Service Type CPT / DRG Desc DRG CPT/HCPCS 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 Preferred Healthcare Lanc Prime Source Tower Health UHC Comm UHC MA UHC MA CHIP UPMC Comm UPMC MA UPMC MA CHIP Vibra Medicare Wellspan Outpatient Fna bx w/us gdn 1st les 10005 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Fna bx w/ct gdn 1st les 10009 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Guide cathet fluid drainage 10030 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Perq dev soft tiss 1st imag 10035 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Acne surgery 10040 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Drainage of skin abscess 10060 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Drainage of skin abscess 10061 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Drainage of pilonidal cyst 10080 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Drainage of pilonidal cyst 10081 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Remove foreign body 10120 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Remove foreign body 10121 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Drainage of hematoma/fluid 10140 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Puncture drainage of lesion 10160 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Deb skin bone at fx site 11012 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Deb subq tissue 20 sq cm/< 11042 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Deb musc/fascia 20 sq cm/< 11043 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Deb bone 20 sq cm/< 11044 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Trim skin lesion 11055 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Trim skin lesions 2 to 4 11056 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Trim skin lesions over 4 11057 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Tangntl bx skin single les 11102 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Punch bx skin single lesion 11104 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Incal bx skn single les 11106 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Removal of skin tags <w/15 11200 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Shave skin lesion 0.5 cm/< 11300 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Shave skin lesion 0.6-1.0 cm 11301 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Shave skin lesion 1.1-2.0 cm 11302 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Shave skin lesion 0.5 cm/< 11305 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Shave skin lesion 0.6-1.0 cm 11306 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Shave skin lesion 0.5 cm/< 11310 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Shave skin lesion 0.6-1.0 cm 11311 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Exc tr-ext b9+marg 0.5 cm< 11400 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc tr-ext b9+marg 0.6-1 cm 11401 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Exc tr-ext b9+marg 1.1-2 cm 11402 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc tr-ext b9+marg 2.1-3cm 11403 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc tr-ext b9+marg 3.1-4 cm 11404 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc tr-ext b9+marg >4.0 cm 11406 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc h-f-nk-sp b9+marg 0.5/< 11420 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc h-f-nk-sp b9+marg 0.6-1 11421 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc h-f-nk-sp b9+marg 1.1-2 11422 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc h-f-nk-sp b9+marg 2.1-3 11423 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc h-f-nk-sp b9+marg 3.1-4 11424 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc h-f-nk-sp b9+marg >4 cm 11426 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Exc face-mm b9+marg 0.5 cm/< 11440 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc face-mm b9+marg 0.6-1 cm 11441 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc face-mm b9+marg 1.1-2 cm 11442 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc face-mm b9+marg 2.1-3 cm 11443 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc face-mm b9+marg 3.1-4 cm 11444 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc face-mm b9+marg >4 cm 11446 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Removal sweat gland lesion 11450 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Removal sweat gland lesion 11462 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Exc tr-ext mal+marg 0.6-1 cm 11601 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc tr-ext mal+marg 1.1-2 cm 11602 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Exc tr-ext mal+marg 2.1-3 cm 11603 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc tr-ext mal+marg 3.1-4 cm 11604 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc tr-ext mal+marg >4 cm 11606 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc s/n/h/f/g mal+mrg 1.1-2 11622 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc s/n/h/f/g mal+mrg 2.1-3 11623 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc s/n/h/f/g mal+mrg 3.1-4 11624 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc s/n/h/f/g mal+mrg >4 cm 11626 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Exc f/e/e/n/l mal+mrg 0.5cm< 11640 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc f/e/e/n/l mal+mrg 0.6-1 11641 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc f/e/e/n/l mal+mrg 1.1-2 11642 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Exc f/e/e/n/l mal+mrg 2.1-3 11643 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc f/e/e/n/l mal+mrg 3.1-4 11644 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc f/e/e/n/l mal+mrg >4 cm 11646 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Trim nail(s) any number 11719 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Debride nail 1-5 11720 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Debride nail 6 or more 11721 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Removal of nail plate 11730 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Drain blood from under nail 11740 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Removal of nail bed 11750 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Biopsy nail unit 11755 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Repair of nail bed 11760 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Remove pilonidal cyst exten 11771 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Remove pilonidal cyst compl 11772 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Inject skin lesions </w 7 11900 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Inject skin lesions >7 11901 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Correct skn color 6.1-20.0cm 11921 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Tx contour defects 1 cc/< 11950 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Tx contour defects 1.1-5.0cc 11951 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Rplcmt tiss xpndr perm implt 11970 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Rmvl tis xpndr wo insj implt 11971 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Insertion drug dlvr implant 11981 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Remove drug implant device 11982 " 1,419.00 " 524.46 234.79 " 1,167.95 " 364.68 936.40 281.74 966.91 234.79 276.22 970.31 255.42 949.59 234.79 295.56 " 1,021.82 " 248.60 276.22 934.35 " 1,167.95 " 273.46 281.74 276.22 " 1,135.20 " 252.74 " 1,064.25 " " 1,064.25 " " 1,121.01 " " 1,092.63 " 243.07 580.37 " 1,064.25 " 539.36 634.72 281.74 " 1,121.01 " Outpatient Remove/insert drug implant 11983 " 1,419.00 " 524.46 234.79 " 1,167.95 " 364.68 936.40 281.74 966.91 234.79 276.22 970.31 255.42 949.59 234.79 295.56 " 1,021.82 " 248.60 276.22 934.35 " 1,167.95 " 273.46 281.74 276.22 " 1,135.20 " 252.74 " 1,064.25 " " 1,064.25 " " 1,121.01 " " 1,092.63 " 243.07 580.37 " 1,064.25 " 539.36 634.72 281.74 " 1,121.01 " Outpatient Rpr s/n/ax/gen/trnk 2.5cm/< 12001 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Rpr s/n/ax/gen/trnk2.6-7.5cm 12002 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Rpr s/n/ax/gen/trk7.6-12.5cm 12004 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Rpr f/e/e/n/l/m 2.5 cm/< 12011 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Rpr f/e/e/n/l/m 2.6-5.0 cm 12013 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Intmd rpr s/a/t/ext 2.5 cm/< 12031 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Intmd rpr s/a/t/ext 2.6-7.5 12032 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Intmd rpr s/tr/ext 7.6-12.5 12034 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Intmd rpr s/a/t/ext 12.6-20 12035 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Intmd rpr n-hf/genit 2.5cm/< 12041 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Intmd rpr n-hf/genit2.6-7.5 12042 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Intmd rpr n-hf/genit7.6-12.5 12044 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Intmd rpr face/mm 2.5 cm/< 12051 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Intmd rpr face/mm 2.6-5.0 cm 12052 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Intmd rpr face/mm 5.1-7.5 cm 12053 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Intmd rpr face/mm 7.6-12.5cm 12054 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Cmplx rpr trunk 2.6-7.5 cm 13101 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Cmplx rpr s/a/l 1.1-2.5 cm 13120 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Cmplx rpr s/a/l 2.6-7.5 cm 13121 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Cmplx rpr f/c/c/m/n/ax/g/h/f 13131 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Cmplx rpr f/c/c/m/n/ax/g/h/f 13132 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Cmplx rpr e/n/e/l 1.1-2.5 cm 13151 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Cmplx rpr e/n/e/l 2.6-7.5 cm 13152 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Late closure of wound 13160 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Tis trnfr s/a/l 10 sq cm/< 14020 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Tis trnfr s/a/l 10.1-30 sqcm 14021 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Tis trnfr f/c/c/m/n/a/g/h/f 14040 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Tis trnfr f/c/c/m/n/a/g/h/f 14041 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Tis trnfr e/n/e/l 10 sq cm/< 14060 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Tis trnfr e/n/e/l10.1-30sqcm 14061 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Tis trnfr any 30.1-60 sq cm 14301 " 18,491.00 " " 6,834.27 " " 3,046.15 " " 15,223.78 " " 4,752.19 " " 12,202.21 " " 3,655.38 " " 12,599.77 " " 3,046.15 " " 3,583.71 " " 12,644.15 " " 3,328.38 " " 12,374.18 " " 3,046.15 " " 3,834.57 " " 13,315.37 " " 3,225.34 " " 3,583.71 " " 12,178.82 " " 15,223.78 " " 3,547.87 " " 3,655.38 " " 3,583.71 " " 14,792.80 " " 3,279.09 " " 13,868.25 " " 13,868.25 " " 14,607.89 " " 14,238.07 " " 3,153.66 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,655.38 " " 14,607.89 " Outpatient Wound prep f/n/hf/g 15004 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Skin splt grft trnk/arm/leg 15100 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Skn splt a-grft fac/nck/hf/g 15120 " 18,491.00 " " 6,834.27 " " 3,046.15 " " 15,223.78 " " 4,752.19 " " 12,202.21 " " 3,655.38 " " 12,599.77 " " 3,046.15 " " 3,583.71 " " 12,644.15 " " 3,328.38 " " 12,374.18 " " 3,046.15 " " 3,834.57 " " 13,315.37 " " 3,225.34 " " 3,583.71 " " 12,178.82 " " 15,223.78 " " 3,547.87 " " 3,655.38 " " 3,583.71 " " 14,792.80 " " 3,279.09 " " 13,868.25 " " 13,868.25 " " 14,607.89 " " 14,238.07 " " 3,153.66 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,655.38 " " 14,607.89 " Outpatient Skin full graft sclp/arm/leg 15220 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Skin full grft face/genit/hf 15240 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Skin full graft een & lips 15260 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Skin sub graft trnk/arm/leg 15271 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Skin sub graft face/nk/hf/g 15275 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Pedicle e/n/e/l/ntroral 15576 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Delay flap f/c/c/n/ax/g/h/f 15620 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Delay flap eye/nos/ear/lip 15630 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Forehead flap w/vasc pedicle 15731 " 18,491.00 " " 6,834.27 " " 3,046.15 " " 15,223.78 " " 4,752.19 " " 12,202.21 " " 3,655.38 " " 12,599.77 " " 3,046.15 " " 3,583.71 " " 12,644.15 " " 3,328.38 " " 12,374.18 " " 3,046.15 " " 3,834.57 " " 13,315.37 " " 3,225.34 " " 3,583.71 " " 12,178.82 " " 15,223.78 " " 3,547.87 " " 3,655.38 " " 3,583.71 " " 14,792.80 " " 3,279.09 " " 13,868.25 " " 13,868.25 " " 14,607.89 " " 14,238.07 " " 3,153.66 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,655.38 " " 14,607.89 " Outpatient Muscle-skin graft trunk 15734 " 18,491.00 " " 6,834.27 " " 3,046.15 " " 15,223.78 " " 4,752.19 " " 12,202.21 " " 3,655.38 " " 12,599.77 " " 3,046.15 " " 3,583.71 " " 12,644.15 " " 3,328.38 " " 12,374.18 " " 3,046.15 " " 3,834.57 " " 13,315.37 " " 3,225.34 " " 3,583.71 " " 12,178.82 " " 15,223.78 " " 3,547.87 " " 3,655.38 " " 3,583.71 " " 14,792.80 " " 3,279.09 " " 13,868.25 " " 13,868.25 " " 14,607.89 " " 14,238.07 " " 3,153.66 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,655.38 " " 14,607.89 " Outpatient Grfg autol soft tiss dir exc 15769 " 18,491.00 " " 6,834.27 " " 3,046.15 " " 15,223.78 " " 4,752.19 " " 12,202.21 " " 3,655.38 " " 12,599.77 " " 3,046.15 " " 3,583.71 " " 12,644.15 " " 3,328.38 " " 12,374.18 " " 3,046.15 " " 3,834.57 " " 13,315.37 " " 3,225.34 " " 3,583.71 " " 12,178.82 " " 15,223.78 " " 3,547.87 " " 3,655.38 " " 3,583.71 " " 14,792.80 " " 3,279.09 " " 13,868.25 " " 13,868.25 " " 14,607.89 " " 14,238.07 " " 3,153.66 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,655.38 " " 14,607.89 " Outpatient Grfg autol fat lipo 50 cc/< 15771 " 18,491.00 " " 6,834.27 " " 3,046.15 " " 15,223.78 " " 4,752.19 " " 12,202.21 " " 3,655.38 " " 12,599.77 " " 3,046.15 " " 3,583.71 " " 12,644.15 " " 3,328.38 " " 12,374.18 " " 3,046.15 " " 3,834.57 " " 13,315.37 " " 3,225.34 " " 3,583.71 " " 12,178.82 " " 15,223.78 " " 3,547.87 " " 3,655.38 " " 3,583.71 " " 14,792.80 " " 3,279.09 " " 13,868.25 " " 13,868.25 " " 14,607.89 " " 14,238.07 " " 3,153.66 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,655.38 " " 14,607.89 " Outpatient Grfg autol fat lipo 25 cc/< 15773 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Chemical peel nonfacial 15793 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Revision of upper eyelid 15823 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Exc skin abd 15830 " 29,053.00 " " 10,737.99 " " 4,787.57 " " 23,919.31 " " 7,466.62 " " 19,172.07 " " 5,745.08 " " 19,796.71 " " 4,787.57 " " 5,632.43 " " 19,866.44 " " 5,229.54 " " 19,442.27 " " 4,787.57 " " 6,026.70 " " 20,921.07 " " 5,069.19 " " 5,632.43 " " 19,135.13 " " 23,919.31 " " 5,576.11 " " 5,745.08 " " 5,632.43 " " 23,242.40 " " 5,153.67 " " 21,789.75 " " 21,789.75 " " 22,951.87 " " 22,370.81 " " 4,956.54 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,745.08 " " 22,951.87 " Outpatient Remove sutures same surgeon 15850 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Dressing change not for burn 15852 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Initial treatment of burn(s) 16000 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Dress/debrid p-thick burn s 16020 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Destruct premalg lesion 17000 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Destroy premal lesions 15/> 17004 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Destruction of skin lesions 17106 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Destruction of skin lesions 17107 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Destruction of skin lesions 17108 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Destruct b9 lesion 1-14 17110 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Destruct lesion 15 or more 17111 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Chem caut of granltj tissue 17250 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Destruction of skin lesions 17260 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Destruction of skin lesions 17261 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Destruction of skin lesions 17262 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Destruction of skin lesions 17263 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Destruction of skin lesions 17271 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Destruction of skin lesions 17272 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Destruction of skin lesions 17282 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Mohs 1 stage h/n/hf/g 17311 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Mohs 1 stage t/a/l 17313 " 2,752.00 " " 1,017.14 " 453.08 " 2,265.63 " 707.26 " 1,816.04 " 543.69 " 1,875.21 " 453.08 533.03 " 1,881.82 " 495.36 " 1,841.64 " 453.08 570.34 " 1,981.72 " 479.73 533.03 " 1,812.48 " " 2,265.63 " 527.70 543.69 533.03 " 2,201.60 " 487.72 " 2,064.00 " " 2,064.00 " " 2,174.08 " " 2,119.04 " 469.07 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 543.69 " 2,174.08 " Outpatient Skin tissue procedure 17999 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Drainage of breast lesion 19000 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Bx breast 1st lesion strtctc 19081 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Bx breast 1st lesion us imag 19083 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Bx breast 1st lesion mr imag 19085 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Removal of breast lesion 19120 " 16,578.00 " " 6,127.23 " " 2,731.71 " " 13,648.71 " " 4,260.55 " " 10,939.82 " " 3,278.06 " " 11,296.25 " " 2,731.71 " " 3,213.78 " " 11,336.04 " " 2,984.04 " " 11,094.00 " " 2,731.71 " " 3,438.74 " " 11,937.82 " " 2,892.40 " " 3,213.78 " " 10,918.78 " " 13,648.71 " " 3,181.64 " " 3,278.06 " " 3,213.78 " " 13,262.40 " " 2,940.61 " " 12,433.50 " " 12,433.50 " " 13,096.62 " " 12,765.06 " " 2,828.13 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,278.06 " " 13,096.62 " Outpatient Excision breast lesion 19125 " 16,578.00 " " 6,127.23 " " 2,731.71 " " 13,648.71 " " 4,260.55 " " 10,939.82 " " 3,278.06 " " 11,296.25 " " 2,731.71 " " 3,213.78 " " 11,336.04 " " 2,984.04 " " 11,094.00 " " 2,731.71 " " 3,438.74 " " 11,937.82 " " 2,892.40 " " 3,213.78 " " 10,918.78 " " 13,648.71 " " 3,181.64 " " 3,278.06 " " 3,213.78 " " 13,262.40 " " 2,940.61 " " 12,433.50 " " 12,433.50 " " 13,096.62 " " 12,765.06 " " 2,828.13 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,278.06 " " 13,096.62 " Outpatient Perq device breast 1st imag 19281 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Perq dev breast 1st us imag 19285 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Partial mastectomy 19301 " 16,578.00 " " 6,127.23 " " 2,731.71 " " 13,648.71 " " 4,260.55 " " 10,939.82 " " 3,278.06 " " 11,296.25 " " 2,731.71 " " 3,213.78 " " 11,336.04 " " 2,984.04 " " 11,094.00 " " 2,731.71 " " 3,438.74 " " 11,937.82 " " 2,892.40 " " 3,213.78 " " 10,918.78 " " 13,648.71 " " 3,181.64 " " 3,278.06 " " 3,213.78 " " 13,262.40 " " 2,940.61 " " 12,433.50 " " 12,433.50 " " 13,096.62 " " 12,765.06 " " 2,828.13 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,278.06 " " 13,096.62 " Outpatient Mast simple complete 19303 " 29,053.00 " " 10,737.99 " " 4,787.57 " " 23,919.31 " " 7,466.62 " " 19,172.07 " " 5,745.08 " " 19,796.71 " " 4,787.57 " " 5,632.43 " " 19,866.44 " " 5,229.54 " " 19,442.27 " " 4,787.57 " " 6,026.70 " " 20,921.07 " " 5,069.19 " " 5,632.43 " " 19,135.13 " " 23,919.31 " " 5,576.11 " " 5,745.08 " " 5,632.43 " " 23,242.40 " " 5,153.67 " " 21,789.75 " " 21,789.75 " " 22,951.87 " " 22,370.81 " " 4,956.54 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,745.08 " " 22,951.87 " Outpatient Suspension of breast 19316 " 29,053.00 " " 10,737.99 " " 4,787.57 " " 23,919.31 " " 7,466.62 " " 19,172.07 " " 5,745.08 " " 19,796.71 " " 4,787.57 " " 5,632.43 " " 19,866.44 " " 5,229.54 " " 19,442.27 " " 4,787.57 " " 6,026.70 " " 20,921.07 " " 5,069.19 " " 5,632.43 " " 19,135.13 " " 23,919.31 " " 5,576.11 " " 5,745.08 " " 5,632.43 " " 23,242.40 " " 5,153.67 " " 21,789.75 " " 21,789.75 " " 22,951.87 " " 22,370.81 " " 4,956.54 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,745.08 " " 22,951.87 " Outpatient Breast reduction 19318 " 29,053.00 " " 10,737.99 " " 4,787.57 " " 23,919.31 " " 7,466.62 " " 19,172.07 " " 5,745.08 " " 19,796.71 " " 4,787.57 " " 5,632.43 " " 19,866.44 " " 5,229.54 " " 19,442.27 " " 4,787.57 " " 6,026.70 " " 20,921.07 " " 5,069.19 " " 5,632.43 " " 19,135.13 " " 23,919.31 " " 5,576.11 " " 5,745.08 " " 5,632.43 " " 23,242.40 " " 5,153.67 " " 21,789.75 " " 21,789.75 " " 22,951.87 " " 22,370.81 " " 4,956.54 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,745.08 " " 22,951.87 " Outpatient Insj breast implt sm d mast 19340 " 29,053.00 " " 10,737.99 " " 4,787.57 " " 23,919.31 " " 7,466.62 " " 19,172.07 " " 5,745.08 " " 19,796.71 " " 4,787.57 " " 5,632.43 " " 19,866.44 " " 5,229.54 " " 19,442.27 " " 4,787.57 " " 6,026.70 " " 20,921.07 " " 5,069.19 " " 5,632.43 " " 19,135.13 " " 23,919.31 " " 5,576.11 " " 5,745.08 " " 5,632.43 " " 23,242.40 " " 5,153.67 " " 21,789.75 " " 21,789.75 " " 22,951.87 " " 22,370.81 " " 4,956.54 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,745.08 " " 22,951.87 " Outpatient Insj/rplcmt brst implt sep d 19342 " 46,830.00 " " 17,308.37 " " 7,713.51 " " 38,555.04 " " 12,035.31 " " 30,903.12 " " 9,256.21 " " 31,909.96 " " 7,713.51 " " 9,074.72 " " 32,022.35 " " 8,429.40 " " 31,338.64 " " 7,713.51 " " 9,709.95 " " 33,722.28 " " 8,167.25 " " 9,074.72 " " 30,843.50 " " 38,555.04 " " 8,983.97 " " 9,256.21 " " 9,074.72 " " 37,464.00 " " 8,303.37 " " 35,122.50 " " 35,122.50 " " 36,995.70 " " 36,059.10 " " 7,985.75 " " 19,153.47 " " 35,122.50 " " 17,800.08 " " 20,947.06 " " 9,256.21 " " 36,995.70 " Outpatient Breast reconstruction 19350 " 16,578.00 " " 6,127.23 " " 2,731.71 " " 13,648.71 " " 4,260.55 " " 10,939.82 " " 3,278.06 " " 11,296.25 " " 2,731.71 " " 3,213.78 " " 11,336.04 " " 2,984.04 " " 11,094.00 " " 2,731.71 " " 3,438.74 " " 11,937.82 " " 2,892.40 " " 3,213.78 " " 10,918.78 " " 13,648.71 " " 3,181.64 " " 3,278.06 " " 3,213.78 " " 13,262.40 " " 2,940.61 " " 12,433.50 " " 12,433.50 " " 13,096.62 " " 12,765.06 " " 2,828.13 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,278.06 " " 13,096.62 " Outpatient Tiss xpndr plmt brst rcnstj 19357 " 78,376.00 " " 28,967.77 " " 12,906.99 " " 64,526.25 " " 20,142.63 " " 51,720.32 " " 15,488.38 " " 53,405.41 " " 12,906.99 " " 15,184.69 " " 53,593.51 " " 14,107.68 " " 52,449.22 " " 12,906.99 " " 16,247.62 " " 56,438.56 " " 13,666.22 " " 15,184.69 " " 51,620.12 " " 64,526.25 " " 15,032.84 " " 15,488.38 " " 15,184.69 " " 62,700.80 " " 13,893.99 " " 58,782.00 " " 58,782.00 " " 61,917.04 " " 60,349.52 " " 13,362.53 " " 32,055.78 " " 58,782.00 " " 29,790.72 " " 35,057.58 " " 15,488.38 " " 61,917.04 " Outpatient Revj reconstructed breast 19380 " 29,053.00 " " 10,737.99 " " 4,787.57 " " 23,919.31 " " 7,466.62 " " 19,172.07 " " 5,745.08 " " 19,796.71 " " 4,787.57 " " 5,632.43 " " 19,866.44 " " 5,229.54 " " 19,442.27 " " 4,787.57 " " 6,026.70 " " 20,921.07 " " 5,069.19 " " 5,632.43 " " 19,135.13 " " 23,919.31 " " 5,576.11 " " 5,745.08 " " 5,632.43 " " 23,242.40 " " 5,153.67 " " 21,789.75 " " 21,789.75 " " 22,951.87 " " 22,370.81 " " 4,956.54 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,745.08 " " 22,951.87 " Outpatient Explore wound extremity 20103 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Deep muscle biopsy 20205 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Needle biopsy muscle 20206 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Bone biopsy trocar/needle 20220 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Bone biopsy trocar/needle 20225 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Ther injection carp tunnel 20526 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Inj tendon sheath/ligament 20550 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Inj tendon origin/insertion 20551 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Inj trigger point 1/2 muscl 20552 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Inject trigger points 3/> 20553 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Drain/inj joint/bursa w/o us 20600 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Drain/inj joint/bursa w/us 20604 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Drain/inj joint/bursa w/o us 20605 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Drain/inj joint/bursa w/us 20606 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Drain/inj joint/bursa w/o us 20610 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Drain/inj joint/bursa w/us 20611 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Aspirate/inj ganglion cyst 20612 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Removal of support implant 20670 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Removal of support implant 20680 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Apply bone fixation device 20690 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Remove bone fixation device 20694 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Removal of bone for graft 20902 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Musculoskeletal surgery 20999 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Exc face les sc <2 cm 21011 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Ear cartilage graft 21235 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Clsd tx nsl fx w/mnpj&stablj 21320 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Opn tx complx malar fx 21365 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Opn tx orbit periorbtl implt 21390 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Treat lower jaw fracture 21470 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Exc neck les sc < 3 cm 21555 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc back les sc < 3 cm 21930 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Exc back les sc 3 cm/> 21931 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Perq vertebral augmentation 22513 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Perq vertebral augmentation 22514 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Arthrd ant ntrbdy cervical 22551 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Arthrd pst tq 1ntrspc lumbar 22612 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Arthrd cmbn 1ntrspc lumbar 22633 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Tot disc arthrp ant 1ntrspc 22856 " 83,308.00 " " 30,790.64 " " 13,987.51 " " 68,586.78 " " 21,410.16 " " 54,974.95 " " 16,785.01 " " 56,766.07 " " 13,987.51 " " 16,455.89 " " 56,966.01 " " 14,995.44 " " 55,749.71 " " 13,987.51 " " 17,607.80 " " 59,990.09 " " 14,810.30 " " 16,455.89 " " 54,868.49 " " 68,586.78 " " 16,291.33 " " 16,785.01 " " 16,455.89 " " 66,646.40 " " 15,057.14 " " 62,481.00 " " 62,481.00 " " 65,813.32 " " 64,147.16 " " 14,481.18 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,785.01 " " 65,813.32 " Outpatient Insj stablj dev w/dcmprn 22867 " 83,308.00 " " 30,790.64 " " 13,987.51 " " 68,586.78 " " 21,410.16 " " 54,974.95 " " 16,785.01 " " 56,766.07 " " 13,987.51 " " 16,455.89 " " 56,966.01 " " 14,995.44 " " 55,749.71 " " 13,987.51 " " 17,607.80 " " 59,990.09 " " 14,810.30 " " 16,455.89 " " 54,868.49 " " 68,586.78 " " 16,291.33 " " 16,785.01 " " 16,455.89 " " 66,646.40 " " 15,057.14 " " 62,481.00 " " 62,481.00 " " 65,813.32 " " 64,147.16 " " 14,481.18 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,785.01 " " 65,813.32 " Outpatient Exc abd les sc < 3 cm 22902 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Repair biceps tendon 23430 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Reconstruct shoulder joint 23472 " 24,630.00 " " 9,103.25 " " 4,433.40 " " 53,228.06 " " 6,329.91 " " 16,253.34 " " 12,800.46 " " 16,782.88 " " 10,667.05 " " 12,549.47 " " 16,841.99 " " 4,433.40 " " 16,482.40 " " 10,667.05 " " 13,427.93 " " 17,736.06 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 19,704.00 " " 11,482.77 " " 18,472.50 " " 18,472.50 " " 19,457.70 " " 18,965.10 " " 11,043.53 " " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " " 12,800.46 " " 19,457.70 " Outpatient Treat clavicle fracture 23500 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat clavicle fracture 23515 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treat humerus fracture 23600 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat shoulder dislocation 23650 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat shoulder dislocation 23655 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Exc arm/elbow les sc 3 cm/> 24071 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Repr elbow lat ligmnt w/tiss 24343 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Treat humerus fracture 24500 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat humerus fracture 24530 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat humerus fracture 24538 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treat humerus fracture 24579 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Treat elbow dislocation 24640 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat radius fracture 24650 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat radius fracture 24665 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treat ulnar fracture 24685 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Incision of tendon sheath 25000 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Exc forearm les sc < 3 cm 25075 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Remove wrist tendon lesion 25111 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Repair forearm tendon/muscle 25260 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Release wrist/forearm tendon 25295 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Repair wrist joints 25447 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Treat fracture radius & ulna 25560 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat fracture radius & ulna 25565 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Treat fracture radius/ulna 25575 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treat fracture radius/ulna 25600 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat fracture radius/ulna 25605 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Treat fx rad extra-articul 25607 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treat fx rad intra-articul 25608 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treat fx radial 3+ frag 25609 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Release palm contracture 26040 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Incise finger tendon sheath 26055 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Exc hand les sc < 1.5 cm 26115 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Release palm contracture 26123 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Remove tendon sheath lesion 26160 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Repair finger/hand tendon 26350 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Repair finger/hand tendon 26356 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Repair finger tendon 26418 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Release palm/finger tendon 26440 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Release hand/finger tendon 26445 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Transplant hand tendon 26480 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Treat metacarpal fracture 26600 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat metacarpal fracture 26615 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Treat finger fracture each 26720 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat finger fracture each 26727 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Treat finger fracture each 26735 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Treat finger fracture each 26750 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Amputation of finger/thumb 26951 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Incision of hip tendon 27001 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Total hip arthroplasty 27130 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Exploration of knee joint 27310 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Repair of thigh muscle 27385 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Repair degenerated kneecap 27418 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Reconstruction knee 27427 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Revision of knee joint 27446 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Total knee arthroplasty 27447 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Surgery to stop leg growth 27479 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treatment of thigh fracture 27500 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treatment of thigh fracture 27502 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Treat kneecap fracture 27524 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treat knee fracture 27530 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Fixation of knee joint 27570 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Decompression of lower leg 27600 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Explore/treat ankle joint 27620 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Remove lower leg bone lesion 27635 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Repair of achilles tendon 27654 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Release of lower leg tendon 27680 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Revision of lower leg tendon 27685 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Revise lower leg tendons 27686 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Revise lower leg tendon 27691 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Repair of ankle ligament 27698 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Reconstruct ankle joint 27702 " 24,630.00 " " 9,103.25 " " 4,433.40 " " 53,228.06 " " 6,329.91 " " 16,253.34 " " 12,800.46 " " 16,782.88 " " 10,667.05 " " 12,549.47 " " 16,841.99 " " 4,433.40 " " 16,482.40 " " 10,667.05 " " 13,427.93 " " 17,736.06 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 19,704.00 " " 11,482.77 " " 18,472.50 " " 18,472.50 " " 19,457.70 " " 18,965.10 " " 11,043.53 " " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " " 12,800.46 " " 19,457.70 " Outpatient Incision of tibia 27705 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Incision of fibula 27707 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Incision of tibia & fibula 27709 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Treatment of tibia fracture 27750 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treatment of tibia fracture 27752 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Treatment of tibia fracture 27759 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Cltx medial ankle fx 27760 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treatment of ankle fracture 27786 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treatment of ankle fracture 27792 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treatment of ankle fracture 27814 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treatment of ankle fracture 27822 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treatment of ankle fracture 27823 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treat lower leg fracture 27828 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Treat lower leg joint 27829 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Fusion of ankle joint open 27870 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Fusion of tibiofibular joint 27871 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Decompression of tibia nerve 28035 " 9,211.00 " " 3,404.39 " " 1,519.01 " " 7,582.98 " " 2,367.23 " " 6,078.34 " " 1,822.81 " " 6,276.38 " " 1,519.01 " " 1,787.07 " " 6,298.48 " " 1,657.98 " " 6,164.00 " " 1,519.01 " " 1,912.16 " " 6,632.84 " " 1,608.36 " " 1,787.07 " " 6,066.28 " " 7,582.98 " " 1,769.20 " " 1,822.81 " " 1,787.07 " " 7,368.80 " " 1,635.17 " " 6,908.25 " " 6,908.25 " " 7,276.69 " " 7,092.47 " " 1,572.62 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,822.81 " " 7,276.69 " Outpatient Partial removal foot fascia 28060 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Part removal of metatarsal 28112 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Removal of heel bone 28118 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Part removal of ankle/heel 28120 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Partial removal of foot bone 28122 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Incision of toe tendon 28232 " 7,310.00 " " 2,701.78 " " 1,204.93 " " 6,018.14 " " 1,878.67 " " 4,823.87 " " 1,445.91 " " 4,981.03 " " 1,204.93 " " 1,417.56 " " 4,998.58 " " 1,315.80 " " 4,891.85 " " 1,204.93 " " 1,516.79 " " 5,263.93 " " 1,275.80 " " 1,417.56 " " 4,814.43 " " 6,018.14 " " 1,403.38 " " 1,445.91 " " 1,417.56 " " 5,848.00 " " 1,297.07 " " 5,482.50 " " 5,482.50 " " 5,774.90 " " 5,628.70 " " 1,247.45 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,445.91 " " 5,774.90 " Outpatient Revision of foot and