thigh Thru Femur 27590 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3539390 27591 Amp Immed Fitng Tech 1St Cast 27591 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3539391 27592 Amputate Thigh Thru Femur Open 27592 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3539392 27594 Amputation Thigh Sec Closure 27594 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539393 27596 Reamputation Thigh 27596 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539394 27598 Amputation Disarticulate Knee 27598 " 64,652.00 " " 18,632.71 " " 16,615.56 " " 60,129.43 " " 16,615.56 " N/A N/A N/A N/A N/A " 33,134.15 " N/A " 38,791.20 " N/A N/A " 42,793.16 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 51,721.60 " N/A N/A " 38,144.68 " " 43,316.84 " N/A " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " N/A 3539396 27600 Fasciotomy Leg Anterior Compar 27600 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537416 27601 Fasciotomy Leg Posterior Compt 27601 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538212 27602 Fasciotomy Leg Ant/ Post Compar 27602 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539397 27603 Inc & Drain Deep Abs Or Hemat 27603 761 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539398 27604 Inc Drng Lg/Ank Inf Bursa 27604 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538213 27605 Tenotomy Achilles Local Anes 27605 761 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538214 27606 Tenotomy Achilles Gen Anes 27606 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539400 27607 Inc Deep W Open Cortex Osteomy 27607 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538215 27610 Arthrotomy Ankle W Exploration 27610 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539401 27612 Arthrotomy Ankle Post Caps Rel 27612 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539407 27613 Biopsy Soft Tiss Lg/Ankle 27613 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539412 27614 Biopsy Soft Tiss Leg Ankle Deep 27614 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539413 27615 Radical Resection Of Tumor 27615 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539414 27616 Rad Res Tumor Leg Or Ankle >=5cm 27616 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3541915 27618 Exc Tumor Leg/Ankle Subcutaneous 27618 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3541917 27619 Excision Tumor Leg Ankle Deep 27619 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539415 27620 Arthrotomy Ankle For Biopsy 27620 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539416 27625 Arthrotomy Ankle Synovectomy 27625 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539417 27626 Arthrtmy W/Synovect W Ten 27626 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539418 27630 Excision Lesion Ten-Don Sheath 27630 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542259 27632 Exc TumorLeg Or Ankle 27632 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539419 27634 Exc TumorLeg Or Ankle >=5cm 27634 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539420 27635 Exc Cyst Benign Tumor Tibia/Fibula 27635 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539421 27637 Excision Cyst Tibia/Fib W Graf 27637 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538216 27638 Excision Cyst Tibia Fibia W Allograft 27638 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539422 27640 Exc Bone Partial For Osteomyel 27640 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539423 27641 Exc Bone Partial Fibula 27641 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539424 27645 Resection Tumor Rad-Ical Tibia 27645 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539425 27646 Extensive Lower Leg Surg 27646 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539426 27647 Resection Tumor Rad-Ical Talus/Calcaneus 27647 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 44002637 SJR XR ARTHROGRAM INJ ANKLE LT 27648 761 324.00 93.38 - 259.20 83.27 - - - - - 166.05 - 194.40 - - 214.46 - - - - - - - 259.20 - - 191.16 217.08 - 132.52 243.00 123.15 144.93 - 44002637 SJR XR ARTHROGRAM INJ ANKLE RT 27648 761 324.00 93.38 - 259.20 83.27 - - - - - 166.05 - 194.40 - - 214.46 - - - - - - - 259.20 - - 191.16 217.08 - 132.52 243.00 123.15 144.93 - 3539427 27648 Inj Proc For Ankle Arthrography 27648 324.00 93.38 - 259.20 83.27 - - - - - 166.05 - 194.40 - - 214.46 - - - - - - - 259.20 - - 191.16 217.08 - 132.52 243.00 123.15 144.93 - 3539428 27650 Suture Tendon Rup Achilles 27650 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539429 27652 Suture Tendon Rup Achil W Grft 27652 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539430 27654 Rep 2Ndry Rup Achill Tend 27654 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539431 27656 Repair Fascial Defect Leg 27656 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542260 27658 Rep Tendon Extensor Leg Sin Pr 27658 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539432 27659 Rep Tendon Flexor Leg Sing Sec 27659 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539433 27664 Rep Tendon Extens Pri W Grf Ea 27664 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538217 27665 Rep Tendon Extens Sec W/Wo Graft 27665 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539434 27675 Rep Dsl Peroneal Ten W/O Fib Ost 27675 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539435 27676 Rep Dsl Peronl Tend W/Fib 27676 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539436 27680 Tenolysis Single 27680 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539437 27681 Tenolysis/Tib/Fib Ank Fle 27681 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539438 27685 Lengthen Or Shorten Tendon Sin 27685 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539439 27686 Leng/Shortng Tendon Multiple 27686 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539440 27687 Revision Of Calf Tendon 27687 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539441 27690 Transfer Tendon Su- Perfi Sing 27690 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539442 27691 Transfer Tendon In- Teros Memb 27691 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539443 27692 Transfer Tendon Superfi Ea Add 27692 608.00 175.23 - 486.40 156.26 - - - - - 311.60 - 364.80 - - 402.44 - - - - - - - 486.40 - - 358.72 407.36 - 248.67 456.00 231.10 271.96 - 3539444 27695 Sut Collat Lig Ankle Primary 27695 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539445 27696 Sut Collat Lig Ankle Prim Both 27696 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539446 27698 Sut Collat Lig Ankle 2Ndry Rep 27698 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539447 27700 Arthroplasty Ankle 27700 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538218 27702 Arthroplasty W Imp Total Ankle 27702 " 24,630.00 " " 7,098.37 " - " 60,129.43 " " 6,329.91 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 12,622.88 " " 12,479.19 " " 14,778.00 " " 10,607.31 " " 13,352.73 " " 16,302.60 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 19,704.00 " " 11,418.46 " - " 14,531.70 " " 16,502.10 " " 10,981.69 " " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " " 12,728.77 " 3539448 27703 Arthroplasty Ankle:Revis 27703 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3537417 27704 Removal Of Ankle Implant 27704 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539449 27705 Osteotomy Tibia 27705 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539450 27707 Osteotomy Fibula 27707 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539451 27709 Osteotomy Tibia And Fibula 27709 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539452 27712 Osteotomy Tib Mult W Realignmt 27712 " 64,652.00 " " 18,632.71 " " 16,615.56 " " 60,129.43 " " 16,615.56 " N/A N/A N/A N/A N/A " 33,134.15 " N/A " 38,791.20 " N/A N/A " 42,793.16 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 51,721.60 " N/A N/A " 38,144.68 " " 43,316.84 " N/A " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " N/A 3539453 27715 Osteoplas Tib & Fib Lngthening 27715 " 24,630.00 " " 7,098.37 " " 6,329.91 " " 60,129.43 " " 6,329.91 " N/A N/A N/A N/A N/A " 12,622.88 " N/A " 14,778.00 " N/A N/A " 16,302.60 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 19,704.00 " N/A N/A " 14,531.70 " " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 3539454 27720 Rep Nonunion Tibia Wo Graft 27720 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538223 27724 Rep Nonunion Tib W Autog Graft 27724 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539455 27725 Rep Nonunion Tib By Synostosis 27725 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539456 27726 Rpr Fibula Nonunion W/Internal Fixation 27726 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538224 27730 Epiphyseal Arrest Dstl Tibia 27730 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539457 27732 Epiphyseal Arrest Dstl Fibula 27732 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539458 27734 Epiphyseal Arrest Dstl Tib&Fib 27734 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539459 27740 Epiphyseal Arst Prx&Dst Tb&Fib 27740 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539460 27745 Prophylac Trtmnt ; Tibia 27745 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46532 TX TIBIAL SHAFT FX 27750 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537991 27750 Fx Tibia Shaft Smp Wo Reduc 27750 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46533 TX TIBIAL SHAFT FX W/MAN 27752 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538225 27752 Fx Tibia Shaft Smp Manip Reduc 27752 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539461 27756 Fx-Tibia Shaft Cls/ Opn Smp W Int Fixation 27756 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539462 27758 Fx Tibia Shaft Close/Open Comp 27758 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539463 27759 Op Tx Tib Shaft W Im Rod 27759 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 46534 TX MEDIAL MALLEOLUS FX 27760 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539219 27760 Fx Tibia Distal Smp Wo Red 27760 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 460924 CLOSED MALLEOLUS FX MANIP 27762 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539464 27762 Fx Tibia Distal Smp Manip Red 27762 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539466 27766 Fx Tibia Distal Smp/Cmp Opn Re 27766 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46987 CLOSED TX POST MALLEOLUS 27767 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539222 27767 Closed Tx Post Malleolus 27767 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46961 CLSD POST MALL FX W MANIP 27768 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3537533 27768 Closed Tx Of Post Malleol 27768 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539467 27769 Orif Posterior Malleolus 27769 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46536 TX PROXIMAL/SHAFT FX 27780 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539224 27780 Fx Fib Prox/Shft Smp Wo Red 27780 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 460912 CLOSED TX FIB/SHAFT FX 27781 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539468 27781 Prox Fibula Fx W Reductio 27781 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539469 27784 Fx-Fib Prox/Shft Cls/Cmp W/Wo Fixation 27784 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46538 TX DISTAL FIBULAR FX 27786 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539227 27786 Fx Fibula Distal Smp Wo Red 27786 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46539 TX DIS FIBULAR FX W/MANIP 27788 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539470 27788 Fx Fibula Distal Smp Manip Red 27788 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539471 27792 Fx-Fibula Distal Cls/Opn W Fixation 27792 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46540 TX BIMALLEOLAR ANKLE FX 27808 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539230 27808 Fx Bi-Malleolar Smp Wo Reduc 27808 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46541 TX BIMALL ANKLE FX W/MAN 27810 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539472 27810 Fx Bi-Malleolar Smp Manip Red 27810 761 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539473 27814 Fx Bi-Malleolar Smp/Cmp Open R 27814 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46542 TX TRIMALLEOLAR ANKLE FX 27816 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539233 27816 Fx Tri-Malleolar Smp Wo Reduc 27816 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46543 TX TRIMALL ANKLE FX W/MAN 27818 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539474 27818 Fx Tri-Malleolar Smp Manip Red 27818 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539475 27822 Fx Tri-Malleol Smp/ Cmp Open Re 27822 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539476 27823 Opn Trtmnt/Trimal Ank Fra 27823 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46806 TX FX DISTAL TIBIA 27824 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542261 27824 Trt Lwr Leg Frc W/W/O Anes W/O Manip 27824 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 460934 CLOSED FX DISTAL TIBIA 27825 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539477 27825 Trt Lwr Leg Frc/W/Skel Traction 27825 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539478 27826 Trt Lw Lg Fr/W/Int/Ext Fix Fibia Only 27826 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539479 27827 Trt Lwr Leg Frac/Tibia Only 27827 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539480 27828 Trt Lwr Leg Frac/Tib & Fib 27828 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539481 27829 Trt Ler Lg Jnt W/W/O Int/Ext Fix 27829 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 5340659T 27831 Clsd Trtmt Prox TibFib Req Anes 27831 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539482 27832 Dsl Prx Tib-Fib Jnt Open W Fix 27832 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46548 TX ANKLE DISLOCATION 27840 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539483 27840 Dsl Ankle Smp Manip Re Wo Anes 27840 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46549 TX ANKLE DISLOC W/ANESTH 27842 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3542262 27842 Dsl Ankle Smp Manip Red W Anes 27842 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538226 27846 Dsl Ankle Cls/Opn Open Reduction 27846 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539484 27848 Ank Dsl Op W/Rep Internal Exter Fixation 27848 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539485 27860 Manipulation Ankle Gen Anes 27860 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539486 27870 Arthrodesis Ankle Any Method 27870 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539487 27871 Arthrodesus Tibiofib Jnt 27871 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3537534 27880 Amputate Leg Thru Tib & Fibula 27880 " 31,736.00 " " 9,146.32 " " 8,156.15 " " 77,479.52 " " 8,156.15 " N/A N/A N/A N/A N/A " 16,264.70 " N/A " 19,041.60 " N/A N/A " 21,006.06 " N/A N/A " 61,983.29 " " 77,479.52 " N/A N/A N/A " 25,388.80 " N/A N/A " 18,724.24 " " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 3539488 27881 Amputate Leg Tib/Fib Immediate Cast Fit 27881 " 32,891.00 " " 9,479.19 " " 8,452.99 " " 30,589.97 " " 8,452.99 " N/A N/A N/A N/A N/A " 16,856.64 " N/A " 19,734.60 " N/A N/A " 21,770.55 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 26,312.80 " N/A N/A " 19,405.69 " " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 3539489 27882 Amputate Tibia-Fibula Guillotine 27882 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539490 27884 Amputate Tib-Fib 2Ndry Closure 27884 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539492 27886 Reamputate Leg Thru Tib-Fib 27886 " 12,530.00 " " 3,611.15 " " 3,220.21 " " 30,589.97 " " 3,220.21 " N/A N/A N/A N/A N/A " 6,421.63 " N/A " 7,518.00 " N/A N/A " 8,293.61 " N/A N/A " 24,471.85 " " 30,589.97 " N/A N/A N/A " 10,024.00 " N/A N/A " 7,392.70 " " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 3539493 27888 Amputation Ankle Resection Nrv 27888 " 64,652.00 " " 18,632.71 " " 16,615.56 " " 60,129.43 " " 16,615.56 " N/A N/A N/A N/A N/A " 33,134.15 " N/A " 38,791.20 " N/A N/A " 42,793.16 " N/A N/A " 48,103.30 " " 60,129.43 " N/A N/A N/A " 