ankle 28262 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Repair of hammertoe 28285 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Correction hallux valgus 28297 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Incision of heel bone 28300 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Incision of midfoot bones 28304 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Incision of metatarsal 28306 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Incision of metatarsal 28308 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Treat heel fracture 28415 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Treat metatarsal fracture 28470 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treat big toe fracture 28490 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Treatment of toe fracture 28510 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Repair foot dislocation 28555 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Repair foot dislocation 28615 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Repair toe dislocation 28645 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Fusion of foot bones 28715 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Fusion of foot bones 28725 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Fusion of foot bones 28730 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Fusion of foot bones 28740 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Fusion of big toe joint 28750 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Amputation toe & metatarsal 28810 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Partial amputation of toe 28825 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Foot/toes surgery procedure 28899 " 1,082.00 " 399.91 178.30 891.23 278.07 714.01 213.97 737.27 178.30 209.77 739.87 194.76 724.07 178.30 224.45 779.15 188.79 209.77 712.97 891.23 207.67 213.97 209.77 865.60 191.94 811.50 811.50 854.78 833.14 184.60 442.54 811.50 411.27 483.98 213.97 854.78 Outpatient Application of body cast 29010 " 1,266.00 " 467.91 208.69 " 1,042.41 " 325.36 835.43 250.43 862.65 208.69 245.52 865.69 227.88 847.21 208.69 262.71 911.65 220.97 245.52 833.92 " 1,042.41 " 243.06 250.43 245.52 " 1,012.80 " 224.65 949.50 949.50 " 1,000.14 " 974.82 216.06 517.79 949.50 481.21 566.28 250.43 " 1,000.14 " Outpatient Application of long arm cast 29065 " 1,266.00 " 467.91 208.69 " 1,042.41 " 325.36 835.43 250.43 862.65 208.69 245.52 865.69 227.88 847.21 208.69 262.71 911.65 220.97 245.52 833.92 " 1,042.41 " 243.06 250.43 245.52 " 1,012.80 " 224.65 949.50 949.50 " 1,000.14 " 974.82 216.06 517.79 949.50 481.21 566.28 250.43 " 1,000.14 " Outpatient Application of forearm cast 29075 " 1,266.00 " 467.91 208.69 " 1,042.41 " 325.36 835.43 250.43 862.65 208.69 245.52 865.69 227.88 847.21 208.69 262.71 911.65 220.97 245.52 833.92 " 1,042.41 " 243.06 250.43 245.52 " 1,012.80 " 224.65 949.50 949.50 " 1,000.14 " 974.82 216.06 517.79 949.50 481.21 566.28 250.43 " 1,000.14 " Outpatient Apply long arm splint 29105 741.00 273.87 122.22 610.22 190.44 488.99 146.67 504.92 122.22 143.79 506.70 133.38 495.88 122.22 153.86 533.59 129.41 143.79 488.17 610.22 142.35 146.67 143.79 592.80 131.57 555.75 555.75 585.39 570.57 126.54 303.07 555.75 281.65 331.45 146.67 585.39 Outpatient Apply forearm splint 29125 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Application of finger splint 29130 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Application of long leg cast 29345 " 1,266.00 " 467.91 208.69 " 1,042.41 " 325.36 835.43 250.43 862.65 208.69 245.52 865.69 227.88 847.21 208.69 262.71 911.65 220.97 245.52 833.92 " 1,042.41 " 243.06 250.43 245.52 " 1,012.80 " 224.65 949.50 949.50 " 1,000.14 " 974.82 216.06 517.79 949.50 481.21 566.28 250.43 " 1,000.14 " Outpatient Apply short leg cast 29405 " 1,266.00 " 467.91 208.69 " 1,042.41 " 325.36 835.43 250.43 862.65 208.69 245.52 865.69 227.88 847.21 208.69 262.71 911.65 220.97 245.52 833.92 " 1,042.41 " 243.06 250.43 245.52 " 1,012.80 " 224.65 949.50 949.50 " 1,000.14 " 974.82 216.06 517.79 949.50 481.21 566.28 250.43 " 1,000.14 " Outpatient Apply short leg cast 29425 " 1,266.00 " 467.91 208.69 " 1,042.41 " 325.36 835.43 250.43 862.65 208.69 245.52 865.69 227.88 847.21 208.69 262.71 911.65 220.97 245.52 833.92 " 1,042.41 " 243.06 250.43 245.52 " 1,012.80 " 224.65 949.50 949.50 " 1,000.14 " 974.82 216.06 517.79 949.50 481.21 566.28 250.43 " 1,000.14 " Outpatient Apply rigid leg cast 29445 " 1,266.00 " 467.91 208.69 " 1,042.41 " 325.36 835.43 250.43 862.65 208.69 245.52 865.69 227.88 847.21 208.69 262.71 911.65 220.97 245.52 833.92 " 1,042.41 " 243.06 250.43 245.52 " 1,012.80 " 224.65 949.50 949.50 " 1,000.14 " 974.82 216.06 517.79 949.50 481.21 566.28 250.43 " 1,000.14 " Outpatient Application of leg cast 29450 741.00 273.87 122.22 610.22 190.44 488.99 146.67 504.92 122.22 143.79 506.70 133.38 495.88 122.22 153.86 533.59 129.41 143.79 488.17 610.22 142.35 146.67 143.79 592.80 131.57 555.75 555.75 585.39 570.57 126.54 303.07 555.75 281.65 331.45 146.67 585.39 Outpatient Application lower leg splint 29515 741.00 273.87 122.22 610.22 190.44 488.99 146.67 504.92 122.22 143.79 506.70 133.38 495.88 122.22 153.86 533.59 129.41 143.79 488.17 610.22 142.35 146.67 143.79 592.80 131.57 555.75 555.75 585.39 570.57 126.54 303.07 555.75 281.65 331.45 146.67 585.39 Outpatient Application of paste boot 29580 741.00 273.87 122.22 610.22 190.44 488.99 146.67 504.92 122.22 143.79 506.70 133.38 495.88 122.22 153.86 533.59 129.41 143.79 488.17 610.22 142.35 146.67 143.79 592.80 131.57 555.75 555.75 585.39 570.57 126.54 303.07 555.75 281.65 331.45 146.67 585.39 Outpatient Apply multlay comprs lwr leg 29581 741.00 273.87 122.22 610.22 190.44 488.99 146.67 504.92 122.22 143.79 506.70 133.38 495.88 122.22 153.86 533.59 129.41 143.79 488.17 610.22 142.35 146.67 143.79 592.80 131.57 555.75 555.75 585.39 570.57 126.54 303.07 555.75 281.65 331.45 146.67 585.39 Outpatient Removal/revision of cast 29700 " 1,266.00 " 467.91 208.69 " 1,042.41 " 325.36 835.43 250.43 862.65 208.69 245.52 865.69 227.88 847.21 208.69 262.71 911.65 220.97 245.52 833.92 " 1,042.41 " 243.06 250.43 245.52 " 1,012.80 " 224.65 949.50 949.50 " 1,000.14 " 974.82 216.06 517.79 949.50 481.21 566.28 250.43 " 1,000.14 " Outpatient Sho arthrs srg xtnsv dbrdmt 29823 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Sho arthrs srg dstl claviclc 29824 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Sho arthrs srg rt8tr cuf rpr 29827 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Sho arthrs srg bicp tenodsis 29828 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Knee arthroscopy/surgery 29877 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Knee arthroscopy/surgery 29881 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Knee arthroscopy/surgery 29882 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Knee arthroscopy/surgery 29888 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Ankle arthroscopy/surgery 29898 " 14,860.00 " " 5,492.26 " " 2,449.88 " " 12,233.82 " " 3,819.02 " " 9,806.11 " " 2,939.85 " " 10,125.60 " " 2,449.88 " " 2,882.21 " " 10,161.27 " " 2,674.80 " " 9,944.31 " " 2,449.88 " " 3,083.96 " " 10,700.69 " " 2,593.99 " " 2,882.21 " " 9,786.89 " " 12,233.82 " " 2,853.39 " " 2,939.85 " " 2,882.21 " " 11,888.00 " " 2,637.22 " " 11,145.00 " " 11,145.00 " " 11,739.40 " " 11,442.20 " " 2,536.34 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,939.85 " " 11,739.40 " Outpatient Intranasal biopsy 30100 " 7,102.00 " " 2,624.90 " " 1,170.22 " " 5,847.14 " " 1,825.21 " " 4,686.61 " " 1,404.26 " " 4,839.30 " " 1,170.22 " " 1,376.73 " " 4,856.35 " " 1,278.36 " " 4,752.66 " " 1,170.22 " " 1,473.10 " " 5,114.15 " " 1,239.06 " " 1,376.73 " " 4,677.63 " " 5,847.14 " " 1,362.96 " " 1,404.26 " " 1,376.73 " " 5,681.60 " " 1,259.71 " " 5,326.50 " " 5,326.50 " " 5,610.58 " " 5,468.54 " " 1,211.52 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,404.26 " " 5,610.58 " Outpatient Resect inferior turbinate 30140 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Insert nasal septal button 30220 " 7,102.00 " " 2,624.90 " " 1,170.22 " " 5,847.14 " " 1,825.21 " " 4,686.61 " " 1,404.26 " " 4,839.30 " " 1,170.22 " " 1,376.73 " " 4,856.35 " " 1,278.36 " " 4,752.66 " " 1,170.22 " " 1,473.10 " " 5,114.15 " " 1,239.06 " " 1,376.73 " " 4,677.63 " " 5,847.14 " " 1,362.96 " " 1,404.26 " " 1,376.73 " " 5,681.60 " " 1,259.71 " " 5,326.50 " " 5,326.50 " " 5,610.58 " " 5,468.54 " " 1,211.52 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,404.26 " " 5,610.58 " Outpatient Remove nasal foreign body 30300 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Reconstruction of nose 30420 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Revision of nose 30450 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Revision of nose 30460 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Revision of nose 30462 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Repair nasal stenosis 30465 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Repair of nasal septum 30520 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Ablate inf turbinate submuc 30802 " 7,102.00 " " 2,624.90 " " 1,170.22 " " 5,847.14 " " 1,825.21 " " 4,686.61 " " 1,404.26 " " 4,839.30 " " 1,170.22 " " 1,376.73 " " 4,856.35 " " 1,278.36 " " 4,752.66 " " 1,170.22 " " 1,473.10 " " 5,114.15 " " 1,239.06 " " 1,376.73 " " 4,677.63 " " 5,847.14 " " 1,362.96 " " 1,404.26 " " 1,376.73 " " 5,681.60 " " 1,259.71 " " 5,326.50 " " 5,326.50 " " 5,610.58 " " 5,468.54 " " 1,211.52 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,404.26 " " 5,610.58 " Outpatient Control of nosebleed 30901 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Control of nosebleed 30903 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Ther fx nasal inf turbinate 30930 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Nasal endoscopy dx 31231 863.00 318.96 142.40 710.55 221.79 569.49 170.88 588.05 142.40 167.53 590.12 155.34 577.52 142.40 179.26 621.45 150.78 167.53 568.43 710.55 165.85 170.88 167.53 690.40 153.29 647.25 647.25 681.77 664.51 147.43 352.97 647.25 328.03 386.02 170.88 681.77 Outpatient Nasal/sinus endoscopy surg 31237 " 7,856.00 " " 2,903.58 " " 1,294.28 " " 6,467.86 " " 2,018.99 " " 5,184.17 " " 1,553.13 " " 5,353.08 " " 1,294.28 " " 1,522.68 " " 5,371.93 " " 1,414.08 " " 5,257.24 " " 1,294.28 " " 1,629.27 " " 5,657.11 " " 1,370.41 " " 1,522.68 " " 5,174.20 " " 6,467.86 " " 1,507.45 " " 1,553.13 " " 1,522.68 " " 6,284.80 " " 1,393.25 " " 5,892.00 " " 5,892.00 " " 6,206.24 " " 6,049.12 " " 1,339.96 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,553.13 " " 6,206.24 " Outpatient Nasal/sinus endoscopy surg 31238 " 7,856.00 " " 2,903.58 " " 1,294.28 " " 6,467.86 " " 2,018.99 " " 5,184.17 " " 1,553.13 " " 5,353.08 " " 1,294.28 " " 1,522.68 " " 5,371.93 " " 1,414.08 " " 5,257.24 " " 1,294.28 " " 1,629.27 " " 5,657.11 " " 1,370.41 " " 1,522.68 " " 5,174.20 " " 6,467.86 " " 1,507.45 " " 1,553.13 " " 1,522.68 " " 6,284.80 " " 1,393.25 " " 5,892.00 " " 5,892.00 " " 6,206.24 " " 6,049.12 " " 1,339.96 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,553.13 " " 6,206.24 " Outpatient Nsl/sins ndsc w/prtl ethmdct 31254 " 30,569.00 " " 11,298.30 " " 5,037.76 " " 25,167.69 " " 7,856.23 " " 20,172.48 " " 6,045.32 " " 20,829.72 " " 5,037.76 " " 5,926.78 " " 20,903.08 " " 5,502.42 " " 20,456.77 " " 5,037.76 " " 6,341.65 " " 22,012.74 " " 5,334.10 " " 5,926.78 " " 20,133.81 " " 25,167.69 " " 5,867.51 " " 6,045.32 " " 5,926.78 " " 24,455.20 " " 5,423.00 " " 22,926.75 " " 22,926.75 " " 24,149.51 " " 23,538.13 " " 5,215.57 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 6,045.32 " " 24,149.51 " Outpatient Nsl/sins ndsc w/tot ethmdct 31255 " 30,569.00 " " 11,298.30 " " 5,037.76 " " 25,167.69 " " 7,856.23 " " 20,172.48 " " 6,045.32 " " 20,829.72 " " 5,037.76 " " 5,926.78 " " 20,903.08 " " 5,502.42 " " 20,456.77 " " 5,037.76 " " 6,341.65 " " 22,012.74 " " 5,334.10 " " 5,926.78 " " 20,133.81 " " 25,167.69 " " 5,867.51 " " 6,045.32 " " 5,926.78 " " 24,455.20 " " 5,423.00 " " 22,926.75 " " 22,926.75 " " 24,149.51 " " 23,538.13 " " 5,215.57 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 6,045.32 " " 24,149.51 " Outpatient Exploration maxillary sinus 31256 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Nsl/sins ndsc tot w/sphendt 31257 " 30,569.00 " " 11,298.30 " " 5,037.76 " " 25,167.69 " " 7,856.23 " " 20,172.48 " " 6,045.32 " " 20,829.72 " " 5,037.76 " " 5,926.78 " " 20,903.08 " " 5,502.42 " " 20,456.77 " " 5,037.76 " " 6,341.65 " " 22,012.74 " " 5,334.10 " " 5,926.78 " " 20,133.81 " " 25,167.69 " " 5,867.51 " " 6,045.32 " " 5,926.78 " " 24,455.20 " " 5,423.00 " " 22,926.75 " " 22,926.75 " " 24,149.51 " " 23,538.13 " " 5,215.57 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 6,045.32 " " 24,149.51 " Outpatient Nsl/sins ndsc sphn tiss rmvl 31259 " 30,569.00 " " 11,298.30 " " 5,037.76 " " 25,167.69 " " 7,856.23 " " 20,172.48 " " 6,045.32 " " 20,829.72 " " 5,037.76 " " 5,926.78 " " 20,903.08 " " 5,502.42 " " 20,456.77 " " 5,037.76 " " 6,341.65 " " 22,012.74 " " 5,334.10 " " 5,926.78 " " 20,133.81 " " 25,167.69 " " 5,867.51 " " 6,045.32 " " 5,926.78 " " 24,455.20 " " 5,423.00 " " 22,926.75 " " 22,926.75 " " 24,149.51 " " 23,538.13 " " 5,215.57 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 6,045.32 " " 24,149.51 " Outpatient Endoscopy maxillary sinus 31267 " 30,569.00 " " 11,298.30 " " 5,037.76 " " 25,167.69 " " 7,856.23 " " 20,172.48 " " 6,045.32 " " 20,829.72 " " 5,037.76 " " 5,926.78 " " 20,903.08 " " 5,502.42 " " 20,456.77 " " 5,037.76 " " 6,341.65 " " 22,012.74 " " 5,334.10 " " 5,926.78 " " 20,133.81 " " 25,167.69 " " 5,867.51 " " 6,045.32 " " 5,926.78 " " 24,455.20 " " 5,423.00 " " 22,926.75 " " 22,926.75 " " 24,149.51 " " 23,538.13 " " 5,215.57 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 6,045.32 " " 24,149.51 " Outpatient Nsl/sins ndsc frnt tiss rmvl 31276 " 30,569.00 " " 11,298.30 " " 5,037.76 " " 25,167.69 " " 7,856.23 " " 20,172.48 " " 6,045.32 " " 20,829.72 " " 5,037.76 " " 5,926.78 " " 20,903.08 " " 5,502.42 " " 20,456.77 " " 5,037.76 " " 6,341.65 " " 22,012.74 " " 5,334.10 " " 5,926.78 " " 20,133.81 " " 25,167.69 " " 5,867.51 " " 6,045.32 " " 5,926.78 " " 24,455.20 " " 5,423.00 " " 22,926.75 " " 22,926.75 " " 24,149.51 " " 23,538.13 " " 5,215.57 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 6,045.32 " " 24,149.51 " Outpatient Insert emergency airway 31500 " 1,111.00 " 410.63 183.02 914.58 285.53 733.15 219.63 757.04 183.02 215.32 759.70 199.98 743.48 183.02 230.39 800.03 193.79 215.32 731.65 914.58 213.17 219.63 215.32 888.80 197.02 833.25 833.25 877.69 855.47 189.48 454.40 833.25 422.29 496.95 219.63 877.69 Outpatient Change of windpipe airway 31502 " 1,111.00 " 410.63 183.02 914.58 285.53 733.15 219.63 757.04 183.02 215.32 759.70 199.98 743.48 183.02 230.39 800.03 193.79 215.32 731.65 914.58 213.17 219.63 215.32 888.80 197.02 833.25 833.25 877.69 855.47 189.48 454.40 833.25 422.29 496.95 219.63 877.69 Outpatient Dx laryngoscopy w/oper scope 31526 " 7,856.00 " " 2,903.58 " " 1,294.28 " " 6,467.86 " " 2,018.99 " " 5,184.17 " " 1,553.13 " " 5,353.08 " " 1,294.28 " " 1,522.68 " " 5,371.93 " " 1,414.08 " " 5,257.24 " " 1,294.28 " " 1,629.27 " " 5,657.11 " " 1,370.41 " " 1,522.68 " " 5,174.20 " " 6,467.86 " " 1,507.45 " " 1,553.13 " " 1,522.68 " " 6,284.80 " " 1,393.25 " " 5,892.00 " " 5,892.00 " " 6,206.24 " " 6,049.12 " " 1,339.96 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,553.13 " " 6,206.24 " Outpatient Laryngoscopy and dilation 31528 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Laryngoscopy w/bx & op scope 31536 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Larynscop w/tumr exc + scope 31541 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Laryngoscop w/vc inj + scope 31571 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Largsc w/laser dstrj les 31572 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Largsc w/njx augmentation 31574 " 7,856.00 " " 2,903.58 " " 1,294.28 " " 6,467.86 " " 2,018.99 " " 5,184.17 " " 1,553.13 " " 5,353.08 " " 1,294.28 " " 1,522.68 " " 5,371.93 " " 1,414.08 " " 5,257.24 " " 1,294.28 " " 1,629.27 " " 5,657.11 " " 1,370.41 " " 1,522.68 " " 5,174.20 " " 6,467.86 " " 1,507.45 " " 1,553.13 " " 1,522.68 " " 6,284.80 " " 1,393.25 " " 5,892.00 " " 5,892.00 " " 6,206.24 " " 6,049.12 " " 1,339.96 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,553.13 " " 6,206.24 " Outpatient Diagnostic laryngoscopy 31575 863.00 318.96 142.40 710.55 221.79 569.49 170.88 588.05 142.40 167.53 590.12 155.34 577.52 142.40 179.26 621.45 150.78 167.53 568.43 710.55 165.85 170.88 167.53 690.40 153.29 647.25 647.25 681.77 664.51 147.43 352.97 647.25 328.03 386.02 170.88 681.77 Outpatient Laryngoscopy telescopic 31579 " 1,977.00 " 730.70 325.16 " 1,627.38 " 508.09 " 1,304.62 " 390.19 " 1,347.13 " 325.16 382.54 " 1,351.87 " 355.86 " 1,323.01 " 325.16 409.32 " 1,423.64 " 344.29 382.54 " 1,301.88 " " 1,627.38 " 378.71 390.19 382.54 " 1,581.60 " 350.02 " 1,482.75 " " 1,482.75 " " 1,561.83 " " 1,522.29 " 336.64 808.59 " 1,482.75 " 751.46 884.31 390.19 " 1,561.83 " Outpatient Larynx surgery procedure 31599 " 1,111.00 " 410.63 183.02 914.58 285.53 733.15 219.63 757.04 183.02 215.32 759.70 199.98 743.48 183.02 230.39 800.03 193.79 215.32 731.65 914.58 213.17 219.63 215.32 888.80 197.02 833.25 833.25 877.69 855.47 189.48 454.40 833.25 422.29 496.95 219.63 877.69 Outpatient Repair windpipe opening 31613 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Visualization of windpipe 31615 " 2,375.00 " 877.80 391.25 " 1,955.23 " 610.38 " 1,567.26 " 469.50 " 1,618.33 " 391.25 460.29 " 1,624.03 " 427.50 " 1,589.35 " 391.25 492.51 " 1,710.24 " 414.26 460.29 " 1,564.15 " " 1,955.23 " 455.69 469.50 460.29 " 1,900.00 " 421.17 " 1,781.25 " " 1,781.25 " " 1,876.25 " " 1,828.75 " 405.06 971.38 " 1,781.25 " 902.74 " 1,062.34 " 469.50 " 1,876.25 " Outpatient Dx bronchoscope/wash 31622 " 7,856.00 " " 2,903.58 " " 1,294.28 " " 6,467.86 " " 2,018.99 " " 5,184.17 " " 1,553.13 " " 5,353.08 " " 1,294.28 " " 1,522.68 " " 5,371.93 " " 1,414.08 " " 5,257.24 " " 1,294.28 " " 1,629.27 " " 5,657.11 " " 1,370.41 " " 1,522.68 " " 5,174.20 " " 6,467.86 " " 1,507.45 " " 1,553.13 " " 1,522.68 " " 6,284.80 " " 1,393.25 " " 5,892.00 " " 5,892.00 " " 6,206.24 " " 6,049.12 " " 1,339.96 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,553.13 " " 6,206.24 " Outpatient Dx bronchoscope/brush 31623 " 7,856.00 " " 2,903.58 " " 1,294.28 " " 6,467.86 " " 2,018.99 " " 5,184.17 " " 1,553.13 " " 5,353.08 " " 1,294.28 " " 1,522.68 " " 5,371.93 " " 1,414.08 " " 5,257.24 " " 1,294.28 " " 1,629.27 " " 5,657.11 " " 1,370.41 " " 1,522.68 " " 5,174.20 " " 6,467.86 " " 1,507.45 " " 1,553.13 " " 1,522.68 " " 6,284.80 " " 1,393.25 " " 5,892.00 " " 5,892.00 " " 6,206.24 " " 6,049.12 " " 1,339.96 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,553.13 " " 6,206.24 " Outpatient Dx bronchoscope/lavage 31624 " 7,856.00 " " 2,903.58 " " 1,294.28 " " 6,467.86 " " 2,018.99 " " 5,184.17 " " 1,553.13 " " 5,353.08 " " 1,294.28 " " 1,522.68 " " 5,371.93 " " 1,414.08 " " 5,257.24 " " 1,294.28 " " 1,629.27 " " 5,657.11 " " 1,370.41 " " 1,522.68 " " 5,174.20 " " 6,467.86 " " 1,507.45 " " 1,553.13 " " 1,522.68 " " 6,284.80 " " 1,393.25 " " 5,892.00 " " 5,892.00 " " 6,206.24 " " 6,049.12 " " 1,339.96 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,553.13 " " 6,206.24 " Outpatient Bronchoscopy w/biopsy(s) 31625 " 7,856.00 " " 2,903.58 " " 1,294.28 " " 6,467.86 " " 2,018.99 " " 5,184.17 " " 1,553.13 " " 5,353.08 " " 1,294.28 " " 1,522.68 " " 5,371.93 " " 1,414.08 " " 5,257.24 " " 1,294.28 " " 1,629.27 " " 5,657.11 " " 1,370.41 " " 1,522.68 " " 5,174.20 " " 6,467.86 " " 1,507.45 " " 1,553.13 " " 1,522.68 " " 6,284.80 " " 1,393.25 " " 5,892.00 " " 5,892.00 " " 6,206.24 " " 6,049.12 " " 1,339.96 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,553.13 " " 6,206.24 " Outpatient Bronchoscopy/lung bx each 31628 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Bronchoscopy/needle bx each 31629 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Bronchoscopy dilate/fx repr 31630 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Bronchoscopy w/fb removal 31635 " 7,856.00 " " 2,903.58 " " 1,294.28 " " 6,467.86 " " 2,018.99 " " 5,184.17 " " 1,553.13 " " 5,353.08 " " 1,294.28 " " 1,522.68 " " 5,371.93 " " 1,414.08 " " 5,257.24 " " 1,294.28 " " 1,629.27 " " 5,657.11 " " 1,370.41 " " 1,522.68 " " 5,174.20 " " 6,467.86 " " 1,507.45 " " 1,553.13 " " 1,522.68 " " 6,284.80 " " 1,393.25 " " 5,892.00 " " 5,892.00 " " 6,206.24 " " 6,049.12 " " 1,339.96 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,553.13 " " 6,206.24 " Outpatient Bronchoscopy treat blockage 31641 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Bronchial valve remov init 31648 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Bronch ebus samplng 1/2 node 31652 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Bronch ebus samplng 3/> node 31653 " 16,265.00 " " 6,011.54 " " 2,679.68 " " 13,390.56 " " 4,180.11 " " 10,733.27 " " 3,215.62 " " 11,082.97 " " 2,679.68 " " 3,152.57 " " 11,122.01 " " 2,927.70 " " 10,884.54 " " 2,679.68 " " 3,373.25 " " 11,712.43 " " 2,837.31 " " 3,152.57 " " 10,712.27 " " 13,390.56 " " 3,121.04 " " 3,215.62 " " 3,152.57 " " 13,012.00 " " 2,884.60 " " 12,198.75 " " 12,198.75 " " 12,849.35 " " 12,524.05 " " 2,774.26 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,215.62 " " 12,849.35 " Outpatient Core ndl bx lng/med perq 32408 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Insert pleural cath 32550 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Insertion of chest tube 32551 " 7,382.00 " " 2,728.39 " " 1,216.49 " " 6,077.74 " " 1,897.17 " " 4,871.38 " " 1,459.78 " " 5,030.09 " " 1,216.49 " " 1,431.16 " " 5,047.81 " " 1,328.76 " " 4,940.03 " " 1,216.49 " " 1,531.34 " " 5,315.78 " " 1,288.04 " " 1,431.16 " " 4,862.11 " " 6,077.74 " " 1,416.85 " " 1,459.78 " " 1,431.16 " " 5,905.60 " " 1,309.51 " " 5,536.50 " " 5,536.50 " " 5,831.78 " " 5,684.14 " " 1,259.42 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,459.78 " " 5,831.78 " Outpatient Remove lung catheter 32552 " 2,844.00 " " 1,051.14 " 467.60 " 2,341.03 " 730.91 " 1,876.76 " 561.12 " 1,937.90 " 467.60 550.12 " 1,944.73 " 511.92 " 1,903.20 " 467.60 588.63 " 2,047.96 " 495.11 550.12 " 1,872.79 " " 2,341.03 " 544.62 561.12 550.12 " 2,275.20 " 503.36 " 2,133.00 " " 2,133.00 " " 2,246.76 " " 2,189.88 " 484.11 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 561.12 " 2,246.76 " Outpatient Aspirate pleura w/ imaging 32555 " 2,844.00 " " 1,051.14 " 467.60 " 2,341.03 " 730.91 " 1,876.76 " 561.12 " 1,937.90 " 467.60 550.12 " 1,944.73 " 511.92 " 1,903.20 " 467.60 588.63 " 2,047.96 " 495.11 550.12 " 1,872.79 " " 2,341.03 " 544.62 561.12 550.12 " 2,275.20 " 503.36 " 2,133.00 " " 2,133.00 " " 2,246.76 " " 2,189.88 " 484.11 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 561.12 " 2,246.76 " Outpatient Insrt heart pm atrial & vent 33208 " 54,601.00 " " 20,180.53 " " 8,995.01 " " 44,952.54 " " 14,032.46 " " 36,031.20 " " 10,794.01 " " 37,205.12 " " 8,995.01 " " 10,582.36 " " 37,336.16 " " 9,828.18 " " 36,538.99 " " 8,995.01 " " 11,323.13 " " 39,318.18 " " 9,524.12 " " 10,582.36 " " 35,961.42 " " 44,952.54 " " 10,476.54 " " 10,794.01 " " 10,582.36 " " 43,680.80 " " 9,682.86 " " 40,950.75 " " 40,950.75 " " 43,134.79 " " 42,042.77 " " 9,312.48 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,794.01 " " 43,134.79 " Outpatient Insert 1 electrode pm-defib 33216 " 42,801.00 " " 15,819.25 " " 7,057.86 " " 35,237.85 " " 10,999.86 " " 28,244.38 " " 8,469.44 " " 29,164.60 " " 7,057.86 " " 8,303.37 " " 29,267.32 " " 7,704.18 " " 28,642.43 " " 7,057.86 " " 8,884.61 " " 30,821.00 " " 7,473.03 " " 8,303.37 " " 28,189.80 " " 35,237.85 " " 8,220.34 " " 8,469.44 " " 8,303.37 " " 34,240.80 " " 7,597.58 " " 32,100.75 " " 32,100.75 " " 33,812.79 " " 32,956.77 " " 7,306.97 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,469.44 " " 33,812.79 " Outpatient Remv&replc pm gen dual lead 33228 " 54,601.00 " " 20,180.53 " " 8,995.01 " " 44,952.54 " " 14,032.46 " " 36,031.20 " " 10,794.01 " " 37,205.12 " " 8,995.01 " " 10,582.36 " " 37,336.16 " " 9,828.18 " " 36,538.99 " " 8,995.01 " " 11,323.13 " " 39,318.18 " " 9,524.12 " " 10,582.36 " " 35,961.42 " " 44,952.54 " " 10,476.54 " " 10,794.01 " " 10,582.36 " " 43,680.80 " " 9,682.86 " " 40,950.75 " " 40,950.75 " " 43,134.79 " " 42,042.77 " " 9,312.48 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,794.01 " " 43,134.79 " Outpatient Removal of pm generator 33233 " 42,801.00 " " 15,819.25 " " 7,057.86 " " 35,237.85 " " 10,999.86 " " 28,244.38 " " 8,469.44 " " 29,164.60 " " 7,057.86 " " 8,303.37 " " 29,267.32 " " 7,704.18 " " 28,642.43 " " 7,057.86 " " 8,884.61 " " 30,821.00 " " 7,473.03 " " 8,303.37 " " 28,189.80 " " 35,237.85 " " 8,220.34 " " 8,469.44 " " 8,303.37 " " 34,240.80 " " 7,597.58 " " 32,100.75 " " 32,100.75 " " 33,812.79 " " 32,956.77 " " 7,306.97 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,469.44 " " 33,812.79 " Outpatient Removal of pacemaker system 33234 " 18,062.00 " " 6,675.72 " " 2,978.89 " " 14,870.29 " " 4,641.93 " " 11,919.11 " " 3,574.67 " " 12,307.45 " " 2,978.89 " " 3,504.58 " " 12,350.80 " " 3,251.16 " " 12,087.09 " " 2,978.89 " " 3,749.90 " " 13,006.45 " " 3,154.12 " " 3,504.58 " " 11,896.03 " " 14,870.29 " " 3,469.53 " " 3,574.67 " " 3,504.58 " " 14,449.60 " " 3,206.69 " " 13,546.50 " " 13,546.50 " " 14,268.98 " " 13,907.74 " " 3,084.03 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,574.67 " " 14,268.98 " Outpatient Remove pulse generator 33241 " 18,062.00 " " 6,675.72 " " 2,978.89 " " 14,870.29 " " 4,641.93 " " 11,919.11 " " 3,574.67 " " 12,307.45 " " 2,978.89 " " 3,504.58 " " 12,350.80 " " 3,251.16 " " 12,087.09 " " 2,978.89 " " 3,749.90 " " 13,006.45 " " 3,154.12 " " 3,504.58 " " 11,896.03 " " 14,870.29 " " 3,469.53 " " 3,574.67 " " 3,504.58 " " 14,449.60 " " 3,206.69 " " 13,546.50 " " 13,546.50 " " 14,268.98 " " 13,907.74 " " 3,084.03 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,574.67 " " 14,268.98 " Outpatient Remove elctrd transvenously 33244 " 18,062.00 " " 6,675.72 " " 2,978.89 " " 14,870.29 " " 4,641.93 " " 11,919.11 " " 3,574.67 " " 12,307.45 " " 2,978.89 " " 3,504.58 " " 12,350.80 " " 3,251.16 " " 12,087.09 " " 2,978.89 " " 3,749.90 " " 13,006.45 " " 3,154.12 " " 3,504.58 " " 11,896.03 " " 14,870.29 " " 3,469.53 " " 3,574.67 " " 3,504.58 " " 14,449.60 " " 3,206.69 " " 13,546.50 " " 13,546.50 " " 14,268.98 " " 13,907.74 " " 3,084.03 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,574.67 " " 14,268.98 " Outpatient Insj/rplcmt defib w/lead(s) 33249 " 172,404.00 " " 63,720.52 " " 28,415.75 " " 141,939.40 " " 44,307.83 " " 113,769.40 " " 34,098.90 " " 117,476.09 " " 28,415.75 " " 33,430.29 " " 117,889.86 " " 31,032.72 " " 115,372.76 " " 28,415.75 " " 35,770.41 " " 124,148.12 " " 30,087.26 " " 33,430.29 " " 113,549.59 " " 141,939.40 " " 33,095.99 " " 34,098.90 " " 33,430.29 " " 137,923.20 " " 30,588.72 " " 129,303.00 " " 129,303.00 " " 136,199.16 " " 132,751.08 " " 29,418.66 " " 70,513.24 " " 129,303.00 " " 65,530.76 " " 77,116.31 " " 34,098.90 " " 136,199.16 " Outpatient Rmvl & rplcmt dfb gen 2 lead 33263 " 120,961.00 " " 44,707.19 " " 19,948.56 " " 99,586.38 " " 31,086.98 " " 79,822.16 " " 23,938.27 " " 82,422.83 " " 19,948.56 " " 23,468.89 " " 82,713.13 " " 21,772.98 " " 80,947.10 " " 19,948.56 " " 25,111.71 " " 87,104.02 " " 21,122.00 " " 23,468.89 " " 79,667.75 " " 99,586.38 " " 23,234.20 " " 23,938.27 " " 23,468.89 " " 96,768.80 " " 21,474.03 " " 90,720.75 " " 90,720.75 " " 95,559.19 " " 93,139.97 " " 20,652.62 " " 49,473.05 " " 90,720.75 " " 45,977.28 " " 54,105.86 " " 23,938.27 " " 95,559.19 " Outpatient Rmvl & rplcmt dfb gen mlt ld 33264 " 172,404.00 " " 63,720.52 " " 28,415.75 " " 141,939.40 " " 44,307.83 " " 113,769.40 " " 34,098.90 " " 117,476.09 " " 28,415.75 " " 33,430.29 " " 117,889.86 " " 31,032.72 " " 115,372.76 " " 28,415.75 " " 35,770.41 " " 124,148.12 " " 30,087.26 " " 33,430.29 " " 113,549.59 " " 141,939.40 " " 33,095.99 " " 34,098.90 " " 33,430.29 " " 137,923.20 " " 30,588.72 " " 129,303.00 " " 129,303.00 " " 136,199.16 " " 132,751.08 " " 29,418.66 " " 70,513.24 " " 129,303.00 " " 65,530.76 " " 77,116.31 " " 34,098.90 " " 136,199.16 " Outpatient Ins/rep subq defibrillator 33270 " 172,404.00 " " 63,720.52 " " 28,415.75 " " 141,939.40 " " 44,307.83 " " 113,769.40 " " 34,098.90 " " 117,476.09 " " 28,415.75 " " 33,430.29 " " 117,889.86 " " 31,032.72 " " 115,372.76 " " 28,415.75 " " 35,770.41 " " 124,148.12 " " 30,087.26 " " 33,430.29 " " 113,549.59 " " 141,939.40 " " 33,095.99 " " 34,098.90 " " 33,430.29 " " 137,923.20 " " 30,588.72 " " 129,303.00 " " 129,303.00 " " 136,199.16 " " 132,751.08 " " 29,418.66 " " 70,513.24 " " 129,303.00 " " 65,530.76 " " 77,116.31 " " 34,098.90 " " 136,199.16 " Outpatient Tcat insj/rpl perm ldls pm 33274 " 84,336.00 " " 31,170.59 " " 13,893.45 " " 69,433.38 " " 21,674.35 " " 55,653.33 " " 16,672.13 " " 57,466.55 " " 13,893.45 " " 16,345.23 " " 57,668.96 " " 15,180.48 " " 56,437.65 " " 13,893.45 " " 17,489.40 " " 60,730.35 " " 14,710.71 " " 16,345.23 " " 55,545.76 " " 69,433.38 " " 16,181.78 " " 16,672.13 " " 16,345.23 " " 67,468.80 " " 14,955.89 " " 63,252.00 " " 63,252.00 " " 66,625.44 " " 64,938.72 " " 14,383.80 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,672.13 " " 66,625.44 " Outpatient Insj subq car rhythm mntr 33285 " 42,801.00 " " 15,819.25 " " 7,057.86 " " 35,237.85 " " 10,999.86 " " 28,244.38 " " 8,469.44 " " 29,164.60 " " 7,057.86 " " 8,303.37 " " 29,267.32 " " 7,704.18 " " 28,642.43 " " 7,057.86 " " 8,884.61 " " 30,821.00 " " 7,473.03 " " 8,303.37 " " 28,189.80 " " 35,237.85 " " 8,220.34 " " 8,469.44 " " 8,303.37 " " 34,240.80 " " 7,597.58 " " 32,100.75 " " 32,100.75 " " 33,812.79 " " 32,956.77 " " 7,306.97 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,469.44 " " 33,812.79 " Outpatient Rmvl subq car rhythm mntr 33286 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Place cath carotid/inom art 36222 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Place cath carotid/inom art 36223 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 16,759.44 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 19,283.88 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Place cath carotd art 36224 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 16,759.44 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 19,283.88 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Place cath subclavian art 36225 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Place cath vertebral art 36226 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 16,759.44 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 19,283.88 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Blood transfusion service 36430 " 2,085.00 " 770.62 343.37 " 1,716.20 " 535.85 " 1,375.89 " 412.04 " 1,420.72 " 343.37 403.96 " 1,425.72 " 375.30 " 1,395.28 " 343.37 432.24 " 1,501.41 " 363.56 403.96 " 1,372.93 " " 1,716.20 " 399.92 412.04 403.96 " 1,668.00 " 369.62 " 1,563.75 " " 1,563.75 " " 1,647.15 " " 1,605.45 " 355.48 852.77 " 1,563.75 " 792.51 932.62 412.04 " 1,647.15 " Outpatient Njx sclrsnt mlt incmptnt vn 36471 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Endovenous rf 1st vein 36475 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Endovenous laser 1st vein 36478 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Endoven ther chem adhes 1st 36482 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 16,759.44 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 19,283.88 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Apheresis rbc 36512 " 7,157.00 " " 2,645.23 " " 1,179.94 " " 5,891.99 " " 1,839.35 " " 4,722.90 " " 1,415.93 " " 4,876.78 " " 1,179.94 " " 1,388.17 " " 4,893.96 " " 1,288.26 " " 4,789.46 " " 1,179.94 " " 1,485.34 " " 5,153.76 " " 1,249.35 " " 1,388.17 " " 4,713.51 " " 5,891.99 " " 1,374.29 " " 1,415.93 " " 1,388.17 " " 5,725.60 " " 1,270.18 " " 5,367.75 " " 5,367.75 " " 5,654.03 " " 5,510.89 " " 1,221.59 " " 2,927.21 " " 5,367.75 " " 2,720.38 " " 3,201.33 " " 1,415.93 " " 5,654.03 " Outpatient Apheresis plasma 36514 " 7,157.00 " " 2,645.23 " " 1,179.94 " " 5,891.99 " " 1,839.35 " " 4,722.90 " " 1,415.93 " " 4,876.78 " " 1,179.94 " " 1,388.17 " " 4,893.96 " " 1,288.26 " " 4,789.46 " " 1,179.94 " " 1,485.34 " " 5,153.76 " " 1,249.35 " " 1,388.17 " " 4,713.51 " " 5,891.99 " " 1,374.29 " " 1,415.93 " " 1,388.17 " " 5,725.60 " " 1,270.18 " " 5,367.75 " " 5,367.75 " " 5,654.03 " " 5,510.89 " " 1,221.59 " " 2,927.21 " " 5,367.75 " " 2,720.38 " " 3,201.33 " " 1,415.93 " " 5,654.03 " Outpatient Photopheresis 36522 " 21,198.00 " " 7,834.78 " " 3,498.68 " " 17,452.16 " " 5,447.89 " " 13,988.56 " " 4,198.41 " " 14,444.32 " " 3,498.68 " " 4,116.09 " " 14,495.19 " " 3,815.64 " " 14,185.70 " " 3,498.68 " " 4,404.22 " " 15,264.68 " " 3,704.48 " " 4,116.09 " " 13,961.49 " " 17,452.16 " " 4,074.93 " " 4,198.41 " " 4,116.09 " " 16,958.40 " " 3,766.22 " " 15,898.50 " " 15,898.50 " " 16,746.42 " " 16,322.46 " " 3,622.16 " " 8,669.98 " " 15,898.50 " " 8,057.36 " " 9,481.87 " " 4,198.41 " " 16,746.42 " Outpatient Insert non-tunnel cv cath 36556 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Insert tunneled cv cath 36558 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Insert tunneled cv cath 36561 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Insert tunneled cv cath 36566 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 16,759.44 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 19,283.88 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Insj picc 5 yr+ w/o imaging 36569 " 7,382.00 " " 2,728.39 " " 1,216.49 " " 6,077.74 " " 1,897.17 " " 4,871.38 " " 1,459.78 " " 5,030.09 " " 1,216.49 " " 1,431.16 " " 5,047.81 " " 1,328.76 " " 4,940.03 " " 1,216.49 " " 1,531.34 " " 5,315.78 " " 1,288.04 " " 1,431.16 " " 4,862.11 " " 6,077.74 " " 1,416.85 " " 1,459.78 " " 1,431.16 " " 5,905.60 " " 1,309.51 " " 5,536.50 " " 5,536.50 " " 5,831.78 " " 5,684.14 " " 1,259.42 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,459.78 " " 5,831.78 " Outpatient Replace tunneled cv cath 36581 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Compl rplcmt picc rs&i 36584 " 7,382.00 " " 2,728.39 " " 1,216.49 " " 6,077.74 " " 1,897.17 " " 4,871.38 " " 1,459.78 " " 5,030.09 " " 1,216.49 " " 1,431.16 " " 5,047.81 " " 1,328.76 " " 4,940.03 " " 1,216.49 " " 1,531.34 " " 5,315.78 " " 1,288.04 " " 1,431.16 " " 4,862.11 " " 6,077.74 " " 1,416.85 " " 1,459.78 " " 1,431.16 " " 5,905.60 " " 1,309.51 " " 5,536.50 " " 5,536.50 " " 5,831.78 " " 5,684.14 " " 1,259.42 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,459.78 " " 5,831.78 " Outpatient Removal tunneled cv cath 36589 " 2,844.00 " " 1,051.14 " 467.60 " 2,341.03 " 730.91 " 1,876.76 " 561.12 " 1,937.90 " 467.60 550.12 " 1,944.73 " 511.92 " 1,903.20 " 467.60 588.63 " 2,047.96 " 495.11 550.12 " 1,872.79 " " 2,341.03 " 544.62 561.12 550.12 " 2,275.20 " 503.36 " 2,133.00 " " 2,133.00 " " 2,246.76 " " 2,189.88 " 484.11 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 561.12 " 2,246.76 " Outpatient Removal tunneled cv cath 36590 " 7,382.00 " " 2,728.39 " " 1,216.49 " " 6,077.74 " " 1,897.17 " " 4,871.38 " " 1,459.78 " " 5,030.09 " " 1,216.49 " " 1,431.16 " " 5,047.81 " " 1,328.76 " " 4,940.03 " " 1,216.49 " " 1,531.34 " " 5,315.78 " " 1,288.04 " " 1,431.16 " " 4,862.11 " " 6,077.74 " " 1,416.85 " " 1,459.78 " " 1,431.16 " " 5,905.60 " " 1,309.51 " " 5,536.50 " " 5,536.50 " " 5,831.78 " " 5,684.14 " " 1,259.42 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,459.78 " " 5,831.78 " Outpatient Draw blood off venous device 36591 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Collect blood from picc 36592 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Declot vascular device 36593 " 1,631.00 " 602.82 275.83 " 1,343.15 " 419.17 " 1,076.30 " 331.00 " 1,111.36 " 275.83 324.51 " 1,115.28 " 293.58 " 1,091.47 " 275.83 347.23 " 1,174.48 " 292.06 324.51 " 1,074.50 " " 1,343.15 " 321.26 331.00 324.51 " 1,304.80 " 296.93 " 1,223.25 " " 1,223.25 " " 1,288.49 " " 1,255.87 " 285.57 667.08 " 1,223.25 " 619.94 729.55 331.00 " 1,288.49 " Outpatient Withdrawal of arterial blood 36600 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Av fuse uppr arm cephalic 36818 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 16,759.44 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 19,283.88 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Av fuse uppr arm basilic 36819 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 16,759.44 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 19,283.88 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Artery-vein nonautograft 36830 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 16,759.44 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 19,283.88 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Av fistula revision open 36832 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 16,759.44 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 19,283.88 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Intro cath dialysis circuit 36901 " 7,382.00 " " 2,728.39 " " 1,216.49 " " 6,077.74 " " 1,897.17 " " 4,871.38 " " 1,459.78 " " 5,030.09 " " 1,216.49 " " 1,431.16 " " 5,047.81 " " 1,328.76 " " 4,940.03 " " 1,216.49 " " 1,531.34 " " 5,315.78 " " 1,288.04 " " 1,431.16 " " 4,862.11 " " 6,077.74 " " 1,416.85 " " 1,459.78 " " 1,431.16 " " 5,905.60 " " 1,309.51 " " 5,536.50 " " 5,536.50 " " 5,831.78 " " 5,684.14 " " 1,259.42 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,459.78 " " 5,831.78 " Outpatient Intro cath dialysis circuit 36902 " 26,023.00 " " 9,618.10 " " 4,287.63 " " 21,424.94 " " 6,687.91 " " 17,172.58 " " 5,145.16 " " 17,732.07 " " 4,287.63 " " 5,044.27 " " 17,794.53 " " 4,684.14 " " 17,414.59 " " 4,287.63 " " 5,397.37 " " 