51,721.60 " N/A N/A " 38,144.68 " " 43,316.84 " N/A " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " N/A 3539494 27889 Ankle Disarticulation 27889 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539495 27892 Decom Fasc Leg Ant & Or Lat Compart 27892 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539496 27893 Decom Fasci Leg Posterior Compart Only 27893 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539497 27894 Decom Fas Leg AntLatPost Compart 27894 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 5431014T 27899 Unl Leg/Ankle Surgery Procedure 27899 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539499 28001 Inc & Drain Infect Bursa Foot 28001 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539500 28002 Deep Inf Below Fascia Sin Burs 28002 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539501 28003 Deep Inf Below Fascia Mul Area 28003 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539502 28005 Inc Deep W Open Bone Cortex 28005 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 48010478 BONE INCISION FOOT 28005 510 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539503 28008 Fasciotomy Plantar/Toe Subcut 28008 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542263 28010 Tenotomy Toe Subcutan Single 28010 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 48010548 PERCUTANEOUS TENOTOMY 28010 510 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539504 28011 Tenotomy Toe Subcutan Mult 28011 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539505 28020 Arthrotomy Int Or Tars W Expl 28020 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539506 28022 Arthrotomy Metatarsophalng Jnt 28022 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539507 28024 Arthrotomy Interpha-Langl Joint 28024 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539508 28035 Tarsal Tunnel Release 28035 " 9,211.00 " " 2,654.61 " - " 8,566.18 " " 2,367.23 " " 8,247.51 " " 1,794.83 " " 8,529.89 " " 1,510.50 " " 1,777.06 " " 4,720.64 " " 1,777.06 " " 5,526.60 " " 1,510.50 " " 1,901.45 " " 6,096.76 " " 1,599.35 " " 1,777.06 " " 6,852.91 " " 8,566.18 " " 1,759.29 " " 1,812.60 " " 1,777.06 " " 7,368.80 " " 1,626.01 " - " 5,434.49 " " 6,171.37 " " 1,563.81 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,812.60 " 3542264 28039 ExcTumorFoot Or Toe 28039 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539509 28041 Exc TumorFoot Or Toe >=1.5cm 28041 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3542265 28043 Excision Tumor Subcutaneous Foot 28043 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539510 28045 Exc Tumor Foot Deep 28045 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539511 28046 Resection Of Tumor Foot 28046 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539512 28047 Resect FootToe Tumor >3C 28047 " 12,443.00 " " 3,586.07 " - " 11,572.10 " " 3,197.85 " " 11,136.83 " " 2,423.61 " " 11,518.13 " " 2,039.67 " " 2,399.61 " " 6,377.04 " " 2,399.61 " " 7,465.80 " " 2,039.67 " " 2,567.58 " " 8,236.02 " " 2,159.65 " " 2,399.61 " " 9,257.64 " " 11,572.10 " " 2,375.61 " " 2,447.60 " " 2,399.61 " " 9,954.40 " " 2,195.64 " - " 7,341.37 " " 8,336.81 " " 2,111.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,447.60 " 3539513 28050 Arthrot Biopsy Inter Tarsomet 28050 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539514 28055 Neurectomy Intrinsic Foot 28055 " 9,211.00 " " 2,654.61 " - " 8,566.18 " " 2,367.23 " " 8,247.51 " " 1,794.83 " " 8,529.89 " " 1,510.50 " " 1,777.06 " " 4,720.64 " " 1,777.06 " " 5,526.60 " " 1,510.50 " " 1,901.45 " " 6,096.76 " " 1,599.35 " " 1,777.06 " " 6,852.91 " " 8,566.18 " " 1,759.29 " " 1,812.60 " " 1,777.06 " " 7,368.80 " " 1,626.01 " - " 5,434.49 " " 6,171.37 " " 1,563.81 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,812.60 " 3539515 28060 Fasciectomy Exc Plantar Part 28060 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537418 28062 Fasciectomy Exc Plantar Radic 28062 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539516 28070 Synovectomy Int Or Tarsometat 28070 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539517 28072 Synovectomy Metatarsoph Joint 28072 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539518 28080 Exc Mortons Neuroma Single 28080 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539519 28086 SynovecTend Sheath Foot 28086 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539520 28090 Exc Les Tend/Sheath/Capsl Foot 28090 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 48010468 CYST REMOVAL FOOT 28090 510 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539521 28092 Exc Les Tend/Sheath Capsl Toes 28092 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 48010469 CYST REMOVAL TOE 28092 510 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539522 28100 Exc Cyst Benign Tumor Talus Calcaneus 28100 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539523 28102 Exc Cyst Tumor Talus Calc W Gr 28102 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539524 28103 Exc/Cur Bone Les Tal/Calc 28103 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539525 28104 Exc Cyst Tumor Tars/Metatarsls 28104 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539526 28106 Exc Cyst Tumor Tars/Metat W Gr 28106 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539527 28107 Exc Bone Cyst Tar/Meta W 28107 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539528 28108 Exc Cyst Tumor Phalanges 28108 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539529 28110 Ostectomy Bunionette Operation 28110 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539530 28111 Ostectomy Comp 1St Metat Head 28111 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539531 28112 Ostectomy Comp 2Nd 3Rd 4Th Met 28112 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539532 28113 Ostectomy Comp 5Th Metat Head 28113 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539533 28114 Ostectomy Metatrs Head All Par 28114 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539534 28116 Ostectomy Exc Tarsal Coalition 28116 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539535 28118 Ostectomy Calcaneus Partial 28118 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539536 28119 Ostectomy Cal; Spur W/Wo Release 28119 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539537 28120 Exc Bone Partial Calcaneus 28120 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539538 28122 Exc Bone Partial Tarsal/Metat 28122 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 48010473 EXCISION BONE METATARSAL 28122 510 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537535 28124 Exc Bone Partial Phalanx 28124 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 48010472 EXCISION BONE TOE 28124 510 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539539 28126 Res Par/Com Phal Sing Toe 28126 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539540 28130 Talectomy (Astragalectomy) 28130 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 5101484 28140 Metatarsectomy 28140 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539541 28150 Phalangectomy Single Each 28150 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539542 28160 Hemiphalangectomy Single Each 28160 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539543 28171 Radical Resection For Tumor Tarsal 28171 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46957 FOREIGN BODY FOOT SUBQ 28190 450 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3539303 28190 Rem Foreign Body Foot Subcut 28190 " 3,265.00 " 940.97 - " 3,036.89 " 839.11 " 2,922.87 " 636.08 " 3,022.94 " 535.31 629.78 " 1,673.31 " 629.78 " 1,959.00 " 535.31 673.86 " 2,161.10 " 566.80 629.78 " 2,429.50 " " 3,036.89 " 623.48 642.38 629.78 " 2,612.00 " 576.25 - " 1,926.35 " " 2,187.55 " 554.21 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 642.38 3537536 28192 Rem Foreign Body Foot Deep 28192 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 3539544 28193 Removal Foreign Body Foot; Complicated 28193 " 7,387.00 " " 2,128.93 " - " 6,869.97 " " 1,898.46 " " 6,608.79 " " 1,438.21 " " 6,835.06 " " 1,210.37 " " 1,423.97 " " 3,785.84 " " 