18,739.16 " " 4,539.84 " " 5,044.27 " " 17,139.66 " " 21,424.94 " " 4,993.83 " " 5,145.16 " " 5,044.27 " " 20,818.40 " " 4,615.51 " " 19,517.25 " " 19,517.25 " " 20,558.17 " " 20,037.71 " " 4,438.96 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,145.16 " " 20,558.17 " Outpatient Rem endovas vena cava filter 37193 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Transcatheter biopsy 37200 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 16,759.44 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 19,283.88 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Iliac revasc 37220 " 26,023.00 " " 9,618.10 " " 4,287.63 " " 21,424.94 " " 6,687.91 " " 17,172.58 " " 5,145.16 " " 17,732.07 " " 4,287.63 " " 5,044.27 " " 17,794.53 " " 4,684.14 " " 17,414.59 " " 4,287.63 " " 5,397.37 " " 18,739.16 " " 4,539.84 " " 5,044.27 " " 17,139.66 " " 21,424.94 " " 4,993.83 " " 5,145.16 " " 5,044.27 " " 20,818.40 " " 4,615.51 " " 19,517.25 " " 19,517.25 " " 20,558.17 " " 20,037.71 " " 4,438.96 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,145.16 " " 20,558.17 " Outpatient Iliac revasc w/stent 37221 " 52,725.00 " " 19,487.16 " " 8,689.37 " " 43,408.58 " " 13,550.33 " " 34,793.23 " " 10,427.25 " " 35,926.82 " " 8,689.37 " " 10,222.79 " " 36,053.36 " " 9,490.50 " " 35,283.57 " " 8,689.37 " " 10,938.39 " " 37,967.27 " " 9,200.51 " " 10,222.79 " " 34,726.27 " " 43,408.58 " " 10,120.56 " " 10,427.25 " " 10,222.79 " " 42,180.00 " " 9,353.85 " " 39,543.75 " " 39,543.75 " " 41,652.75 " " 40,598.25 " " 8,996.06 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,427.25 " " 41,652.75 " Outpatient Fem/popl revas w/tla 37224 " 26,023.00 " " 9,618.10 " " 4,287.63 " " 21,424.94 " " 6,687.91 " " 17,172.58 " " 5,145.16 " " 17,732.07 " " 4,287.63 " " 5,044.27 " " 17,794.53 " " 4,684.14 " " 17,414.59 " " 4,287.63 " " 5,397.37 " " 18,739.16 " " 4,539.84 " " 5,044.27 " " 17,139.66 " " 21,424.94 " " 4,993.83 " " 5,145.16 " " 5,044.27 " " 20,818.40 " " 4,615.51 " " 19,517.25 " " 19,517.25 " " 20,558.17 " " 20,037.71 " " 4,438.96 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,145.16 " " 20,558.17 " Outpatient Fem/popl revasc w/stent 37226 " 52,725.00 " " 19,487.16 " " 8,689.37 " " 43,408.58 " " 13,550.33 " " 34,793.23 " " 10,427.25 " " 35,926.82 " " 8,689.37 " " 10,222.79 " " 36,053.36 " " 9,490.50 " " 35,283.57 " " 8,689.37 " " 10,938.39 " " 37,967.27 " " 9,200.51 " " 10,222.79 " " 34,726.27 " " 43,408.58 " " 10,120.56 " " 10,427.25 " " 10,222.79 " " 42,180.00 " " 9,353.85 " " 39,543.75 " " 39,543.75 " " 41,652.75 " " 40,598.25 " " 8,996.06 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,427.25 " " 41,652.75 " Outpatient Tib/per revasc w/tla 37228 " 52,725.00 " " 19,487.16 " " 8,689.37 " " 43,408.58 " " 13,550.33 " " 34,793.23 " " 10,427.25 " " 35,926.82 " " 8,689.37 " " 10,222.79 " " 36,053.36 " " 9,490.50 " " 35,283.57 " " 8,689.37 " " 10,938.39 " " 37,967.27 " " 9,200.51 " " 10,222.79 " " 34,726.27 " " 43,408.58 " " 10,120.56 " " 10,427.25 " " 10,222.79 " " 42,180.00 " " 9,353.85 " " 39,543.75 " " 39,543.75 " " 41,652.75 " " 40,598.25 " " 8,996.06 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,427.25 " " 41,652.75 " Outpatient Open/perq place stent 1st 37236 " 52,725.00 " " 19,487.16 " " 8,689.37 " " 43,408.58 " " 13,550.33 " " 34,793.23 " " 10,427.25 " " 35,926.82 " " 8,689.37 " " 10,222.79 " " 36,053.36 " " 9,490.50 " " 35,283.57 " " 8,689.37 " " 10,938.39 " " 37,967.27 " " 9,200.51 " " 10,222.79 " " 34,726.27 " " 43,408.58 " " 10,120.56 " " 10,427.25 " " 10,222.79 " " 42,180.00 " " 9,353.85 " " 39,543.75 " " 39,543.75 " " 41,652.75 " " 40,598.25 " " 8,996.06 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,427.25 " " 41,652.75 " Outpatient Open/perq place stent same 37238 " 52,725.00 " " 19,487.16 " " 8,689.37 " " 43,408.58 " " 13,550.33 " " 34,793.23 " " 10,427.25 " " 35,926.82 " " 8,689.37 " " 10,222.79 " " 36,053.36 " " 9,490.50 " " 35,283.57 " " 8,689.37 " " 10,938.39 " " 37,967.27 " " 9,200.51 " " 10,222.79 " " 34,726.27 " " 43,408.58 " " 10,120.56 " " 10,427.25 " " 10,222.79 " " 42,180.00 " " 9,353.85 " " 39,543.75 " " 39,543.75 " " 41,652.75 " " 40,598.25 " " 8,996.06 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,427.25 " " 41,652.75 " Outpatient Vasc embolize/occlude venous 37241 " 52,725.00 " " 19,487.16 " " 8,689.37 " " 43,408.58 " " 13,550.33 " " 34,793.23 " " 10,427.25 " " 35,926.82 " " 8,689.37 " " 10,222.79 " " 36,053.36 " " 9,490.50 " " 35,283.57 " " 8,689.37 " " 10,938.39 " " 37,967.27 " " 9,200.51 " " 10,222.79 " " 34,726.27 " " 43,408.58 " " 10,120.56 " " 10,427.25 " " 10,222.79 " " 42,180.00 " " 9,353.85 " " 39,543.75 " " 39,543.75 " " 41,652.75 " " 40,598.25 " " 8,996.06 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,427.25 " " 41,652.75 " Outpatient Vasc embolize/occlude artery 37242 " 52,725.00 " " 19,487.16 " " 8,689.37 " " 43,408.58 " " 13,550.33 " " 34,793.23 " " 10,427.25 " " 35,926.82 " " 8,689.37 " " 10,222.79 " " 36,053.36 " " 9,490.50 " " 35,283.57 " " 8,689.37 " " 10,938.39 " " 37,967.27 " " 9,200.51 " " 10,222.79 " " 34,726.27 " " 43,408.58 " " 10,120.56 " " 10,427.25 " " 10,222.79 " " 42,180.00 " " 9,353.85 " " 39,543.75 " " 39,543.75 " " 41,652.75 " " 40,598.25 " " 8,996.06 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,427.25 " " 41,652.75 " Outpatient Vasc embolize/occlude organ 37243 " 52,725.00 " " 19,487.16 " " 8,689.37 " " 43,408.58 " " 13,550.33 " " 34,793.23 " " 10,427.25 " " 35,926.82 " " 8,689.37 " " 10,222.79 " " 36,053.36 " " 9,490.50 " " 35,283.57 " " 8,689.37 " " 10,938.39 " " 37,967.27 " " 9,200.51 " " 10,222.79 " " 34,726.27 " " 43,408.58 " " 10,120.56 " " 10,427.25 " " 10,222.79 " " 42,180.00 " " 9,353.85 " " 39,543.75 " " 39,543.75 " " 41,652.75 " " 40,598.25 " " 8,996.06 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,427.25 " " 41,652.75 " Outpatient Trluml balo angiop 1st art 37246 " 26,023.00 " " 9,618.10 " " 4,287.63 " " 21,424.94 " " 6,687.91 " " 17,172.58 " " 5,145.16 " " 17,732.07 " " 4,287.63 " " 5,044.27 " " 17,794.53 " " 4,684.14 " " 17,414.59 " " 4,287.63 " " 5,397.37 " " 18,739.16 " " 4,539.84 " " 5,044.27 " " 17,139.66 " " 21,424.94 " " 4,993.83 " " 5,145.16 " " 5,044.27 " " 20,818.40 " " 4,615.51 " " 19,517.25 " " 19,517.25 " " 20,558.17 " " 20,037.71 " " 4,438.96 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,145.16 " " 20,558.17 " Outpatient Trluml balo angiop 1st vein 37248 " 26,023.00 " " 9,618.10 " " 4,287.63 " " 21,424.94 " " 6,687.91 " " 17,172.58 " " 5,145.16 " " 17,732.07 " " 4,287.63 " " 5,044.27 " " 17,794.53 " " 4,684.14 " " 17,414.59 " " 4,287.63 " " 5,397.37 " " 18,739.16 " " 4,539.84 " " 5,044.27 " " 17,139.66 " " 21,424.94 " " 4,993.83 " " 5,145.16 " " 5,044.27 " " 20,818.40 " " 4,615.51 " " 19,517.25 " " 19,517.25 " " 20,558.17 " " 20,037.71 " " 4,438.96 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,145.16 " " 20,558.17 " Outpatient Temporal artery procedure 37609 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Stab phleb veins xtr 10-20 37765 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Vascular surgery procedure 37799 " 2,844.00 " " 1,051.14 " 467.60 " 2,341.03 " 730.91 " 1,876.76 " 561.12 " 1,937.90 " 467.60 550.12 " 1,944.73 " 511.92 " 1,903.20 " 467.60 588.63 " 2,047.96 " 495.11 550.12 " 1,872.79 " " 2,341.03 " 544.62 561.12 550.12 " 2,275.20 " 503.36 " 2,133.00 " " 2,133.00 " " 2,246.76 " " 2,189.88 " 484.11 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 561.12 " 2,246.76 " Outpatient Harvest auto stem cells 38206 " 7,157.00 " " 2,645.23 " " 1,179.94 " " 5,891.99 " " 1,839.35 " " 4,722.90 " " 1,415.93 " " 4,876.78 " " 1,179.94 " " 1,388.17 " " 4,893.96 " " 1,288.26 " " 4,789.46 " " 1,179.94 " " 1,485.34 " " 5,153.76 " " 1,249.35 " " 1,388.17 " " 4,713.51 " " 5,891.99 " " 1,374.29 " " 1,415.93 " " 1,388.17 " " 5,725.60 " " 1,270.18 " " 5,367.75 " " 5,367.75 " " 5,654.03 " " 5,510.89 " " 1,221.59 " " 2,927.21 " " 5,367.75 " " 2,720.38 " " 3,201.33 " " 1,415.93 " " 5,654.03 " Outpatient Cryopreserve stem cells 38207 " 2,085.00 " 770.62 343.37 " 1,716.20 " 535.85 " 1,375.89 " 412.04 " 1,420.72 " 343.37 403.96 " 1,425.72 " 375.30 " 1,395.28 " 343.37 432.24 " 1,501.41 " 363.56 403.96 " 1,372.93 " " 1,716.20 " 399.92 412.04 403.96 " 1,668.00 " 369.62 " 1,563.75 " " 1,563.75 " " 1,647.15 " " 1,605.45 " 355.48 852.77 " 1,563.75 " 792.51 932.62 412.04 " 1,647.15 " Outpatient Thaw preserved stem cells 38208 " 2,085.00 " 770.62 343.37 " 1,716.20 " 535.85 " 1,375.89 " 412.04 " 1,420.72 " 343.37 403.96 " 1,425.72 " 375.30 " 1,395.28 " 343.37 432.24 " 1,501.41 " 363.56 403.96 " 1,372.93 " " 1,716.20 " 399.92 412.04 403.96 " 1,668.00 " 369.62 " 1,563.75 " " 1,563.75 " " 1,647.15 " " 1,605.45 " 355.48 852.77 " 1,563.75 " 792.51 932.62 412.04 " 1,647.15 " Outpatient Dx bone marrow aspirations 38220 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Dx bone marrow biopsies 38221 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Dx bone marrow bx & aspir 38222 " 12,443.00 " " 4,598.93 " " 2,051.15 " " 10,243.90 " " 3,197.85 " " 8,211.14 " " 2,461.38 " " 8,478.66 " " 2,051.15 " " 2,413.12 " " 8,508.52 " " 2,239.74 " " 8,326.86 " " 2,051.15 " " 2,582.04 " " 8,960.20 " " 2,171.81 " " 2,413.12 " " 8,194.98 " " 10,243.90 " " 2,388.99 " " 2,461.38 " " 2,413.12 " " 9,954.40 " " 2,208.00 " " 9,332.25 " " 9,332.25 " " 9,829.97 " " 9,581.11 " " 2,123.55 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,461.38 " " 9,829.97 " Outpatient Transplt autol hct/donor 38241 " 7,157.00 " " 2,645.23 " " 1,179.94 " " 5,891.99 " " 1,839.35 " " 4,722.90 " " 1,415.93 " " 4,876.78 " " 1,179.94 " " 1,388.17 " " 4,893.96 " " 1,288.26 " " 4,789.46 " " 1,179.94 " " 1,485.34 " " 5,153.76 " " 1,249.35 " " 1,388.17 " " 4,713.51 " " 5,891.99 " " 1,374.29 " " 1,415.93 " " 1,388.17 " " 5,725.60 " " 1,270.18 " " 5,367.75 " " 5,367.75 " " 5,654.03 " " 5,510.89 " " 1,221.59 " " 2,927.21 " " 5,367.75 " " 2,720.38 " " 3,201.33 " " 1,415.93 " " 5,654.03 " Outpatient Biopsy/removal lymph nodes 38500 " 16,578.00 " " 6,127.23 " " 2,731.71 " " 13,648.71 " " 4,260.55 " " 10,939.82 " " 3,278.06 " " 11,296.25 " " 2,731.71 " " 3,213.78 " " 11,336.04 " " 2,984.04 " " 11,094.00 " " 2,731.71 " " 3,438.74 " " 11,937.82 " " 2,892.40 " " 3,213.78 " " 10,918.78 " " 13,648.71 " " 3,181.64 " " 3,278.06 " " 3,213.78 " " 13,262.40 " " 2,940.61 " " 12,433.50 " " 12,433.50 " " 13,096.62 " " 12,765.06 " " 2,828.13 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,278.06 " " 13,096.62 " Outpatient Needle biopsy lymph nodes 38505 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Biopsy/removal lymph nodes 38510 " 16,578.00 " " 6,127.23 " " 2,731.71 " " 13,648.71 " " 4,260.55 " " 10,939.82 " " 3,278.06 " " 11,296.25 " " 2,731.71 " " 3,213.78 " " 11,336.04 " " 2,984.04 " " 11,094.00 " " 2,731.71 " " 3,438.74 " " 11,937.82 " " 2,892.40 " " 3,213.78 " " 10,918.78 " " 13,648.71 " " 3,181.64 " " 3,278.06 " " 3,213.78 " " 13,262.40 " " 2,940.61 " " 12,433.50 " " 12,433.50 " " 13,096.62 " " 12,765.06 " " 2,828.13 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,278.06 " " 13,096.62 " Outpatient Biopsy/removal lymph nodes 38525 " 16,578.00 " " 6,127.23 " " 2,731.71 " " 13,648.71 " " 4,260.55 " " 10,939.82 " " 3,278.06 " " 11,296.25 " " 2,731.71 " " 3,213.78 " " 11,336.04 " " 2,984.04 " " 11,094.00 " " 2,731.71 " " 3,438.74 " " 11,937.82 " " 2,892.40 " " 3,213.78 " " 10,918.78 " " 13,648.71 " " 3,181.64 " " 3,278.06 " " 3,213.78 " " 13,262.40 " " 2,940.61 " " 12,433.50 " " 12,433.50 " " 13,096.62 " " 12,765.06 " " 2,828.13 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,278.06 " " 13,096.62 " Outpatient Open bx/exc inguinofem nodes 38531 " 16,578.00 " " 6,127.23 " " 2,731.71 " " 13,648.71 " " 4,260.55 " " 10,939.82 " " 3,278.06 " " 11,296.25 " " 2,731.71 " " 3,213.78 " " 11,336.04 " " 2,984.04 " " 11,094.00 " " 2,731.71 " " 3,438.74 " " 11,937.82 " " 2,892.40 " " 3,213.78 " " 10,918.78 " " 13,648.71 " " 3,181.64 " " 3,278.06 " " 3,213.78 " " 13,262.40 " " 2,940.61 " " 12,433.50 " " 12,433.50 " " 13,096.62 " " 12,765.06 " " 2,828.13 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,278.06 " " 13,096.62 " Outpatient Laparoscopy lymphadenectomy 38571 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Laparoscopy lymphadenectomy 38572 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Mediastinoscpy w/lmph nod bx 39402 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Biopsy of lip 40490 " 1,111.00 " 410.63 183.02 914.58 285.53 733.15 219.63 757.04 183.02 215.32 759.70 199.98 743.48 183.02 230.39 800.03 193.79 215.32 731.65 914.58 213.17 219.63 215.32 888.80 197.02 833.25 833.25 877.69 855.47 189.48 454.40 833.25 422.29 496.95 219.63 877.69 Outpatient Repair cleft lip/nasal 40700 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Biopsy of mouth lesion 40808 " 2,375.00 " 877.80 391.25 " 1,955.23 " 610.38 " 1,567.26 " 469.50 " 1,618.33 " 391.25 460.29 " 1,624.03 " 427.50 " 1,589.35 " 391.25 492.51 " 1,710.24 " 414.26 460.29 " 1,564.15 " " 1,955.23 " 455.69 469.50 460.29 " 1,900.00 " 421.17 " 1,781.25 " " 1,781.25 " " 1,876.25 " " 1,828.75 " 405.06 971.38 " 1,781.25 " 902.74 " 1,062.34 " 469.50 " 1,876.25 " Outpatient Incision of tongue fold 41010 " 7,102.00 " " 2,624.90 " " 1,170.22 " " 5,847.14 " " 1,825.21 " " 4,686.61 " " 1,404.26 " " 4,839.30 " " 1,170.22 " " 1,376.73 " " 4,856.35 " " 1,278.36 " " 4,752.66 " " 1,170.22 " " 1,473.10 " " 5,114.15 " " 1,239.06 " " 1,376.73 " " 4,677.63 " " 5,847.14 " " 1,362.96 " " 1,404.26 " " 1,376.73 " " 5,681.60 " " 1,259.71 " " 5,326.50 " " 5,326.50 " " 5,610.58 " " 5,468.54 " " 1,211.52 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,404.26 " " 5,610.58 " Outpatient Biopsy of tongue 41100 " 2,375.00 " 877.80 391.25 " 1,955.23 " 610.38 " 1,567.26 " 469.50 " 1,618.33 " 391.25 460.29 " 1,624.03 " 427.50 " 1,589.35 " 391.25 492.51 " 1,710.24 " 414.26 460.29 " 1,564.15 " " 1,955.23 " 455.69 469.50 460.29 " 1,900.00 " 421.17 " 1,781.25 " " 1,781.25 " " 1,876.25 " " 1,828.75 " 405.06 971.38 " 1,781.25 " 902.74 " 1,062.34 " 469.50 " 1,876.25 " Outpatient Biopsy of floor of mouth 41108 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Drainage of gum lesion 41800 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Dental surgery procedure 41899 " 1,111.00 " 410.63 183.02 914.58 285.53 733.15 219.63 757.04 183.02 215.32 759.70 199.98 743.48 183.02 230.39 800.03 193.79 215.32 731.65 914.58 213.17 219.63 215.32 888.80 197.02 833.25 833.25 877.69 855.47 189.48 454.40 833.25 422.29 496.95 219.63 877.69 Outpatient Reconstruct cleft palate 42200 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Reconstruct cleft palate 42210 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Biopsy of salivary gland 42400 " 3,265.00 " " 1,206.74 " 538.33 " 2,688.34 " 839.11 " 2,154.57 " 646.00 " 2,224.77 " 538.33 633.33 " 2,232.61 " 587.70 " 2,184.94 " 538.33 677.66 " 2,351.13 " 570.00 633.33 " 2,150.63 " " 2,688.34 " 627.00 646.00 633.33 " 2,612.00 " 579.50 " 2,448.75 " " 2,448.75 " " 2,579.35 " " 2,514.05 " 557.33 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 646.00 " 2,579.35 " Outpatient Excise parotid gland/lesion 42415 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Excise submaxillary gland 42440 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Salivary surgery procedure 42699 " 1,111.00 " 410.63 183.02 914.58 285.53 733.15 219.63 757.04 183.02 215.32 759.70 199.98 743.48 183.02 230.39 800.03 193.79 215.32 731.65 914.58 213.17 219.63 215.32 888.80 197.02 833.25 833.25 877.69 855.47 189.48 454.40 833.25 422.29 496.95 219.63 877.69 Outpatient Biopsy of throat 42800 " 7,102.00 " " 2,624.90 " " 1,170.22 " " 5,847.14 " " 1,825.21 " " 4,686.61 " " 1,404.26 " " 4,839.30 " " 1,170.22 " " 1,376.73 " " 4,856.35 " " 1,278.36 " " 4,752.66 " " 1,170.22 " " 1,473.10 " " 5,114.15 " " 1,239.06 " " 1,376.73 " " 4,677.63 " " 5,847.14 " " 1,362.96 " " 1,404.26 " " 1,376.73 " " 5,681.60 " " 1,259.71 " " 5,326.50 " " 5,326.50 " " 5,610.58 " " 5,468.54 " " 1,211.52 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,404.26 " " 5,610.58 " Outpatient Excision of neck cyst 42815 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Remove tonsils and adenoids 42820 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Remove tonsils and adenoids 42821 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Removal of tonsils 42825 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Removal of tonsils 42826 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Removal of adenoids 42830 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Control throat bleeding 42962 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Esophagoscopy rigid trnso 43180 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Esophagoscopy flexible brush 43200 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Esophagoscopy flex remove fb 43215 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Esophagoscopy balloon <30mm 43220 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd diagnostic brush wash 43235 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Uppr gi scope w/submuc inj 43236 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Endoscopic us exam esoph 43237 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd us fine needle bx/aspir 43238 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd biopsy single/multiple 43239 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Egd tube/cath insertion 43241 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd us fine needle bx/aspir 43242 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd varices ligation 43244 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd dilate stricture 43245 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd place gastrostomy tube 43246 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd remove foreign body 43247 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Egd guide wire insertion 43248 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Esoph egd dilation <30 mm 43249 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd remove lesion snare 43251 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd us transmural injxn/mark 43253 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd endo mucosal resection 43254 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd control bleeding any 43255 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Egd us exam duodenum/jejunum 43259 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Endo cholangiopancreatograph 43261 " 16,174.00 " " 5,977.91 " " 2,656.24 " " 13,316.10 " " 4,156.72 " " 10,673.22 " " 3,187.49 " " 11,020.96 " " 2,656.24 " " 3,124.99 " " 11,059.78 " " 2,911.32 " " 10,823.64 " " 2,656.24 " " 3,343.74 " " 11,646.90 " " 2,812.49 " " 3,124.99 " " 10,652.70 " " 13,316.10 " " 3,093.74 " " 3,187.49 " " 3,124.99 " " 12,939.20 " " 2,859.37 " " 12,130.50 " " 12,130.50 " " 12,777.46 " " 12,453.98 " " 2,749.99 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,187.49 " " 12,777.46 " Outpatient Endo cholangiopancreatograph 43262 " 16,174.00 " " 5,977.91 " " 2,656.24 " " 13,316.10 " " 4,156.72 " " 10,673.22 " " 3,187.49 " " 11,020.96 " " 2,656.24 " " 3,124.99 " " 11,059.78 " " 2,911.32 " " 10,823.64 " " 2,656.24 " " 3,343.74 " " 11,646.90 " " 2,812.49 " " 3,124.99 " " 10,652.70 " " 13,316.10 " " 3,093.74 " " 3,187.49 " " 3,124.99 " " 12,939.20 " " 2,859.37 " " 12,130.50 " " 12,130.50 " " 12,777.46 " " 12,453.98 " " 2,749.99 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,187.49 " " 12,777.46 " Outpatient Ercp remove duct calculi 43264 " 16,174.00 " " 5,977.91 " " 2,656.24 " " 13,316.10 " " 4,156.72 " " 10,673.22 " " 3,187.49 " " 11,020.96 " " 2,656.24 " " 3,124.99 " " 11,059.78 " " 2,911.32 " " 10,823.64 " " 2,656.24 " " 3,343.74 " " 11,646.90 " " 2,812.49 " " 3,124.99 " " 10,652.70 " " 13,316.10 " " 3,093.74 " " 3,187.49 " " 3,124.99 " " 12,939.20 " " 2,859.37 " " 12,130.50 " " 12,130.50 " " 12,777.46 " " 12,453.98 " " 2,749.99 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,187.49 " " 12,777.46 " Outpatient Egd endoscopic stent place 43266 " 26,400.00 " " 9,757.44 " " 4,354.52 " " 21,734.77 " " 6,784.80 " " 17,421.36 " " 5,225.42 " " 17,988.96 " " 4,354.52 " " 5,122.96 " " 18,052.32 " " 4,752.00 " " 17,666.88 " " 4,354.52 " " 5,481.57 " " 19,010.64 " " 4,610.66 " " 5,122.96 " " 17,387.52 " " 21,734.77 " " 5,071.73 " " 5,225.42 " " 5,122.96 " " 21,120.00 " " 4,687.51 " " 19,800.00 " " 19,800.00 " " 20,856.00 " " 20,328.00 " " 4,508.20 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,225.42 " " 20,856.00 " Outpatient Egd lesion ablation 43270 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Ercp duct stent placement 43274 " 26,400.00 " " 9,757.44 " " 4,354.52 " " 21,734.77 " " 6,784.80 " " 17,421.36 " " 5,225.42 " " 17,988.96 " " 4,354.52 " " 5,122.96 " " 18,052.32 " " 4,752.00 " " 17,666.88 " " 4,354.52 " " 5,481.57 " " 19,010.64 " " 4,610.66 " " 5,122.96 " " 17,387.52 " " 21,734.77 " " 5,071.73 " " 5,225.42 " " 5,122.96 " " 21,120.00 " " 4,687.51 " " 19,800.00 " " 19,800.00 " " 20,856.00 " " 20,328.00 " " 4,508.20 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,225.42 " " 20,856.00 " Outpatient Ercp remove forgn body duct 43275 " 16,174.00 " " 5,977.91 " " 2,656.24 " " 13,316.10 " " 4,156.72 " " 10,673.22 " " 3,187.49 " " 11,020.96 " " 2,656.24 " " 3,124.99 " " 11,059.78 " " 2,911.32 " " 10,823.64 " " 2,656.24 " " 3,343.74 " " 11,646.90 " " 2,812.49 " " 3,124.99 " " 10,652.70 " " 13,316.10 " " 3,093.74 " " 3,187.49 " " 3,124.99 " " 12,939.20 " " 2,859.37 " " 12,130.50 " " 12,130.50 " " 12,777.46 " " 12,453.98 " " 2,749.99 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,187.49 " " 12,777.46 " Outpatient Ercp stent exchange w/dilate 43276 " 26,400.00 " " 9,757.44 " " 4,354.52 " " 21,734.77 " " 6,784.80 " " 17,421.36 " " 5,225.42 " " 17,988.96 " " 4,354.52 " " 5,122.96 " " 18,052.32 " " 4,752.00 " " 17,666.88 " " 4,354.52 " " 5,481.57 " " 19,010.64 " " 4,610.66 " " 5,122.96 " " 17,387.52 " " 21,734.77 " " 5,071.73 " " 5,225.42 " " 5,122.96 " " 21,120.00 " " 4,687.51 " " 19,800.00 " " 19,800.00 " " 20,856.00 " " 20,328.00 " " 4,508.20 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,225.42 " " 20,856.00 " Outpatient Ercp ea duct/ampulla dilate 43277 " 16,174.00 " " 5,977.91 " " 2,656.24 " " 13,316.10 " " 4,156.72 " " 10,673.22 " " 3,187.49 " " 11,020.96 " " 2,656.24 " " 3,124.99 " " 11,059.78 " " 2,911.32 " " 10,823.64 " " 2,656.24 " " 3,343.74 " " 11,646.90 " " 2,812.49 " " 3,124.99 " " 10,652.70 " " 13,316.10 " " 3,093.74 " " 3,187.49 " " 3,124.99 " " 12,939.20 " " 2,859.37 " " 12,130.50 " " 12,130.50 " " 12,777.46 " " 12,453.98 " " 2,749.99 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,187.49 " " 12,777.46 " Outpatient Lap paraesophag hern repair 43281 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Lap paraesoph her rpr w/mesh 43282 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Dilate esophagus 1/mult pass 43450 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Esophagus surgery procedure 43499 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Laparoscopy gastrostomy 43653 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Laparoscope proc stom 43659 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Nasal/orogastric w/tube plmt 43752 " 1,419.00 " 524.46 234.79 " 1,167.95 " 364.68 936.40 281.74 966.91 234.79 276.22 970.31 255.42 949.59 234.79 295.56 " 1,021.82 " 248.60 276.22 934.35 " 1,167.95 " 273.46 281.74 276.22 " 1,135.20 " 252.74 " 1,064.25 " " 1,064.25 " " 1,121.01 " " 1,092.63 " 243.07 580.37 " 1,064.25 " 539.36 634.72 281.74 " 1,121.01 " Outpatient Rplc gtube no revj trc 43762 " 1,397.00 " 516.33 230.20 " 1,150.34 " 359.03 921.88 276.24 951.92 230.20 270.82 955.27 251.46 934.87 230.20 289.78 " 1,005.98 " 243.74 270.82 920.26 " 1,150.34 " 268.11 276.24 270.82 " 1,117.60 " 247.80 " 1,047.75 " " 1,047.75 " " 1,103.63 " " 1,075.69 " 238.32 571.37 " 1,047.75 " 531.00 624.88 276.24 " 1,103.63 " Outpatient Lap rmvl gastr adj all parts 43774 " 16,174.00 " " 5,977.91 " " 2,656.24 " " 13,316.10 " " 4,156.72 " " 10,673.22 " " 3,187.49 " " 11,020.96 " " 2,656.24 " " 3,124.99 " " 11,059.78 " " 2,911.32 " " 10,823.64 " " 2,656.24 " " 3,343.74 " " 11,646.90 " " 2,812.49 " " 3,124.99 " " 10,652.70 " " 13,316.10 " " 3,093.74 " " 3,187.49 " " 3,124.99 " " 12,939.20 " " 2,859.37 " " 12,130.50 " " 12,130.50 " " 12,777.46 " " 12,453.98 " " 2,749.99 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,187.49 " " 12,777.46 " Outpatient Repair stomach opening 43870 " 16,174.00 " " 5,977.91 " " 2,656.24 " " 13,316.10 " " 4,156.72 " " 10,673.22 " " 3,187.49 " " 11,020.96 " " 2,656.24 " " 3,124.99 " " 11,059.78 " " 2,911.32 " " 10,823.64 " " 2,656.24 " " 3,343.74 " " 11,646.90 " " 2,812.49 " " 3,124.99 " " 10,652.70 " " 13,316.10 " " 3,093.74 " " 3,187.49 " " 3,124.99 " " 12,939.20 " " 2,859.37 " " 12,130.50 " " 12,130.50 " " 12,777.46 " " 12,453.98 " " 2,749.99 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,187.49 " " 12,777.46 " Outpatient Stomach surgery procedure 43999 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Small bowel endoscopy 44360 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Small bowel endoscopy/biopsy 44361 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Small bowel endoscopy 44373 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Small bowel endoscopy br/wa 44380 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Small bowel endoscopy 44382 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Endoscopy of bowel pouch 44385 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Endoscopy bowel pouch/biop 44386 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Colonoscopy thru stoma spx 44388 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Unlisted px small intestine 44799 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Laparoscopy appendectomy 44970 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Biopsy of rectum 45100 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Exc rect tum transanal part 45171 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Proctosigmoidoscopy dx 45300 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Proctosigmoidoscopy w/bx 45305 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Diagnostic sigmoidoscopy 45330 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Sigmoidoscopy and biopsy 45331 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Sigmoidoscopy for bleeding 45334 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Sigmoidoscopy w/tumr remove 45338 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Sig w/tndsc balloon dilation 45340 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Sigmoidoscopy w/ultrasound 45341 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Sigmoidoscopy w/us guide bx 45342 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Diagnostic colonoscopy 45378 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Colonoscopy and biopsy 45380 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Colonoscopy submucous njx 45381 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Colonoscopy w/control bleed 45382 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Colonoscopy w/lesion removal 45385 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Colonoscopy w/balloon dilat 45386 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Colonoscopy w/resection 45390 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Unlisted procedure colon 45399 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Remove rectal obstruction 45915 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Surg dx exam anorectal 45990 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Rectum surgery procedure 45999 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Placement of seton 46020 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Incision of anal abscess 46050 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Incision of rectal abscess 46060 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Ligation of hemorrhoid(s) 46221 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Remove int/ext hem 1 group 46255 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Remove in/ex hem groups 2+ 46260 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Remove anal fist subq 46270 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Remove anal fist inter 46275 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Remove anal fist complex 46280 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Chemodenervation anal musc 46505 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Diagnostic anoscopy spx 46600 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Anoscopy and biopsy 46606 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Diagnostic anoscopy & biopsy 46607 " 5,444.00 " " 2,012.10 " 897.06 " 4,482.05 " " 1,399.11 " " 3,592.50 " " 1,076.48 " " 3,709.54 " 897.06 " 1,055.37 " " 3,722.61 " 979.92 " 3,643.12 " 897.06 " 1,129.25 " " 3,920.22 " 949.83 " 1,055.37 " " 3,585.58 " " 4,482.05 " " 1,044.82 " " 1,076.48 " " 1,055.37 " " 4,355.20 " 965.66 " 4,083.00 " " 4,083.00 " " 4,300.76 " " 4,191.88 " 928.73 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,076.48 " " 4,300.76 " Outpatient Destruction anal lesion(s) 46910 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Excision of anal lesion(s) 46922 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Destruction anal lesion(s) 46924 " 12,828.00 " " 4,741.23 " " 2,113.41 " " 10,561.06 " " 3,296.80 " " 8,465.20 " " 2,536.09 " " 8,741.00 " " 2,113.41 " " 2,486.36 " " 8,771.79 " " 2,309.04 " " 8,584.50 " " 2,113.41 " " 2,660.41 " " 9,237.44 " " 2,237.72 " " 2,486.36 " " 8,448.71 " " 10,561.06 " " 2,461.50 " " 2,536.09 " " 2,486.36 " " 10,262.40 " " 2,275.02 " " 9,621.00 " " 9,621.00 " " 10,134.12 " " 9,877.56 " " 2,188.00 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,536.09 " " 10,134.12 " Outpatient Anus surgery procedure 46999 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Needle biopsy of liver 47000 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Laparoscope procedure liver 47379 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Injection for cholangiogram 47531 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Plmt biliary drainage cath 47534 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Exchange biliary drg cath 47536 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Biliary endoscopy thru skin 47554 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Laparoscopic cholecystectomy 47562 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Laparo cholecystectomy/graph 47563 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Abd paracentesis 49082 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Abd paracentesis w/imaging 49083 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Biopsy abdominal mass 49180 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Diag laparo separate proc 49320 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Laparoscopy biopsy 49321 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Laparoscopy aspiration 49322 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Laparo proc abdm/per/oment 49329 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Image cath fluid peri/retro 49406 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Insert tun ip cath perc 49418 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Ins tun ip cath for dial opn 49421 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Exchange drainage catheter 49423 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Place gastrostomy tube perc 49440 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Change g-tube to g-j perc 49446 " 8,531.00 " " 3,153.06 " " 1,405.08 " " 7,023.83 " " 2,192.47 " " 5,629.61 " " 1,686.10 " " 5,813.02 " " 1,405.08 " " 1,653.04 " " 5,833.50 " " 1,535.58 " " 5,708.95 " " 1,405.08 " " 1,768.75 " " 6,143.17 " " 1,487.74 " " 1,653.04 " " 5,618.97 " " 7,023.83 " " 1,636.51 " " 1,686.10 " " 1,653.04 " " 6,824.80 " " 1,512.53 " " 6,398.25 " " 6,398.25 " " 6,739.49 " " 6,568.87 " " 1,454.68 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,686.10 " " 6,739.49 " Outpatient Replace g/c tube perc 49450 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Replace duod/jej tube perc 49451 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Replace g-j tube perc 49452 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Rpr ing hernia baby reduc 49495 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Rpr ing hernia init reduce 49500 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Prp i/hern init reduc >5 yr 49505 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Rerepair ing hernia reduce 49520 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Rpr ventral hern init reduc 49560 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Rpr epigastric hern reduce 49570 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Rpr epigastric hern blocked 49572 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Rpr umbil hern reduc < 5 yr 49580 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Rpr umbil hern reduc > 5 yr 49585 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Rpr umbil hern block > 5 yr 49587 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Lap ing hernia repair init 49650 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Lap ing hernia repair recur 49651 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Lap vent/abd hernia repair 49652 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Lap vent/abd hern proc comp 49653 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Lap inc hernia repair 49654 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Removal of kidney stone 50080 " 43,355.00 " " 16,024.01 " " 7,139.57 " " 35,694.10 " " 11,142.24 " " 28,609.96 " " 8,567.48 " " 29,542.10 " " 7,139.57 " " 8,399.49 " " 29,646.15 " " 7,803.90 " " 29,013.17 " " 7,139.57 " " 8,987.45 " " 31,219.94 " " 7,559.54 " " 8,399.49 " " 28,554.80 " " 35,694.10 " " 8,315.50 " " 8,567.48 " " 8,399.49 " " 34,684.00 " " 7,685.53 " " 32,516.25 " " 32,516.25 " " 34,250.45 " " 33,383.35 " " 7,391.55 " " 17,732.20 " " 32,516.25 " " 16,479.24 " " 19,392.69 " " 8,567.48 " " 34,250.45 " Outpatient Removal of kidney stone 50081 " 43,355.00 " " 16,024.01 " " 7,139.57 " " 35,694.10 " " 11,142.24 " " 28,609.96 " " 8,567.48 " " 29,542.10 " " 7,139.57 " " 8,399.49 " " 29,646.15 " " 7,803.90 " " 29,013.17 " " 7,139.57 " " 8,987.45 " " 31,219.94 " " 7,559.54 " " 8,399.49 " " 28,554.80 " " 35,694.10 " " 8,315.50 " " 8,567.48 " " 8,399.49 " " 34,684.00 " " 7,685.53 " " 32,516.25 " " 32,516.25 " " 34,250.45 " " 33,383.35 " " 7,391.55 " " 17,732.20 " " 32,516.25 " " 16,479.24 " " 19,392.69 " " 8,567.48 " " 34,250.45 " Outpatient Renal biopsy perq 50200 " 7,387.00 " " 2,730.24 " " 1,217.19 " " 6,081.49 " " 1,898.46 " " 4,874.68 " " 1,460.63 " " 5,033.50 " " 1,217.19 " " 1,431.99 " " 5,051.23 " " 1,329.66 " " 4,943.38 " " 1,217.19 " " 1,532.23 " " 5,319.38 " " 1,288.79 " " 1,431.99 " " 4,865.11 " " 6,081.49 " " 1,417.67 " " 1,460.63 " " 1,431.99 " " 5,909.60 " " 1,310.27 " " 5,540.25 " " 5,540.25 " " 5,835.73 " " 5,687.99 " " 1,260.15 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,460.63 " " 5,835.73 " Outpatient Change nephroureteral cath 50387 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Remove renal tube w/fluoro 50389 " 3,018.00 " " 1,115.45 " 497.69 " 2,484.31 " 775.63 " 1,991.58 " 597.23 " 2,056.47 " 497.69 585.52 " 2,063.71 " 543.24 " 2,019.65 " 497.69 626.51 " 2,173.26 " 526.97 585.52 " 1,987.42 " " 2,484.31 " 579.66 597.23 585.52 " 2,414.40 " 535.75 " 2,263.50 " " 2,263.50 " " 2,384.22 " " 2,323.86 " 515.26 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 597.23 " 2,384.22 " Outpatient Njx px nfrosgrm &/urtrgrm 50431 " 3,018.00 " " 1,115.45 " 497.69 " 2,484.31 " 775.63 " 1,991.58 " 597.23 " 2,056.47 " 497.69 585.52 " 2,063.71 " 543.24 " 2,019.65 " 497.69 626.51 " 2,173.26 " 526.97 585.52 " 1,987.42 " " 2,484.31 " 579.66 597.23 585.52 " 2,414.40 " 535.75 " 2,263.50 " " 2,263.50 " " 2,384.22 " " 2,323.86 " 515.26 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 597.23 " 2,384.22 " Outpatient Plmt nephrostomy catheter 50432 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Plmt nephroureteral catheter 50433 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Convert nephrostomy catheter 50434 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Exchange nephrostomy cath 50435 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Laparoscopy pyeloplasty 50544 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Perc rf ablate renal tumor 50592 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Change of ureter tube/stent 50688 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Plmt ureteral stent prq 50693 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Endoscopy of ureter 50951 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Ureter endoscopy & treatment 50961 " 23,173.00 " " 8,564.74 " " 3,816.68 " " 19,078.17 " " 5,955.46 " " 15,291.86 " " 4,580.01 " " 15,790.08 " " 3,816.68 " " 4,490.21 " " 15,845.70 " " 4,171.14 " " 15,507.37 " " 3,816.68 " " 4,804.52 " " 16,686.88 " " 4,041.19 " " 4,490.21 " " 15,262.28 " " 19,078.17 " " 4,445.31 " " 4,580.01 " " 4,490.21 " " 18,538.40 " " 4,108.54 " " 17,379.75 " " 17,379.75 " " 18,306.67 " " 17,843.21 " " 3,951.38 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,580.01 " " 18,306.67 " Outpatient Drain bl w/cath insertion 51102 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Irrigation of bladder 51700 " 1,397.00 " 516.33 230.20 " 1,150.34 " 359.03 921.88 276.24 951.92 230.20 270.82 955.27 251.46 934.87 230.20 289.78 " 1,005.98 " 243.74 270.82 920.26 " 1,150.34 " 268.11 276.24 270.82 " 1,117.60 " 247.80 " 1,047.75 " " 1,047.75 " " 1,103.63 " " 1,075.69 " 238.32 571.37 " 1,047.75 " 531.00 624.88 276.24 " 