1,423.97 " " 4,432.20 " " 1,210.37 " " 1,523.65 " " 4,889.46 " " 1,281.57 " " 1,423.97 " " 5,495.95 " " 6,869.97 " " 1,409.73 " " 1,452.45 " " 1,423.97 " " 5,909.60 " " 1,302.93 " - " 4,358.33 " " 4,949.29 " " 1,253.09 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,452.45 " 5189492 28200 Rep Tendon Flexor Single Critical Care 28200 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539546 28200 Rep Tendon Flexor Single 28200 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 460913 REPAIR TENDON EXTENS FOOT 28208 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539547 28208 Rep Tendon Extensor Single 28208 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539548 28210 Rep Tendon Extsr Sin Free Gft 28210 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539549 28220 Tenolysis Foot Flexor Single 28220 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539550 28225 Tenolysis Foot Extensor Single 28225 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539551 28226 Tenolysis Foot Extensor Multi 28226 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539552 28230 Tenotomy Open Flexor Foot Single/Multip 28230 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3542266 28232 Tenotomy Flexor Toe Single 28232 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539553 28234 Tenotomy Extensor Foot Or Toe 28234 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539554 28238 Adv Post Tib Tend W Exc Nav Bo 28238 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539555 28240 Tenotomy Release Abductor Hallucis Musc 28240 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539556 28250 Div Plantar Fascia & Muscle 28250 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539557 28260 Capsulotomy Midfoot 28260 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539558 28261 Capsulotomy Midfoot W Tnd Leng 28261 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3538227 28262 Capsulotomy Exten- Sive Clubfoot 28262 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539559 28264 Capsulotomy Midtar- Sal 28264 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539560 28270 Capsulotomy Open Metatarsophal 28270 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539561 28272 Capsulotomy Open Interphalang 28272 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539562 28280 Webbing Oper Creat Syndac 28280 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539563 28285 Hammer Toe Operation One Toe 28285 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539564 28286 Repair Of Hammer Toe 28286 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539565 28288 Part Removal Of Foot Bone 28288 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539566 28289 Repair Hallux Rigidus 28289 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539568 28291 Hallux Rigidus W/Cheilectomy 1St Mp Jt W/I 28291 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539569 28292 Hallux Valg Keller Mcbrid Mayo 28292 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539571 28295 Corrj Hallux Valgus W/Sesmdc W/Prox Metar 28295 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539572 28296 Hallux Valg W Metata Osteotomy 28296 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539573 28297 Hal Valgus Cor Lapidus 28297 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539574 28298 Hallux Valgus Corr Phal Osteot 28298 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539575 28299 Bunion By Double Osteotomy 28299 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539576 28300 Osteotomy Calcaneous 28300 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539577 28302 Osteotomy Talus 28302 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539578 28304 Osteotomy Other Midtarsal Bone 28304 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539579 28305 Osteotomy W/Autograft 28305 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539580 28306 Osteotomy First Met-Atarsal 28306 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539581 28307 Osteotomy W Or W/O Length 28307 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539582 28308 Osteotomy Other Metatarsals 28308 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538228 28309 Osteotomy Metatarsals Multiple 28309 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539583 28310 Osteotomy Phalanax Proximal 28310 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539584 28312 Osteotomy Other Phalanges 28312 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539585 28313 Recon Ang Deform/Toe 28313 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539586 28315 Sesamoidectomy 1St Toe 28315 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539587 28320 Repair Tarsal Bones 28320 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539588 28322 Repair Metatar Bones W/Wo Grf 28322 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539589 28341 Recon Toe Req Bone Resec 28341 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3541918 28344 Reconstruction Toes Polydactyly 28344 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538230 28345 Reconstruction Toes Syndactyly W/Wo Grf 28345 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539590 28360 Reconstruction Cleft Foot 28360 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46552 CALCANEAL FX (CLOSED) 28400 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539350 28400 Fx-Calcaneal Closed Wo Manipulation 28400 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539591 28405 Fx-Calcaneal Closed Wo Manipulation 28405 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539592 28406 Perc Skel Fix Cal Fx W/Man 28406 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539593 28415 Fx-Calcaneal Cls/Opn W/Wo Fixation 28415 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539594 28420 Fx-Calcaneal Cls/Open W Graft 28420 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 46554 TALUS FX (CLOSED) 28430 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537997 28430 Fx-Closed Talus Wo Manipulation 28430 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542267 28435 Fx-Closed Talus W Manipulation 28435 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539596 28436 Treatment Of Ankle Fract 28436 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539597 28445 Fx-Cls/Open Talus W/Wo Int Fix 28445 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539598 28446 Open Osteochondral Autograph Talus 28446 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46556 TARSAL BONE FX EACH 28450 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539358 28450 Fx Tarsal Bones Smp Wo Reduc 28450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539599 28455 Fx-Tarsal Bones Manip Red 28455 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539600 28456 Perc Skel Fix Tarsl Bone 28456 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539601 28465 Fx-Tarsal Bones Open W/Wo Fix 28465 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46558 METATARSAL FX EACH 28470 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539362 28470 Fx Metatarsal Wo Re-Duction 28470 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46559 METATARSAL FX W/MAN EA 28475 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539602 28475 Fx-Metatarsal Manip Reduction 28475 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539603 28476 Fx Metatarsal Manip Perc Pin 28476 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539604 28485 Fx-Metatarsal Cls/Open W/Wo Fixation 28485 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46560 FX BIG TOE 28490 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539366 28490 Fx Great Toe Wo Reduction 28490 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46561 FX BIG TOE W/MANIPULATION 28495 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537419 28495 Fx Great Toe Clsd Manip Reduction 28495 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3538231 28496 Fx Great Toe Clsd Manip Perc Pinning 28496 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539605 28505 Fx-Great Toe Close/Open W/Wo Fixation 28505 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46562 