1,103.63 " Outpatient Insert bladder catheter 51701 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Insert temp bladder cath 51702 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Insert bladder cath complex 51703 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Change of bladder tube 51705 " 1,397.00 " 516.33 230.20 " 1,150.34 " 359.03 921.88 276.24 951.92 230.20 270.82 955.27 251.46 934.87 230.20 289.78 " 1,005.98 " 243.74 270.82 920.26 " 1,150.34 " 268.11 276.24 270.82 " 1,117.60 " 247.80 " 1,047.75 " " 1,047.75 " " 1,103.63 " " 1,075.69 " 238.32 571.37 " 1,047.75 " 531.00 624.88 276.24 " 1,103.63 " Outpatient Endoscopic injection/implant 51715 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Treatment of bladder lesion 51720 " 1,397.00 " 516.33 230.20 " 1,150.34 " 359.03 921.88 276.24 951.92 230.20 270.82 955.27 251.46 934.87 230.20 289.78 " 1,005.98 " 243.74 270.82 920.26 " 1,150.34 " 268.11 276.24 270.82 " 1,117.60 " 247.80 " 1,047.75 " " 1,047.75 " " 1,103.63 " " 1,075.69 " 238.32 571.37 " 1,047.75 " 531.00 624.88 276.24 " 1,103.63 " Outpatient Simple cystometrogram 51725 " 1,397.00 " 516.33 230.20 " 1,150.34 " 359.03 921.88 276.24 951.92 230.20 270.82 955.27 251.46 934.87 230.20 289.78 " 1,005.98 " 243.74 270.82 920.26 " 1,150.34 " 268.11 276.24 270.82 " 1,117.60 " 247.80 " 1,047.75 " " 1,047.75 " " 1,103.63 " " 1,075.69 " 238.32 571.37 " 1,047.75 " 531.00 624.88 276.24 " 1,103.63 " Outpatient Cystometrogram w/vp 51728 " 3,018.00 " " 1,115.45 " 497.69 " 2,484.31 " 775.63 " 1,991.58 " 597.23 " 2,056.47 " 497.69 585.52 " 2,063.71 " 543.24 " 2,019.65 " 497.69 626.51 " 2,173.26 " 526.97 585.52 " 1,987.42 " " 2,484.31 " 579.66 597.23 585.52 " 2,414.40 " 535.75 " 2,263.50 " " 2,263.50 " " 2,384.22 " " 2,323.86 " 515.26 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 597.23 " 2,384.22 " Outpatient Cystometrogram w/vp&up 51729 " 3,018.00 " " 1,115.45 " 497.69 " 2,484.31 " 775.63 " 1,991.58 " 597.23 " 2,056.47 " 497.69 585.52 " 2,063.71 " 543.24 " 2,019.65 " 497.69 626.51 " 2,173.26 " 526.97 585.52 " 1,987.42 " " 2,484.31 " 579.66 597.23 585.52 " 2,414.40 " 535.75 " 2,263.50 " " 2,263.50 " " 2,384.22 " " 2,323.86 " 515.26 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 597.23 " 2,384.22 " Outpatient Electro-uroflowmetry first 51741 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Anal/urinary muscle study 51784 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Us urine capacity measure 51798 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Cystoscopy 52000 " 3,018.00 " " 1,115.45 " 497.69 " 2,484.31 " 775.63 " 1,991.58 " 597.23 " 2,056.47 " 497.69 585.52 " 2,063.71 " 543.24 " 2,019.65 " 497.69 626.51 " 2,173.26 " 526.97 585.52 " 1,987.42 " " 2,484.31 " 579.66 597.23 585.52 " 2,414.40 " 535.75 " 2,263.50 " " 2,263.50 " " 2,384.22 " " 2,323.86 " 515.26 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 597.23 " 2,384.22 " Outpatient Cystoscopy & ureter catheter 52005 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Cystoscopy w/biopsy(s) 52204 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Cystoscopy and treatment 52214 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Cystoscopy and treatment 52224 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Cystoscopy and treatment 52234 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Cystoscopy and treatment 52235 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Cystoscopy and treatment 52240 " 23,173.00 " " 8,564.74 " " 3,816.68 " " 19,078.17 " " 5,955.46 " " 15,291.86 " " 4,580.01 " " 15,790.08 " " 3,816.68 " " 4,490.21 " " 15,845.70 " " 4,171.14 " " 15,507.37 " " 3,816.68 " " 4,804.52 " " 16,686.88 " " 4,041.19 " " 4,490.21 " " 15,262.28 " " 19,078.17 " " 4,445.31 " " 4,580.01 " " 4,490.21 " " 18,538.40 " " 4,108.54 " " 17,379.75 " " 17,379.75 " " 18,306.67 " " 17,843.21 " " 3,951.38 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,580.01 " " 18,306.67 " Outpatient Cystoscopy and treatment 52260 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Cystoscopy and treatment 52281 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Cystoscopy chemodenervation 52287 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Cystoscopy and treatment 52310 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Remove bladder stone 52317 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Cystoscopy and treatment 52332 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Cystouretero & or pyeloscope 52351 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Cystouretero w/stone remove 52352 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Cystouretero w/biopsy 52354 " 23,173.00 " " 8,564.74 " " 3,816.68 " " 19,078.17 " " 5,955.46 " " 15,291.86 " " 4,580.01 " " 15,790.08 " " 3,816.68 " " 4,490.21 " " 15,845.70 " " 4,171.14 " " 15,507.37 " " 3,816.68 " " 4,804.52 " " 16,686.88 " " 4,041.19 " " 4,490.21 " " 15,262.28 " " 19,078.17 " " 4,445.31 " " 4,580.01 " " 4,490.21 " " 18,538.40 " " 4,108.54 " " 17,379.75 " " 17,379.75 " " 18,306.67 " " 17,843.21 " " 3,951.38 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,580.01 " " 18,306.67 " Outpatient Cysto/uretero w/lithotripsy 52356 " 23,173.00 " " 8,564.74 " " 3,816.68 " " 19,078.17 " " 5,955.46 " " 15,291.86 " " 4,580.01 " " 15,790.08 " " 3,816.68 " " 4,490.21 " " 15,845.70 " " 4,171.14 " " 15,507.37 " " 3,816.68 " " 4,804.52 " " 16,686.88 " " 4,041.19 " " 4,490.21 " " 15,262.28 " " 19,078.17 " " 4,445.31 " " 4,580.01 " " 4,490.21 " " 18,538.40 " " 4,108.54 " " 17,379.75 " " 17,379.75 " " 18,306.67 " " 17,843.21 " " 3,951.38 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,580.01 " " 18,306.67 " Outpatient Prostatectomy (turp) 52601 " 23,173.00 " " 8,564.74 " " 3,816.68 " " 19,078.17 " " 5,955.46 " " 15,291.86 " " 4,580.01 " " 15,790.08 " " 3,816.68 " " 4,490.21 " " 15,845.70 " " 4,171.14 " " 15,507.37 " " 3,816.68 " " 4,804.52 " " 16,686.88 " " 4,041.19 " " 4,490.21 " " 15,262.28 " " 19,078.17 " " 4,445.31 " " 4,580.01 " " 4,490.21 " " 18,538.40 " " 4,108.54 " " 17,379.75 " " 17,379.75 " " 18,306.67 " " 17,843.21 " " 3,951.38 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,580.01 " " 18,306.67 " Outpatient Laser surgery of prostate 52648 " 23,173.00 " " 8,564.74 " " 3,816.68 " " 19,078.17 " " 5,955.46 " " 15,291.86 " " 4,580.01 " " 15,790.08 " " 3,816.68 " " 4,490.21 " " 15,845.70 " " 4,171.14 " " 15,507.37 " " 3,816.68 " " 4,804.52 " " 16,686.88 " " 4,041.19 " " 4,490.21 " " 15,262.28 " " 19,078.17 " " 4,445.31 " " 4,580.01 " " 4,490.21 " " 18,538.40 " " 4,108.54 " " 17,379.75 " " 17,379.75 " " 18,306.67 " " 17,843.21 " " 3,951.38 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,580.01 " " 18,306.67 " Outpatient Prostate laser enucleation 52649 " 23,173.00 " " 8,564.74 " " 3,816.68 " " 19,078.17 " " 5,955.46 " " 15,291.86 " " 4,580.01 " " 15,790.08 " " 3,816.68 " " 4,490.21 " " 15,845.70 " " 4,171.14 " " 15,507.37 " " 3,816.68 " " 4,804.52 " " 16,686.88 " " 4,041.19 " " 4,490.21 " " 15,262.28 " " 19,078.17 " " 4,445.31 " " 4,580.01 " " 4,490.21 " " 18,538.40 " " 4,108.54 " " 17,379.75 " " 17,379.75 " " 18,306.67 " " 17,843.21 " " 3,951.38 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,580.01 " " 18,306.67 " Outpatient Incision of urethra 53020 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Dilate urethra stricture 53600 " 1,397.00 " 516.33 230.20 " 1,150.34 " 359.03 921.88 276.24 951.92 230.20 270.82 955.27 251.46 934.87 230.20 289.78 " 1,005.98 " 243.74 270.82 920.26 " 1,150.34 " 268.11 276.24 270.82 " 1,117.60 " 247.80 " 1,047.75 " " 1,047.75 " " 1,103.63 " " 1,075.69 " 238.32 571.37 " 1,047.75 " 531.00 624.88 276.24 " 1,103.63 " Outpatient Cryosurgery penis lesion(s) 54056 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Circumcision w/regionl block 54150 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Circum 28 days or older 54161 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Lysis penil circumic lesion 54162 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Repair of circumcision 54163 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Treatment of penis lesion 54200 " 1,397.00 " 516.33 230.20 " 1,150.34 " 359.03 921.88 276.24 951.92 230.20 270.82 955.27 251.46 934.87 230.20 289.78 " 1,005.98 " 243.74 270.82 920.26 " 1,150.34 " 268.11 276.24 270.82 " 1,117.60 " 247.80 " 1,047.75 " " 1,047.75 " " 1,103.63 " " 1,075.69 " 238.32 571.37 " 1,047.75 " 531.00 624.88 276.24 " 1,103.63 " Outpatient Penile injection 54235 " 1,397.00 " 516.33 230.20 " 1,150.34 " 359.03 921.88 276.24 951.92 230.20 270.82 955.27 251.46 934.87 230.20 289.78 " 1,005.98 " 243.74 270.82 920.26 " 1,150.34 " 268.11 276.24 270.82 " 1,117.60 " 247.80 " 1,047.75 " " 1,047.75 " " 1,103.63 " " 1,075.69 " 238.32 571.37 " 1,047.75 " 531.00 624.88 276.24 " 1,103.63 " Outpatient Revision of penis 54300 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Revise penis/urethra 54328 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Revise penis/urethra 54332 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Penis plastic surgery 54360 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Insert multi-comp penis pros 54405 " 95,856.00 " " 35,428.38 " " 15,799.90 " " 78,917.99 " " 24,634.99 " " 63,255.37 " " 18,959.88 " " 65,316.28 " " 15,799.90 " " 18,588.12 " " 65,546.33 " " 17,254.08 " " 64,146.84 " " 15,799.90 " " 19,889.29 " " 69,025.91 " " 16,729.31 " " 18,588.12 " " 63,133.32 " " 78,917.99 " " 18,402.24 " " 18,959.88 " " 18,588.12 " " 76,684.80 " " 17,008.13 " " 71,892.00 " " 71,892.00 " " 75,726.24 " " 73,809.12 " " 16,357.55 " " 39,205.10 " " 71,892.00 " " 36,434.87 " " 42,876.39 " " 18,959.88 " " 75,726.24 " Outpatient Preputial stretching 54450 " 1,397.00 " 516.33 230.20 " 1,150.34 " 359.03 921.88 276.24 951.92 230.20 270.82 955.27 251.46 934.87 230.20 289.78 " 1,005.98 " 243.74 270.82 920.26 " 1,150.34 " 268.11 276.24 270.82 " 1,117.60 " 247.80 " 1,047.75 " " 1,047.75 " " 1,103.63 " " 1,075.69 " 238.32 571.37 " 1,047.75 " 531.00 624.88 276.24 " 1,103.63 " Outpatient Removal of testis 54520 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Removal of testis 54530 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Suspension of testis 54620 " 16,151.00 " " 5,969.41 " " 2,659.74 " " 13,296.85 " " 4,150.81 " " 10,658.04 " " 3,191.69 " " 11,005.29 " " 2,659.74 " " 3,129.11 " " 11,044.05 " " 2,907.18 " " 10,808.25 " " 2,659.74 " " 3,348.15 " " 11,630.34 " " 2,816.20 " " 3,129.11 " " 10,637.30 " " 13,296.85 " " 3,097.82 " " 3,191.69 " " 3,129.11 " " 12,920.80 " " 2,863.14 " " 12,113.25 " " 12,113.25 " " 12,759.29 " " 12,436.27 " " 2,753.62 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,191.69 " " 12,759.29 " Outpatient Orchiopexy ingun/scrot appr 54640 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Removal of hydrocele 55040 " 16,713.00 " " 6,177.12 " " 2,752.33 " " 13,759.64 " " 4,295.24 " " 11,028.91 " " 3,302.80 " " 11,388.24 " " 2,752.33 " " 3,238.04 " " 11,428.35 " " 3,008.34 " " 11,184.34 " " 2,752.33 " " 3,464.70 " " 12,035.03 " " 2,914.24 " " 3,238.04 " " 11,007.52 " " 13,759.64 " " 3,205.66 " " 3,302.80 " " 3,238.04 " " 13,370.40 " " 2,962.81 " " 12,534.75 " " 12,534.75 " " 13,203.27 " " 12,869.01 " " 2,849.48 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,302.80 " " 13,203.27 " Outpatient Removal of sperm duct(s) 55250 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Biopsy of prostate 55700 " 9,413.00 " " 3,479.04 " " 1,548.95 " " 7,749.83 " " 2,419.14 " " 6,211.64 " " 1,858.74 " " 6,414.02 " " 1,548.95 " " 1,822.29 " " 6,436.61 " " 1,694.34 " " 6,299.18 " " 1,548.95 " " 1,949.85 " " 6,778.30 " " 1,640.06 " " 1,822.29 " " 6,199.76 " " 7,749.83 " " 1,804.07 " " 1,858.74 " " 1,822.29 " " 7,530.40 " " 1,667.40 " " 7,059.75 " " 7,059.75 " " 7,436.27 " " 7,248.01 " " 1,603.62 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,858.74 " " 7,436.27 " Outpatient Laparo radical prostatectomy 55866 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Tprnl plmt biodegrdabl matrl 55874 " 23,173.00 " " 8,564.74 " " 3,816.68 " " 19,078.17 " " 5,955.46 " " 15,291.86 " " 4,580.01 " " 15,790.08 " " 3,816.68 " " 4,490.21 " " 15,845.70 " " 4,171.14 " " 15,507.37 " " 3,816.68 " " 4,804.52 " " 16,686.88 " " 4,041.19 " " 4,490.21 " " 15,262.28 " " 19,078.17 " " 4,445.31 " " 4,580.01 " " 4,490.21 " " 18,538.40 " " 4,108.54 " " 17,379.75 " " 17,379.75 " " 18,306.67 " " 17,843.21 " " 3,951.38 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,580.01 " " 18,306.67 " Outpatient Place rt device/marker pros 55876 " 6,626.00 " " 2,448.97 " " 1,092.40 " " 5,455.51 " " 1,702.88 " " 4,372.50 " " 1,310.88 " " 4,514.96 " " 1,092.40 " " 1,285.18 " " 4,530.86 " " 1,192.68 " " 4,434.12 " " 1,092.40 " " 1,375.14 " " 4,771.38 " " 1,156.66 " " 1,285.18 " " 4,364.33 " " 5,455.51 " " 1,272.33 " " 1,310.88 " " 1,285.18 " " 5,300.80 " " 1,175.94 " " 4,969.50 " " 4,969.50 " " 5,234.54 " " 5,102.02 " " 1,130.96 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,310.88 " " 5,234.54 " Outpatient I & d of vulva/perineum 56405 " 1,478.00 " 546.27 243.98 " 1,216.64 " 379.85 975.33 292.78 " 1,007.11 " 243.98 287.04 " 1,010.66 " 266.04 989.08 243.98 307.13 " 1,064.31 " 258.34 287.04 973.30 " 1,216.64 " 284.17 292.78 287.04 " 1,182.40 " 262.64 " 1,108.50 " " 1,108.50 " " 1,167.62 " " 1,138.06 " 252.60 604.50 " 1,108.50 " 561.79 661.11 292.78 " 1,167.62 " Outpatient Drainage of gland abscess 56420 894.00 330.42 147.37 736.16 229.76 589.95 176.85 609.17 147.37 173.38 611.32 160.92 598.26 147.37 185.52 643.77 156.04 173.38 588.91 736.16 171.65 176.85 173.38 715.20 158.64 670.50 670.50 706.26 688.38 152.57 365.65 670.50 339.81 399.89 176.85 706.26 Outpatient Destroy vulva lesions sim 56501 " 9,006.00 " " 3,328.62 " " 1,481.69 " " 7,414.31 " " 2,314.54 " " 5,943.06 " " 1,778.03 " " 6,136.69 " " 1,481.69 " " 1,743.17 " " 6,158.30 " " 1,621.08 " " 6,026.82 " " 1,481.69 " " 1,865.19 " " 6,485.22 " " 1,568.85 " " 1,743.17 " " 5,931.35 " " 7,414.31 " " 1,725.74 " " 1,778.03 " " 1,743.17 " " 7,204.80 " " 1,595.00 " " 6,754.50 " " 6,754.50 " " 7,114.74 " " 6,934.62 " " 1,533.99 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,778.03 " " 7,114.74 " Outpatient Biopsy of vulva/perineum 56605 " 3,325.00 " " 1,228.92 " 548.44 " 2,737.78 " 854.53 " 2,194.17 " 658.12 " 2,265.66 " 548.44 645.22 " 2,273.64 " 598.50 " 2,225.09 " 548.44 690.39 " 2,394.33 " 580.70 645.22 " 2,190.18 " " 2,737.78 " 638.77 658.12 645.22 " 2,660.00 " 590.38 " 2,493.75 " " 2,493.75 " " 2,626.75 " " 2,560.25 " 567.79 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 658.12 " 2,626.75 " Outpatient Partial removal of vulva 56620 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Biopsy of vagina 57100 " 3,325.00 " " 1,228.92 " 548.44 " 2,737.78 " 854.53 " 2,194.17 " 658.12 " 2,265.66 " 548.44 645.22 " 2,273.64 " 598.50 " 2,225.09 " 548.44 690.39 " 2,394.33 " 580.70 645.22 " 2,190.18 " " 2,737.78 " 638.77 658.12 645.22 " 2,660.00 " 590.38 " 2,493.75 " " 2,493.75 " " 2,626.75 " " 2,560.25 " 567.79 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 658.12 " 2,626.75 " Outpatient Remove vagina lesion 57135 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Ins vag brachytx device 57156 " 1,478.00 " 546.27 243.98 " 1,216.64 " 379.85 975.33 292.78 " 1,007.11 " 243.98 287.04 " 1,010.66 " 266.04 989.08 243.98 307.13 " 1,064.31 " 258.34 287.04 973.30 " 1,216.64 " 284.17 292.78 287.04 " 1,182.40 " 262.64 " 1,108.50 " " 1,108.50 " " 1,167.62 " " 1,138.06 " 252.60 604.50 " 1,108.50 " 561.79 661.11 292.78 " 1,167.62 " Outpatient Insert pessary/other device 57160 894.00 330.42 147.37 736.16 229.76 589.95 176.85 609.17 147.37 173.38 611.32 160.92 598.26 147.37 185.52 643.77 156.04 173.38 588.91 736.16 171.65 176.85 173.38 715.20 158.64 670.50 670.50 706.26 688.38 152.57 365.65 670.50 339.81 399.89 176.85 706.26 Outpatient Anterior colporrhaphy 57240 " 23,150.00 " " 8,556.24 " " 3,814.65 " " 19,059.32 " " 5,949.55 " " 15,276.69 " " 4,577.58 " " 15,774.41 " " 3,814.65 " " 4,487.82 " " 15,829.97 " " 4,167.00 " " 15,491.98 " " 3,814.65 " " 4,801.97 " " 16,670.32 " " 4,039.04 " " 4,487.82 " " 15,247.20 " " 19,059.32 " " 4,442.94 " " 4,577.58 " " 4,487.82 " " 18,520.00 " " 4,106.36 " " 17,362.50 " " 17,362.50 " " 18,288.50 " " 17,825.50 " " 3,949.28 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,577.58 " " 18,288.50 " Outpatient Repair rectum & vagina 57250 " 23,150.00 " " 8,556.24 " " 3,814.65 " " 19,059.32 " " 5,949.55 " " 15,276.69 " " 4,577.58 " " 15,774.41 " " 3,814.65 " " 4,487.82 " " 15,829.97 " " 4,167.00 " " 15,491.98 " " 3,814.65 " " 4,801.97 " " 16,670.32 " " 4,039.04 " " 4,487.82 " " 15,247.20 " " 19,059.32 " " 4,442.94 " " 4,577.58 " " 4,487.82 " " 18,520.00 " " 4,106.36 " " 17,362.50 " " 17,362.50 " " 18,288.50 " " 17,825.50 " " 3,949.28 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,577.58 " " 18,288.50 " Outpatient Cmbn ant pst colprhy 57260 " 23,150.00 " " 8,556.24 " " 3,814.65 " " 19,059.32 " " 5,949.55 " " 15,276.69 " " 4,577.58 " " 15,774.41 " " 3,814.65 " " 4,487.82 " " 15,829.97 " " 4,167.00 " " 15,491.98 " " 3,814.65 " " 4,801.97 " " 16,670.32 " " 4,039.04 " " 4,487.82 " " 15,247.20 " " 19,059.32 " " 4,442.94 " " 4,577.58 " " 4,487.82 " " 18,520.00 " " 4,106.36 " " 17,362.50 " " 17,362.50 " " 18,288.50 " " 17,825.50 " " 3,949.28 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,577.58 " " 18,288.50 " Outpatient Colpopexy extraperitoneal 57282 " 35,670.00 " " 13,183.63 " " 5,872.73 " " 29,367.01 " " 9,167.19 " " 23,538.63 " " 7,047.27 " " 24,305.54 " " 5,872.73 " " 6,909.09 " " 24,391.15 " " 6,420.60 " " 23,870.36 " " 5,872.73 " " 7,392.73 " " 25,685.97 " " 6,218.18 " " 6,909.09 " " 23,493.21 " " 29,367.01 " " 6,840.00 " " 7,047.27 " " 6,909.09 " " 28,536.00 " " 6,321.82 " " 26,752.50 " " 26,752.50 " " 28,179.30 " " 27,465.90 " " 6,080.00 " " 14,589.03 " " 26,752.50 " " 13,558.17 " " 15,955.19 " " 7,047.27 " " 28,179.30 " Outpatient Colpopexy intraperitoneal 57283 " 35,670.00 " " 13,183.63 " " 5,872.73 " " 29,367.01 " " 9,167.19 " " 23,538.63 " " 7,047.27 " " 24,305.54 " " 5,872.73 " " 6,909.09 " " 24,391.15 " " 6,420.60 " " 23,870.36 " " 5,872.73 " " 7,392.73 " " 25,685.97 " " 6,218.18 " " 6,909.09 " " 23,493.21 " " 29,367.01 " " 6,840.00 " " 7,047.27 " " 6,909.09 " " 28,536.00 " " 6,321.82 " " 26,752.50 " " 26,752.50 " " 28,179.30 " " 27,465.90 " " 6,080.00 " " 14,589.03 " " 26,752.50 " " 13,558.17 " " 15,955.19 " " 7,047.27 " " 28,179.30 " Outpatient Repair bladder defect 57288 " 23,150.00 " " 8,556.24 " " 3,814.65 " " 19,059.32 " " 5,949.55 " " 15,276.69 " " 4,577.58 " " 15,774.41 " " 3,814.65 " " 4,487.82 " " 15,829.97 " " 4,167.00 " " 15,491.98 " " 3,814.65 " " 4,801.97 " " 16,670.32 " " 4,039.04 " " 4,487.82 " " 15,247.20 " " 19,059.32 " " 4,442.94 " " 4,577.58 " " 4,487.82 " " 18,520.00 " " 4,106.36 " " 17,362.50 " " 17,362.50 " " 18,288.50 " " 17,825.50 " " 3,949.28 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,577.58 " " 18,288.50 " Outpatient Pelvic examination 57410 