FX PHALANX/PHALANGES EA 28510 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539368 28510 Fx Phalanx W/O Reduction 28510 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46563 FX PHALX/PHALG W/MAN EA 28515 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537537 28515 Fx Phalanx Manip Reduction 28515 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539606 28525 Fx-Phalanx Cls/Opn W/Wo Fixation 28525 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542268 28530 Clsd Trtmt Sesamoid Fract 28530 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539607 28531 Open Trtmt Sesamoid Fract 28531 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 460942 CLD TX OF TARSAL BONE DIS 28540 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3542269 28540 Dsl Tarsal Manip Red Wo Anesth 28540 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 5342698T 28545 Clsd Trtmt Tarsal Disloc Req Anes 28545 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539608 28546 Dsl Tarsal Clo W Per Skel Fix 28546 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539609 28555 Dsl Tarsal Cls/Opn W/Wo Fixation 28555 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 5289172T 28575 Closed Dstl Talotarsal Manip W Ane 28575 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539610 28575 Dsl Talotarasal Manip W Anes 28575 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539611 28576 Trt Foot Disloc W/Manip 28576 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539612 28585 Dsl Talotarasal Cls/Opn W/Wo Fixation 28585 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3542270 28600 Dsl Tarsometars Manip Wo Anes 28600 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539613 28605 Dsl Tarsometars Manip W Anes 28605 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539614 28606 Dsl Tarsometars W Per Ske Fix 28606 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539615 28615 Dsl Tarsometars Cls/Opn W/Wo Fixation 28615 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 46965 DSL METARSOPHAL MANIP 28630 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3537538 28630 Dsl Metarsophal Manip Wo Anes 28630 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46572 TX METAPHAL JT DIS W/ANES 28635 450 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539616 28635 Dsl Metars-Phal Manip W Anes 28635 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539617 28636 Trt Toe Dislocat W/Manip 28636 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539618 28645 Dsl Metarsophal Cls/Opn Op Red 28645 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46573 TX INTERPHALANG JT DISLOC 28660 450 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539619 28660 Dsl Interphalangeal Man W/O An 28660 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 46574 TX INTRPHAL JT DIS W/ANES 28665 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3539383 28665 Dsl Interphalang Manip W Anes 28665 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3539620 28666 Perc Skel Fx Intphal Jnt Disloc 28666 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539621 28675 Dsl Interphalang Cls/Opn Op Re 28675 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539622 28705 Arthrodesis Pantalar 28705 " 83,308.00 " " 24,009.37 " - " 78,546.00 " " 21,410.16 " " 75,945.80 " " 16,527.39 " " 78,546.00 " " 13,909.19 " " 16,363.75 " " 42,695.35 " " 16,363.75 " " 49,984.80 " " 13,909.19 " " 17,509.21 " " 55,141.57 " " 14,727.38 " " 16,363.75 " " 61,983.29 " " 77,479.52 " " 16,200.11 " " 16,691.03 " " 16,363.75 " " 66,646.40 " " 14,972.83 " - " 49,151.72 " " 55,816.36 " " 14,400.10 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,691.03 " 3539623 28715 Arhtrodesis Triple 28715 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539624 28725 Arthrodesis Subtalar 28725 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539625 28730 Arthrodesis Midtar Tarsomet 28730 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539626 28735 Arthrodesis Midtar Tarso Ostet 28735 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539627 28737 Arthro Midtarsal Navicular-Cuneiform 28737 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539628 28740 Arthrodesis Tarsometars Sgl Jt 28740 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539629 28750 Arthrodesis Great Toe 28750 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539630 28755 ArthrodesisInterphalangeal Joint 28755 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539631 28760 Arthrodesis Interphal Jones Pr 28760 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539632 28800 Amputate Foot Midtarsal Chopar 28800 " 14,860.00 " " 4,282.65 " " 3,819.02 " " 13,820.05 " " 3,819.02 " N/A N/A N/A N/A N/A " 7,615.75 " N/A " 8,916.00 " N/A N/A " 9,835.83 " N/A N/A " 11,055.99 " " 13,820.05 " N/A N/A N/A " 11,888.00 " N/A N/A " 8,767.40 " " 9,956.20 " N/A " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " N/A 3539633 28805 Amp Ft Transmetatarsal 28805 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539634 28810 Amputate Metatarsal W Toe Sing 28810 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 46942 AMPUTATION;TOE;MP JOINT 28820 450 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539399 28820 Amputate Toe Metatar- Sophlangeal Jt 28820 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 48010457 TOE AMP MPJ 28820 510 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542271 28825 Amputate Toe Interphalangeal 28825 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 48010456 TOE AMP IPJ 28825 510 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539636 29010 Risser Jacket Body Only 29010 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 46575 CAST LONG ARM 29065 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3539402 29065 Cast Long Arm 29065 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 46576 CAST SHORT ARM 29075 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3539403 29075 Cast Short Arm 29075 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3542272 29085 Cast Gauntlet 29085 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 46577 APPLICAT LONG ARM SPLINT 29105 450 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 3539404 29105 Splint Long Arm 29105 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 46578 APPLICAT SHORT ARM SPLINT 29125 450 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3539405 29125 Splint Short Arm Over 10 Years 29125 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 4053559 29126 App Of Shrt Arm Splt Dynamic 29126 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 46579 APPL FINGER SPLINT STATIC 29130 450 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3539406 29130 Splint Finger Static 29130 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3542273 29131 Apply Finger Splint Dynamic 29131 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 46454 TAPE/WRAP/SLING SHOULDER 29240 450 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3537539 29240 Strapping Shoulder 29240 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 46456 TAPE/WRP/SLNG HAND/FINGER 29280 450 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 3539637 29305 Cast Hip Spica 1 Leg 29305 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3542274 29325 Cast Hip Spica 1 1/2 Spica Or Both Legs 29325 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 46582 APP LONG LEG CAST 29345 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3542275 29345 Cast Long Leg 29345 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 46583 APP LL CAST WALK/AMBU 29355 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3542276 29355 Cast Long Leg Walking 29355 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 46584 APP LL CAST BRACE 29358 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3542277 29365 Cast Thigh To Ankle Cylinder 29365 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 46585 APP SHORT LEG CAST 29405 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3539408 29405 Cast Short Leg 29405 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 46586 APP SL CAST WALK/AMBU 29425 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3539409 29425 Cast Short Leg Walk-Ing 29425 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3542278 29445 App Rigd Tot Cont Leg Cst 29445 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 48010169 TOTAL CONTACT CAST 29445 420 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 48010496 TOTAL CONTACT CASTING NURSE 29445 510 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3542279 29450 Cast Clubfoot Long Or Short Leg 29450 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 46589 APP LONG LEG SPLINT 29505 450 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 3539410 29505 Splint Long Leg 29505 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 46590 APP SHORT LEG SPLINT 29515 450 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 3539411 29515 Splint Short Leg 29515 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 3542280 29520 Strapping Hip 29520 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 46459 TAPE/WRAP/SLING ANKLE 29540 450 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 46460 STRAPPING TOES 29550 450 292.00 84.15 - 271.75 75.04 261.43 56.89 270.38 47.88 56.33 149.65 56.33 175.20 47.88 60.27 193.27 50.70 56.33 217.40 271.75 55.77 57.46 56.33 233.60 51.54 - 172.28 195.64 49.57 119.43 219.00 110.99 130.61 57.46 3537795T NON PROVIDER 29580 Strapping Unna Boot 29580 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 3542282 29580 Strapping Unna Boot 29580 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 48010425 UNNA BILAT NURSE 29580 510 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 48010165 UNNA BOOT 29580 420 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 48010376 UNNA BOOT BILATERAL 29580 420 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 48010424 UNNABOOT NURSE 29580 510 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 3542283 29581 Profore Dressing Application 29581 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 3541781T NON PROVIDER 29581 Profore Dressing Application 29581 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 48010482 MULTI-LAYER WRAP 29581 420 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 48010480 MULTI-LAYER WRAP BILAT 29581 420 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 48010481 MULTI-LAYER WRAP NURSE 29581 510 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 48010479 MULTI-LAYER WRAP NURSE BILAT 29581 510 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 3542284 29584 Profore-Upper Arm Forearm Hand Fingers 29584 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 3541771T NON PROVIDER 29584 Profore-Upper Arm Forearm Hand Fingers 29584 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 46805 BIVALV/REM GAUNT/BOOT/BDY 29700 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3542077 29700 Bivalv/Rem Gaunt/Boot/Bdy 29700 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 46592 REMV/BIV FULL ARM/LEG CST 29705 450 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 3539638 29710 Rem Bivalve Spica Risser Etc 29710 " 1,266.00 " 364.86 - " 1,177.56 " 325.36 " 1,133.12 " 246.59 " 1,171.92 " 207.53 244.15 648.83 244.15 759.60 207.53 261.24 837.97 219.74 244.15 942.04 " 1,177.56 " 241.71 249.03 244.15 " 1,012.80 " 223.40 - 746.94 848.22 214.85 517.79 949.50 481.21 566.28 249.03 46596 WINDOWING OF CAST 29730 450 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 5928796T 29730 Windowing Cast 29730 741.00 213.56 - 689.33 190.44 663.58 144.41 686.30 121.53 142.98 379.76 142.98 444.60 121.53 152.99 490.47 128.68 142.98 551.46 689.33 141.55 145.84 142.98 592.80 130.83 - 437.19 496.47 125.82 303.07 555.75 281.65 331.45 145.84 3539639 29805 Scope Shldr W/Wo Syn Bx D 29805 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539640 29806 Scope Shldr Surg Capsulorrh 29806 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539641 29807 Scope Shldr Surg Rpr Slap 29807 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539642 29819 Arthroscopy Shoulder Rem Loose Body 29819 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539643 29820 Arthroscopy Shoulder Synov Par 29820 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539644 29821 Arthroscopy Shoulder Synov Com 29821 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539645 29822 Arthroscopy Shoulder Debri Lim 29822 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542285 29823 Arthroscopy Shoulder Debri Ext 29823 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3542286 29824 Scope Shldr Dstl Clav Mum 29824 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539646 29825 Arthroscopy Should W Lys & Res 29825 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3541919 29826 Arthroscopy Shoulder W Par Acromoplasty 29826 " 3,863.00 " " 1,113.32 " - " 3,090.40 " 992.79 - - - - - " 1,979.79 " - " 2,317.80 " - - " 2,556.92 " - - - - - - - " 3,090.40 " - - " 2,279.17 " " 2,588.21 " - " 1,579.97 " " 2,897.25 " " 1,468.33 " " 1,727.92 " - 3542287 29827 Arthroscopy W/Rotator Cuff Repair 29827 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539647 29828 Arthroscopy W/ Tenodesis 29828 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3538232 29830 Arthroscopy Elbow Diagnostic 29830 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538233 29834 Arthroscopy Elbow Rem Loose Body 29834 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539648 29835 Arthroscopy Elbow Synov Part 29835 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539649 29836 Arthroscopy Elbow Synov Comp 29836 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539650 29837 Arthroscopy Elbow Debri Limit 29837 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539651 29838 Arthroscopy Elbow Debrid Exten 29838 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539652 29840 Arthroscopy Wrist Diagnostic 29840 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539653 29844 Arthroscopy Wrist Synovec Part 29844 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539654 29845 Arthroscopy Wrist Synovec Complete 29845 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538238 29846 Arthroscopy Wrist Exc Cart/Debreidment 29846 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539655 29847 Arthroscopy Wrist Int Fixation 29847 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539656 29848 Arthros W/Release/Transverse Carp Lig 29848 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 4453184 29850 Knee Arthro Fx W/o Fixj 29850 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539657 29851 Knee Arthr/W/Int/Ext Fix 29851 " 7,310.00 " " 2,106.74 " - " 6,798.45 " " 1,878.67 " " 6,542.19 " " 1,423.72 " " 6,766.18 " " 1,198.18 " " 1,409.62 " " 3,746.38 " " 1,409.62 " " 4,386.00 " " 1,198.18 " " 1,508.29 " " 4,838.49 " " 1,268.66 " " 1,409.62 " " 5,438.73 " " 6,798.45 " " 1,395.52 " " 1,437.81 " " 1,409.62 " " 5,848.00 " " 1,289.80 " - " 4,312.90 " " 4,897.70 " " 1,240.47 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,437.81 " 3539658 29855 Tibial Arthroscopy/Unicondylar 29855 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 4799298 29856 Arthr Tibial Fx Prox Bicondylar 29856 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539659 29860 Arthro Hip W Or W/O Biopsy 29860 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539660 29861 Arthroscopy Hip Surg Reml Lo/Forn 29861 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539661 29862 Arthro Hip W/Debrid&Shaviving 29862 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539662 29863 Arthroscopy Hip W/Synovec 29863 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539663 29866 Arthrosco Osteonchon Autogrf 29866 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539664 29867 Arthrosco Osteonchon Autogrf 29867 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539665 29868 Arthrosco Meniscal Tsplnt 29868 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537540 29870 Arthroscopy Knee Diagnostic 29870 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537420 29871 Arthroscopy Knee Inf Lav & Drainage 29871 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539666 29873 Arthr Knee Sug W/Lateral Release 29873 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539667 29874 Arthroscopy Knee Rem Loose Body 29874 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537541 29875 Arthroscopy Knee Synovec Limit 29875 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539668 29876 Arthroscopy Knee Synovec Major 29876 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537542 29877 Arthroscopy Knee Debrid Chondr 29877 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3537421 29879 Arthroscopy Knee Abras Arthrop 29879 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538241 29880 Arthro Knee Meniscec Medial & Lateral 29880 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3541920 29881 Arthro Knee Menisec Medial Or Lateral 29881 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538244 29882 Arthry Knee Menisec Repair Med Or Lat 29882 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538245 29883 Arthro Knee Menisec Repair Med & Lat 29883 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539669 29884 Arthroscopy Knee Lysis Adhes 29884 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539670 29885 Arth/Dril/Osteo/Diss W Bne Grft 29885 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537543 29886 Arthroscopy Knee Drill Ost Les 29886 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539671 29887 Arthr Knee Drill Ost Les W Fix 29887 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537544 29888 Arthro Anter Cruc Ligament Rep Recon 29888 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3537545 29889 Arthro Post Cruc Ligamnt Repair Recon 29889 " 64,652.00 " " 18,632.71 " - " 60,129.43 " " 16,615.56 " " 57,917.17 " " 12,603.98 " " 59,900.11 " " 10,607.31 " " 12,479.19 " " 33,134.15 " " 12,479.19 " " 38,791.20 " " 10,607.31 " " 13,352.73 " " 42,793.16 " " 11,231.27 " " 12,479.19 " " 48,103.30 " " 60,129.43 " " 12,354.40 " " 12,728.77 " " 12,479.19 " " 51,721.60 " " 11,418.46 " - " 38,144.68 " " 43,316.84 " " 10,981.69 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,728.77 " 3539672 29891 Arthr Ankle Surg Exc Tibi 29891 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539673 29892 Repr Talar/Tibial Fx W/Scope 29892 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 4403932 29893 Endoscopic Plantar Fasciotomy 29893 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538246 29894 Arthroscopy Ankle Rem Loose Body 29894 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539674 29895 Arthroscopy Ankle Synov Par 29895 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538247 29897 Arthroscopy Ankle Bebrid Limit 29897 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3538254 29898 Arthroscopy Ankle Bebrid Ext 29898 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539675 29899 Arthorscopy Ankle Arthode 29899 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539676 29900 Arthroscopy Metacarpophalangeal Joint Bx 29900 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539677 29906 Scope Subtalar Joint 29906 " 14,860.00 " " 4,282.65 " - " 13,820.05 " " 3,819.02 " " 13,301.76 " " 2,894.74 " " 13,757.18 " " 2,436.17 " " 2,866.08 " " 7,615.75 " " 2,866.08 " " 8,916.00 " " 2,436.17 " " 3,066.71 " " 9,835.83 " " 2,579.47 " " 2,866.08 " " 11,055.99 " " 13,820.05 " " 2,837.42 " " 2,923.40 " " 2,866.08 " " 11,888.00 " " 2,622.46 " - " 8,767.40 " " 9,956.20 " " 2,522.15 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,923.40 " 3539678 29914 Arthroscopy Hip W/Femoroplasty 29914 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539679 29915 Arthroscopy Hip Surgical; W/Acetabulopla 29915 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 3539680 29916 Arthroscopy Hip W/Labral Repair 29916 " 32,891.00 " " 9,479.19 " - " 30,589.97 " " 8,452.99 " " 29,420.35 " " 6,402.48 " " 30,427.63 " " 5,388.23 " " 6,339.09 " " 16,856.64 " " 6,339.09 " " 19,734.60 " " 5,388.23 " " 6,782.83 " " 21,770.55 " " 5,705.18 " " 6,339.09 " " 24,471.85 " " 30,589.97 " " 6,275.70 " " 6,465.87 " " 6,339.09 " " 26,312.80 " " 5,800.27 " - " 19,405.69 " " 22,036.97 " " 5,578.40 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,465.87 " 6342752T 29999 Arthroscopic Capslr Plication; Hip 29999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 5978801T 29999 Unl Arthro Lig ReconKneeEx-Articul 29999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 5191137 29999 Unl Arthro Thermal Capsulorrhaphy 29999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 6356853T 29999 Unl Arthroscopy Calcium Phosph Inj 29999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 5390679T 29999 Unl Arthroscopy Sup Capsular Recon 29999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4457862 29999 arthroscopic Iliopsoas release 29999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4457861 29999 arthroscopic lat meniscus w/trephanation eva 29999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 4457797 29999 endoscopic rt knee prepatellar bursectomy 29999 " 1,082.00 " 311.83 - " 1,006.77 " 278.07 968.09 210.68 " 1,001.23 " 177.30 208.59 554.53 208.59 649.20 177.30 223.19 716.18 187.73 208.59 805.41 " 1,006.77 " 206.50 212.76 208.59 865.60 190.86 - 638.38 724.94 183.56 442.54 811.50 411.27 483.98 212.76 3539681 30000 Drain Abscess Hematoma Intrana 30000 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 3539682 30020 Drain Abscess Or Hematoma Nasal Septum 30020 " 2,375.00 " 684.48 - " 2,208.75 " 610.38 " 2,124.32 " 462.30 " 2,197.06 " 389.06 457.72 " 1,217.19 " 457.72 " 1,425.00 " 389.06 489.76 " 1,572.01 " 411.95 457.72 " 1,766.99 " " 2,208.75 " 453.14 466.87 457.72 " 1,900.00 " 418.81 - " 1,401.25 " " 1,591.25 " 402.79 971.38 " 1,781.25 " 902.74 " 1,062.34 " 466.87 3541921 30100 Biopsy Soft Tissue Nose 30100 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3541922 30110 Exc Nasal Polyps Simple 30110 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3537422 30115 Exc Nasal Polyps Extended 30115 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3539683 30117 Exc/Dest Intranas Les Internal Appr 30117 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3539684 30118 Exc Intranasal Les Ext Appr 30118 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3542288 30120 Excision Planing Skin 30120 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3539685 30124 Exc Dermoid Cyst Nose Simple 30124 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3539686 30125 Exc Dermoid Cyst Nose Complex 30125 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538263 30130 Exc Turbinate Part Complete 30130 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3539687 30140 Sub Resect Turbinate Part/Comp 30140 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3539688 30150 Rhinectomy Partial 30150 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539689 30160 Rhinectomy Total 30160 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539690 30220 Ins Nasal Septal Prost (Button 30220 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 46599 REM FB INTRANASAL 30300 450 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3539465 30300 Removal Foreign Body Intranasl 30300 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3539691 30310 Rem Forgn Body Intranasal W Anes 30310 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3539692 30320 Removal Foreign Body Rhinotomy 30320 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3542289 30400 Rhinoplasty Primary 30400 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539693 30410 Rhinoplasty Complete 30410 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3537546 30420 Rhinoplasty Comp/ Septial Repair 30420 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3542290 30430 Rhinoplasty 2D Minor Rev 30430 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3542291 30435 Rhinoplasty Intermed Revision 30435 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539694 30450 Rhinoplasty Major Revision 30450 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539695 30460 Rhino/Nas Deform Secndary To Cleft Lp 30460 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539696 30462 Rino/Nsl Defrm Clf Lp; Tip Septum 30462 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3542292 30465 Repr Nasal Vestibular Stenosis 30465 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 5290595T 30468 Repair Nasal Valve Collapse W/Impl 30468 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3537547 30520 Septoplasty W/Wo Cart Impl 30520 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3539697 30540 Repair Choanal Atresia Intrana 30540 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3542293 30560 Lysis Intranasal Synechia 30560 " 2,375.00 " 684.48 - " 2,208.75 " 610.38 " 2,124.32 " 462.30 " 2,197.06 " 389.06 457.72 " 1,217.19 " 457.72 " 1,425.00 " 389.06 489.76 " 1,572.01 " 411.95 457.72 " 1,766.99 " " 2,208.75 " 453.14 466.87 457.72 " 1,900.00 " 418.81 - " 1,401.25 " " 1,591.25 " 402.79 971.38 " 1,781.25 " 902.74 " 1,062.34 " 466.87 3539698 30580 Repair Oromaxillary Fistula 30580 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539699 30600 Repair Oronasal Fistula 30600 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3542294 30620 Septal Dermatoplasty 30620 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539700 30630 Rep Nasal Septal Perforations 30630 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3541923 30801 Cauterize Turbin Uni/Bil Super 30801 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3542295 30802 Cauterize Turbinate Intramural 30802 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 46600 CAUT ANT NOSEBLEED SIMP 30901 450 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3538010 30901 Control Nasal Hemor Ant Simple 30901 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 46601 CAUT POST NOSEBLEED COMP 30903 450 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3538011 30903 Control Nasal Hemor Ant Complex 30903 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 46602 CAUT NOSEBLEED POST;INIT 30905 450 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 3541924 30905 Nasal Hemor Post Pack Ini 30905 588.00 169.46 - 547.78 151.12 529.64 115.26 547.78 97.00 114.12 301.35 114.12 352.80 97.00 122.11 389.20 102.71 114.12 437.30 546.63 112.98 116.40 114.12 470.40 104.42 - 346.92 393.96 100.43 240.49 441.00 223.50 263.01 116.40 46603 CAUT POST NOSEBLEED;SUBS 30906 450 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 3537548 30906 Nasal Hemor Posterior Pack Sub 30906 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 3539701 30920 Ligation Int Max Art Trans 30920 " 15,024.00 " " 4,329.92 " - " 13,972.65 " " 3,861.17 " " 13,445.92 " " 2,926.11 " " 13,906.27 " " 2,462.57 " " 2,897.14 " " 7,699.80 " " 2,897.14 " " 9,014.40 " " 2,462.57 " " 3,099.94 " " 9,944.39 " " 2,607.43 " " 2,897.14 " " 11,178.06 " " 13,972.65 " " 2,868.17 " " 2,955.08 " " 2,897.14 " " 12,019.20 " " 2,650.88 " - " 8,864.16 " " 10,066.08 " " 2,549.48 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,955.08 " 3542296 30930 Frac Nasal Turbinates Therap 30930 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 4509153 30999 Middle Turbinectomy 30999 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 4629298 30999 Unl Latera Nasal Implant 30999 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 4629299 30999 Unl Middle Turbinate Excsn 30999 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 4829360 30999 Unl Open Concha Bullosa 30999 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 4543167 30999 Unlisted Nasoseptal Flap 30999 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 3542297 31000 Antrum Punc Maxillar Sinus 31000 " 1,111.00 " 320.19 - " 1,033.19 " 285.53 993.71 216.25 " 1,027.73 " 181.99 214.11 569.39 214.11 666.60 181.99 229.10 735.37 192.70 214.11 826.55 " 1,033.19 " 211.97 218.39 214.11 888.80 195.91 - 655.49 744.37 188.42 454.40 833.25 422.29 496.95 218.39 3542298 31002 Lavage By Cannulation Sphenoid Sinus 31002 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3537549 31020 Sinusot Antrotomy Intranasal 31020 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3539703 31030 Sinusotomy Caldwell-Luc 31030 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539704 31032 Sinusot Rad W Rem Ant Poly 31032 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539705 31040 Sur Pterygomax Fossa Con Tran 31040 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 5178168 31050 Sinusotomy Sphenoid W/WO Bx 31050 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3538264 31051 Sinusotomy Sphenoid W Muscosal Strip 31051 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539706 31070 Sinusotomy Frontal External 31070 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539707 31075 Sinusotomy Frontal Transorb Un 31075 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539708 31080 Sinus Fr Oblit Wo Ost Fl Brow 31080 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539709 31081 Sinus Fr Oblit Wo Ost Fl Coron 31081 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 4433155 31084 Sinusot Fr Oblit W Ost Fl Brow Inc 31084 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539710 31085 Sinus Fr Oblit W Oste Fl Coron 31085 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539711 31086 Sinus Fr Nonoblit W Ost Fl Bro 31086 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539712 31087 Sinus Fr Nonoblit W Ost Fl Cor 31087 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3537423 31090 Sinusotomy Comb 3/More Sinsus 31090 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3542299 31200 Ethmoidectomy Intranasal Anter 31200 " 26,702.00 " " 7,695.52 " - " 24,833.73 " " 6,862.41 " " 23,888.72 " " 5,198.68 " " 24,706.61 " " 4,375.13 " " 5,147.21 " " 13,684.78 " " 5,147.21 " " 16,021.20 " " 4,375.13 " " 5,507.51 " " 17,674.05 " " 4,632.49 " " 5,147.21 " " 19,866.88 " " 24,833.73 " " 5,095.74 " " 5,250.15 " " 5,147.21 " " 21,361.60 " " 4,709.70 " - " 15,754.18 " " 17,890.34 " " 4,529.54 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,250.15 " 3539713 31201 Ethmoidectomy Total Intranasal 31201 " 7,102.00 " " 2,046.80 " - " 6,605.29 " " 1,825.21 " " 6,353.76 " " 1,382.71 " " 6,571.30 " " 1,163.67 " " 1,369.02 " " 3,639.78 " " 1,369.02 " " 4,261.20 " " 1,163.67 " " 1,464.85 " " 4,700.81 " " 1,232.12 " " 1,369.02 " " 5,284.20 " " 6,605.29 " " 1,355.33 " " 1,396.40 " " 1,369.02 " " 5,681.60 " " 1,252.65 " - " 4,190.18 " " 4,758.34 " " 1,204.74 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,396.40 " 3539714 31205 Ethmoidectomy Extranasal Total 31205 " 14,366.00 " " 4,140.28 " - " 13,360.98 " " 3,692.06 " " 12,849.67 " " 2,796.36 " " 13,289.62 " " 2,353.37 " " 2,768.67 " " 7,362.58 " " 2,768.67 " " 8,619.60 " " 2,353.37 " " 2,962.48 " " 9,508.86 " " 2,491.80 " " 2,768.67 " " 10,688.73 " " 13,360.98 " " 2,740.98 " " 2,824.04 " " 2,768.67 " " 11,492.80 " " 2,533.33 " - " 8,475.94 " " 9,625.22 " " 2,436.43 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,824.04 " 3537424 31225 Maxillectomy Wo Orbital Exent 31225 " 3,863.00 " " 1,113.32 " 992.79 " 3,090.40 " 992.79 N/A N/A N/A N/A N/A " 1,979.79 " N/A " 2,317.80 " N/A N/A " 2,556.92 " N/A N/A N/A N/A N/A N/A N/A " 3,090.40 " N/A N/A " 2,279.17 " " 2,588.21 " N/A " 1,579.97 " " 2,897.25 " " 1,468.33 " " 1,727.92 " N/A 3539715 31230 Maxillectomy W Orbital Exenter 31230 " 2,147.00 " 618.77 551.78 " 1,717.60 " 551.78 N/A N/A N/A N/A N/A " 1,100.34 " N/A " 1,288.20 " N/A N/A " 1,421.10 " N/A N/A N/A N/A N/A N/A N/A " 1,717.60 " N/A N/A " 1,266.73 " " 1,438.49 " N/A 878.12 " 1,610.25 " 816.07 960.35 N/A 327959 31231 Nasal Endoscopy Diag 31231 761 863.00 248.72 - 802.69 221.79 773.21 168.27 799.68 141.61 166.60 442.29 166.60 517.80 141.61 178.26 571.22 149.94 166.60 642.15 802.69 164.93 169.93 166.60 690.40 152.44 - 509.17 578.21 146.61 352.97 647.25 328.03 386.02 169.93 3539491 31231 nasal endoscopy dx; uni or bil 31231 863.00 248.72 - 802.69 221.79 773.21 168.27 799.68 141.61 166.60 442.29 166.60 517.80 141.61 178.26 571.22 149.94 166.60 642.15 802.69 164.93 169.93 166.60 690.40 152.44 - 509.17 578.21 146.61 352.97 647.25 328.03 386.02 169.93 3539716 31233 Nasal/Sinus Endoscopy 31233 " 1,977.00 " 569.77 - " 1,838.37 " 508.09 " 1,765.47 " 384.20 " 1,825.92 " 323.34 380.40 " 1,013.21 " 380.40 " 1,186.20 " 323.34 407.03 " 1,308.58 " 342.36 380.40 " 1,470.69 " " 1,838.37 " 376.60 388.01 380.40 " 1,581.60 " 348.07 - " 1,166.