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Exam/biopsy of vag w/scope 57421 " 3,325.00 " " 1,228.92 " 548.44 " 2,737.78 " 854.53 " 2,194.17 " 658.12 " 2,265.66 " 548.44 645.22 " 2,273.64 " 598.50 " 2,225.09 " 548.44 690.39 " 2,394.33 " 580.70 645.22 " 2,190.18 " " 2,737.78 " 638.77 658.12 645.22 " 2,660.00 " 590.38 " 2,493.75 " " 2,493.75 " " 2,626.75 " " 2,560.25 " 567.79 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 658.12 " 2,626.75 " Outpatient Laparoscopy surg colpopexy 57425 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Exam of cervix w/scope 57452 894.00 330.42 147.37 736.16 229.76 589.95 176.85 609.17 147.37 173.38 611.32 160.92 598.26 147.37 185.52 643.77 156.04 173.38 588.91 736.16 171.65 176.85 173.38 715.20 158.64 670.50 670.50 706.26 688.38 152.57 365.65 670.50 339.81 399.89 176.85 706.26 Outpatient Bx/curett of cervix w/scope 57454 " 1,478.00 " 546.27 243.98 " 1,216.64 " 379.85 975.33 292.78 " 1,007.11 " 243.98 287.04 " 1,010.66 " 266.04 989.08 243.98 307.13 " 1,064.31 " 258.34 287.04 973.30 " 1,216.64 " 284.17 292.78 287.04 " 1,182.40 " 262.64 " 1,108.50 " " 1,108.50 " " 1,167.62 " " 1,138.06 " 252.60 604.50 " 1,108.50 " 561.79 661.11 292.78 " 1,167.62 " Outpatient Biopsy of cervix w/scope 57455 " 1,478.00 " 546.27 243.98 " 1,216.64 " 379.85 975.33 292.78 " 1,007.11 " 243.98 287.04 " 1,010.66 " 266.04 989.08 243.98 307.13 " 1,064.31 " 258.34 287.04 973.30 " 1,216.64 " 284.17 292.78 287.04 " 1,182.40 " 262.64 " 1,108.50 " " 1,108.50 " " 1,167.62 " " 1,138.06 " 252.60 604.50 " 1,108.50 " 561.79 661.11 292.78 " 1,167.62 " Outpatient Endocerv curettage w/scope 57456 " 1,478.00 " 546.27 243.98 " 1,216.64 " 379.85 975.33 292.78 " 1,007.11 " 243.98 287.04 " 1,010.66 " 266.04 989.08 243.98 307.13 " 1,064.31 " 258.34 287.04 973.30 " 1,216.64 " 284.17 292.78 287.04 " 1,182.40 " 262.64 " 1,108.50 " " 1,108.50 " " 1,167.62 " " 1,138.06 " 252.60 604.50 " 1,108.50 " 561.79 661.11 292.78 " 1,167.62 " Outpatient Bx of cervix w/scope leep 57460 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Biopsy of cervix 57500 " 3,325.00 " " 1,228.92 " 548.44 " 2,737.78 " 854.53 " 2,194.17 " 658.12 " 2,265.66 " 548.44 645.22 " 2,273.64 " 598.50 " 2,225.09 " 548.44 690.39 " 2,394.33 " 580.70 645.22 " 2,190.18 " " 2,737.78 " 638.77 658.12 645.22 " 2,660.00 " 590.38 " 2,493.75 " " 2,493.75 " " 2,626.75 " " 2,560.25 " 567.79 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 658.12 " 2,626.75 " Outpatient Endocervical curettage 57505 " 3,325.00 " " 1,228.92 " 548.44 " 2,737.78 " 854.53 " 2,194.17 " 658.12 " 2,265.66 " 548.44 645.22 " 2,273.64 " 598.50 " 2,225.09 " 548.44 690.39 " 2,394.33 " 580.70 645.22 " 2,190.18 " " 2,737.78 " 638.77 658.12 645.22 " 2,660.00 " 590.38 " 2,493.75 " " 2,493.75 " " 2,626.75 " " 2,560.25 " 567.79 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 658.12 " 2,626.75 " Outpatient Conization of cervix 57520 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Conization of cervix 57522 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Biopsy of uterus lining 58100 894.00 330.42 147.37 736.16 229.76 589.95 176.85 609.17 147.37 173.38 611.32 160.92 598.26 147.37 185.52 643.77 156.04 173.38 588.91 736.16 171.65 176.85 173.38 715.20 158.64 670.50 670.50 706.26 688.38 152.57 365.65 670.50 339.81 399.89 176.85 706.26 Outpatient Dilation and curettage 58120 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Vaginal hysterectomy 58260 " 23,150.00 " " 8,556.24 " " 3,814.65 " " 19,059.32 " " 5,949.55 " " 15,276.69 " " 4,577.58 " " 15,774.41 " " 3,814.65 " " 4,487.82 " " 15,829.97 " " 4,167.00 " " 15,491.98 " " 3,814.65 " " 4,801.97 " " 16,670.32 " " 4,039.04 " " 4,487.82 " " 15,247.20 " " 19,059.32 " " 4,442.94 " " 4,577.58 " " 4,487.82 " " 18,520.00 " " 4,106.36 " " 17,362.50 " " 17,362.50 " " 18,288.50 " " 17,825.50 " " 3,949.28 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,577.58 " " 18,288.50 " Outpatient Vag hyst including t/o 58262 " 23,150.00 " " 8,556.24 " " 3,814.65 " " 19,059.32 " " 5,949.55 " " 15,276.69 " " 4,577.58 " " 15,774.41 " " 3,814.65 " " 4,487.82 " " 15,829.97 " " 4,167.00 " " 15,491.98 " " 3,814.65 " " 4,801.97 " " 16,670.32 " " 4,039.04 " " 4,487.82 " " 15,247.20 " " 19,059.32 " " 4,442.94 " " 4,577.58 " " 4,487.82 " " 18,520.00 " " 4,106.36 " " 17,362.50 " " 17,362.50 " " 18,288.50 " " 17,825.50 " " 3,949.28 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,577.58 " " 18,288.50 " Outpatient Insert intrauterine device 58300 " 3,496.00 " " 1,292.12 " - " 4,301.27 " 898.47 " 2,307.01 " - " 2,382.17 " - - " 2,390.56 " 629.28 " 2,339.52 " - - " 2,517.47 " - - " 3,441.00 " " 4,301.27 " - - " 2,796.80 " - " 2,622.00 " " 2,622.00 " " 2,761.84 " " 2,691.92 " - " 1,429.86 " " 2,622.00 " " 1,328.83 " " 1,563.76 " - " 2,761.84 " Outpatient Remove intrauterine device 58301 " 1,478.00 " 546.27 243.98 " 1,216.64 " 379.85 975.33 292.78 " 1,007.11 " 243.98 287.04 " 1,010.66 " 266.04 989.08 243.98 307.13 " 1,064.31 " 258.34 287.04 973.30 " 1,216.64 " 284.17 292.78 287.04 " 1,182.40 " 262.64 " 1,108.50 " " 1,108.50 " " 1,167.62 " " 1,138.06 " 252.60 604.50 " 1,108.50 " 561.79 661.11 292.78 " 1,167.62 " Outpatient Artificial insemination 58322 894.00 330.42 147.37 736.16 229.76 589.95 176.85 609.17 147.37 173.38 611.32 160.92 598.26 147.37 185.52 643.77 156.04 173.38 588.91 736.16 171.65 176.85 173.38 715.20 158.64 670.50 670.50 706.26 688.38 152.57 365.65 670.50 339.81 399.89 176.85 706.26 Outpatient Sperm washing 58323 894.00 330.42 147.37 736.16 229.76 589.95 176.85 609.17 147.37 173.38 611.32 160.92 598.26 147.37 185.52 643.77 156.04 173.38 588.91 736.16 171.65 176.85 173.38 715.20 158.64 670.50 670.50 706.26 688.38 152.57 365.65 670.50 339.81 399.89 176.85 706.26 Outpatient Reopen fallopian tube 58350 " 23,150.00 " " 8,556.24 " " 3,814.65 " " 19,059.32 " " 5,949.55 " " 15,276.69 " " 4,577.58 " " 15,774.41 " " 3,814.65 " " 4,487.82 " " 15,829.97 " " 4,167.00 " " 15,491.98 " " 3,814.65 " " 4,801.97 " " 16,670.32 " " 4,039.04 " " 4,487.82 " " 15,247.20 " " 19,059.32 " " 4,442.94 " " 4,577.58 " " 4,487.82 " " 18,520.00 " " 4,106.36 " " 17,362.50 " " 17,362.50 " " 18,288.50 " " 17,825.50 " " 3,949.28 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,577.58 " " 18,288.50 " Outpatient Lsh w/t/o ut 250 g or less 58542 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Laparoscopic myomectomy 58545 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Laparo-vag hyst incl t/o 58552 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Hysteroscopy dx sep proc 58555 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Hysteroscopy biopsy 58558 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Hysteroscopy resect septum 58560 " 23,150.00 " " 8,556.24 " " 3,814.65 " " 19,059.32 " " 5,949.55 " " 15,276.69 " " 4,577.58 " " 15,774.41 " " 3,814.65 " " 4,487.82 " " 15,829.97 " " 4,167.00 " " 15,491.98 " " 3,814.65 " " 4,801.97 " " 16,670.32 " " 4,039.04 " " 4,487.82 " " 15,247.20 " " 19,059.32 " " 4,442.94 " " 4,577.58 " " 4,487.82 " " 18,520.00 " " 4,106.36 " " 17,362.50 " " 17,362.50 " " 18,288.50 " " 17,825.50 " " 3,949.28 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,577.58 " " 18,288.50 " Outpatient Hysteroscopy remove myoma 58561 " 23,150.00 " " 8,556.24 " " 3,814.65 " " 19,059.32 " " 5,949.55 " " 15,276.69 " " 4,577.58 " " 15,774.41 " " 3,814.65 " " 4,487.82 " " 15,829.97 " " 4,167.00 " " 15,491.98 " " 3,814.65 " " 4,801.97 " " 16,670.32 " " 4,039.04 " " 4,487.82 " " 15,247.20 " " 19,059.32 " " 4,442.94 " " 4,577.58 " " 4,487.82 " " 18,520.00 " " 4,106.36 " " 17,362.50 " " 17,362.50 " " 18,288.50 " " 17,825.50 " " 3,949.28 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,577.58 " " 18,288.50 " Outpatient Hysteroscopy ablation 58563 " 23,150.00 " " 8,556.24 " " 3,814.65 " " 19,059.32 " " 5,949.55 " " 15,276.69 " " 4,577.58 " " 15,774.41 " " 3,814.65 " " 4,487.82 " " 15,829.97 " " 4,167.00 " " 15,491.98 " " 3,814.65 " " 4,801.97 " " 16,670.32 " " 4,039.04 " " 4,487.82 " " 15,247.20 " " 19,059.32 " " 4,442.94 " " 4,577.58 " " 4,487.82 " " 18,520.00 " " 4,106.36 " " 17,362.50 " " 17,362.50 " " 18,288.50 " " 17,825.50 " " 3,949.28 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,577.58 " " 18,288.50 " Outpatient Tlh uterus 250 g or less 58570 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Tlh w/t/o 250 g or less 58571 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Tlh w/t/o uterus over 250 g 58573 " 46,765.00 " " 17,284.34 " " 7,705.08 " " 38,501.54 " " 12,018.61 " " 30,860.22 " " 9,246.10 " " 31,865.67 " " 7,705.08 " " 9,064.80 " " 31,977.91 " " 8,417.70 " " 31,295.14 " " 7,705.08 " " 9,699.34 " " 33,675.48 " " 8,158.32 " " 9,064.80 " " 30,800.70 " " 38,501.54 " " 8,974.15 " " 9,246.10 " " 9,064.80 " " 37,412.00 " " 8,294.29 " " 35,073.75 " " 35,073.75 " " 36,944.35 " " 36,009.05 " " 7,977.02 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,246.10 " " 36,944.35 " Outpatient Laparoscopy lysis 58660 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Laparoscopy remove adnexa 58661 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Laparoscopy excise lesions 58662 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Laparo proc oviduct-ovary 58679 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Retrieval of oocyte 58970 " 3,325.00 " " 1,228.92 " 548.44 " 2,737.78 " 854.53 " 2,194.17 " 658.12 " 2,265.66 " 548.44 645.22 " 2,273.64 " 598.50 " 2,225.09 " 548.44 690.39 " 2,394.33 " 580.70 645.22 " 2,190.18 " " 2,737.78 " 638.77 658.12 645.22 " 2,660.00 " 590.38 " 2,493.75 " " 2,493.75 " " 2,626.75 " " 2,560.25 " 567.79 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 658.12 " 2,626.75 " Outpatient Transfer of embryo 58974 " 3,325.00 " " 1,228.92 " 548.44 " 2,737.78 " 854.53 " 2,194.17 " 658.12 " 2,265.66 " 548.44 645.22 " 2,273.64 " 598.50 " 2,225.09 " 548.44 690.39 " 2,394.33 " 580.70 645.22 " 2,190.18 " " 2,737.78 " 638.77 658.12 645.22 " 2,660.00 " 590.38 " 2,493.75 " " 2,493.75 " " 2,626.75 " " 2,560.25 " 567.79 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 658.12 " 2,626.75 " Outpatient Genital surgery procedure 58999 894.00 330.42 147.37 736.16 229.76 589.95 176.85 609.17 147.37 173.38 611.32 160.92 598.26 147.37 185.52 643.77 156.04 173.38 588.91 736.16 171.65 176.85 173.38 715.20 158.64 670.50 670.50 706.26 688.38 152.57 365.65 670.50 339.81 399.89 176.85 706.26 Outpatient Amniocentesis diagnostic 59000 " 3,325.00 " " 1,228.92 " 548.44 " 2,737.78 " 854.53 " 2,194.17 " 658.12 " 2,265.66 " 548.44 645.22 " 2,273.64 " 598.50 " 2,225.09 " 548.44 690.39 " 2,394.33 " 580.70 645.22 " 2,190.18 " " 2,737.78 " 638.77 658.12 645.22 " 2,660.00 " 590.38 " 2,493.75 " " 2,493.75 " " 2,626.75 " " 2,560.25 " 567.79 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 658.12 " 2,626.75 " Outpatient Fetal non-stress test 59025 894.00 330.42 147.37 736.16 229.76 589.95 176.85 609.17 147.37 173.38 611.32 160.92 598.26 147.37 185.52 643.77 156.04 173.38 588.91 736.16 171.65 176.85 173.38 715.20 158.64 670.50 670.50 706.26 688.38 152.57 365.65 670.50 339.81 399.89 176.85 706.26 Outpatient Treat ectopic pregnancy 59151 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Revision of cervix 59320 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Treatment of miscarriage 59812 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Care of miscarriage 59820 " 13,772.00 " " 5,090.13 " " 2,269.70 " " 11,338.27 " " 3,539.40 " " 9,088.14 " " 2,723.64 " " 9,384.24 " " 2,269.70 " " 2,670.24 " " 9,417.29 " " 2,478.96 " " 9,216.22 " " 2,269.70 " " 2,857.16 " " 9,917.22 " " 2,403.22 " " 2,670.24 " " 9,070.46 " " 11,338.27 " " 2,643.54 " " 2,723.64 " " 2,670.24 " " 11,017.60 " " 2,443.27 " " 10,329.00 " " 10,329.00 " " 10,879.88 " " 10,604.44 " " 2,349.81 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,723.64 " " 10,879.88 " Outpatient Partial removal of thyroid 60220 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Removal of thyroid 60240 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Remove thyroid duct lesion 60280 " 26,567.00 " " 9,819.16 " " 4,377.25 " " 21,872.71 " " 6,827.72 " " 17,531.56 " " 5,252.70 " " 18,102.75 " " 4,377.25 " " 5,149.71 " " 18,166.51 " " 4,782.06 " " 17,778.64 " " 4,377.25 " " 5,510.19 " " 19,130.90 " " 4,634.74 " " 5,149.71 " " 17,497.87 " " 21,872.71 " " 5,098.21 " " 5,252.70 " " 5,149.71 " " 21,253.60 " " 4,711.98 " " 19,925.25 " " 19,925.25 " " 20,987.93 " " 20,456.59 " " 4,531.74 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,252.70 " " 20,987.93 " Outpatient Explore parathyroid glands 60500 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Removal of thymus gland 60520 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Remove brain cavity fluid 61020 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Injection into brain canal 61026 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Brain canal shunt procedure 61070 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Insrt/redo neurostim 1 array 61885 " 107,519.00 " " 39,739.02 " " 17,713.80 " " 88,519.67 " " 27,632.38 " " 70,951.79 " " 21,256.57 " " 73,263.45 " " 17,713.80 " " 20,839.77 " " 73,521.49 " " 19,353.42 " " 71,951.71 " " 17,713.80 " " 22,298.55 " " 77,424.43 " " 18,755.79 " " 20,839.77 " " 70,814.54 " " 88,519.67 " " 20,631.37 " " 21,256.57 " " 20,839.77 " " 86,015.20 " " 19,068.39 " " 80,639.25 " " 80,639.25 " " 84,940.01 " " 82,789.63 " " 18,339.00 " " 43,975.27 " " 80,639.25 " " 40,867.97 " " 48,093.25 " " 21,256.57 " " 84,940.01 " Outpatient Implant neurostim arrays 61886 " 154,584.00 " " 57,134.25 " " 25,465.03 " " 127,267.96 " " 39,728.09 " " 102,009.98 " " 30,558.04 " " 105,333.54 " " 25,465.03 " " 29,958.86 " " 105,704.54 " " 27,825.12 " " 103,447.61 " " 25,465.03 " " 32,055.98 " " 111,315.94 " " 26,962.97 " " 29,958.86 " " 101,812.64 " " 127,267.96 " " 29,659.27 " " 30,558.04 " " 29,958.86 " " 123,667.20 " " 27,412.36 " " 115,938.00 " " 115,938.00 " " 122,121.36 " " 119,029.68 " " 26,363.80 " " 63,224.86 " " 115,938.00 " " 58,757.38 " " 69,145.42 " " 30,558.04 " " 122,121.36 " Outpatient Replace/irrigate catheter 62225 " 29,927.00 " " 11,061.02 " " 4,933.13 " " 24,638.34 " " 7,691.24 " " 19,748.83 " " 5,919.75 " " 20,392.26 " " 4,933.13 " " 5,803.68 " " 20,464.08 " " 5,386.86 " " 20,027.15 " " 4,933.13 " " 6,209.94 " " 21,550.43 " " 5,223.31 " " 5,803.68 " " 19,710.34 " " 24,638.34 " " 5,745.64 " " 5,919.75 " " 5,803.68 " " 23,941.60 " " 5,310.37 " " 22,445.25 " " 22,445.25 " " 23,642.33 " " 23,043.79 " " 5,107.24 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,919.75 " " 23,642.33 " Outpatient Replace/revise brain shunt 62230 " 29,927.00 " " 11,061.02 " " 4,933.13 " " 24,638.34 " " 7,691.24 " " 19,748.83 " " 5,919.75 " " 20,392.26 " " 4,933.13 " " 5,803.68 " " 20,464.08 " " 5,386.86 " " 20,027.15 " " 4,933.13 " " 6,209.94 " " 21,550.43 " " 5,223.31 " " 5,803.68 " " 19,710.34 " " 24,638.34 " " 5,745.64 " " 5,919.75 " " 5,803.68 " " 23,941.60 " " 5,310.37 " " 22,445.25 " " 22,445.25 " " 23,642.33 " " 23,043.79 " " 5,107.24 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,919.75 " " 23,642.33 " Outpatient Csf shunt reprogram 62252 " 1,430.00 " 528.53 236.21 " 1,177.71 " 367.51 943.66 283.45 974.40 236.21 277.89 977.83 257.40 956.96 236.21 297.34 " 1,029.74 " 250.10 277.89 942.15 " 1,177.71 " 275.11 283.45 277.89 " 1,144.00 " 254.27 " 1,072.50 " " 1,072.50 " " 1,129.70 " " 1,101.10 " 244.54 584.87 " 1,072.50 " 543.54 639.64 283.45 " 1,129.70 " Outpatient Dx lmbr spi pnxr 62270 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Ther spi pnxr drg csf 62272 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Inject epidural patch 62273 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx interlaminar crv/thrc 62321 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx interlaminar lmbr/sac 62322 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx interlaminar lmbr/sac 62323 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx interlaminar crv/thrc 62324 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Dx lmbr spi pnxr w/fluor/ct 62328 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Implant spinal canal cath 62350 " 29,927.00 " " 11,061.02 " " 4,933.13 " " 24,638.34 " " 7,691.24 " " 19,748.83 " " 5,919.75 " " 20,392.26 " " 4,933.13 " " 5,803.68 " " 20,464.08 " " 5,386.86 " " 20,027.15 " " 4,933.13 " " 6,209.94 " " 21,550.43 " " 5,223.31 " " 5,803.68 " " 19,710.34 " " 24,638.34 " " 5,745.64 " " 5,919.75 " " 5,803.68 " " 23,941.60 " " 5,310.37 " " 22,445.25 " " 22,445.25 " " 23,642.33 " " 23,043.79 " " 5,107.24 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,919.75 " " 23,642.33 " Outpatient Implant spine infusion pump 62362 " 89,417.00 " " 33,048.52 " " 14,743.03 " " 73,616.94 " " 22,980.17 " " 59,006.28 " " 17,691.63 " " 60,928.74 " " 14,743.03 " " 17,344.74 " " 61,143.34 " " 16,095.06 " " 59,837.86 " " 14,743.03 " " 18,558.87 " " 64,389.18 " " 15,610.27 " " 17,344.74 " " 58,892.55 " " 73,616.94 " " 17,171.29 " " 17,691.63 " " 17,344.74 " " 71,533.60 " " 15,870.44 " " 67,062.75 " " 67,062.75 " " 70,639.43 " " 68,851.09 " " 15,263.37 " " 36,571.55 " " 67,062.75 " " 33,987.40 " " 39,996.22 " " 17,691.63 " " 70,639.43 " Outpatient Analyze spine infus pump 62367 " 1,430.00 " 528.53 236.21 " 1,177.71 " 367.51 943.66 283.45 974.40 236.21 277.89 977.83 257.40 956.96 236.21 297.34 " 1,029.74 " 250.10 277.89 942.15 " 1,177.71 " 275.11 283.45 277.89 " 1,144.00 " 254.27 " 1,072.50 " " 1,072.50 " " 1,129.70 " " 1,101.10 " 244.54 584.87 " 1,072.50 " 543.54 639.64 283.45 " 1,129.70 " Outpatient Analyze sp inf pump w/reprog 62368 " 1,430.00 " 528.53 236.21 " 1,177.71 " 367.51 943.66 283.45 974.40 236.21 277.89 977.83 257.40 956.96 236.21 297.34 " 1,029.74 " 250.10 277.89 942.15 " 1,177.71 " 275.11 283.45 277.89 " 1,144.00 " 254.27 " 1,072.50 " " 1,072.50 " " 1,129.70 " " 1,101.10 " 244.54 584.87 " 1,072.50 " 543.54 639.64 283.45 " 1,129.70 " Outpatient Anl sp inf pmp w/mdreprg&fil 62370 " 1,430.00 " 528.53 236.21 " 1,177.71 " 367.51 943.66 283.45 974.40 236.21 277.89 977.83 257.40 956.96 236.21 297.34 " 1,029.74 " 250.10 277.89 942.15 " 1,177.71 " 275.11 283.45 277.89 " 1,144.00 " 254.27 " 1,072.50 " " 1,072.50 " " 1,129.70 " " 1,101.10 " 244.54 584.87 " 1,072.50 " 543.54 639.64 283.45 " 1,129.70 " Outpatient Low back disk surgery 63030 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Laminotomy single lumbar 63042 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Lam facetec & foramot crv 63045 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Lam facetec & foramot lumbar 63047 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Decompress spinal cord lmbr 63056 " 32,891.00 " " 12,156.51 " " 5,418.57 " " 27,078.95 " " 8,452.99 " " 21,704.77 " " 6,502.29 " " 22,411.93 " " 5,418.57 " " 6,374.79 " " 22,490.87 " " 5,920.38 " " 22,010.66 " " 5,418.57 " " 6,821.03 " " 23,684.81 " " 5,737.31 " " 6,374.79 " " 21,662.80 " " 27,078.95 " " 6,311.04 " " 6,502.29 " " 6,374.79 " " 26,312.80 " " 5,832.93 " " 24,668.25 " " 24,668.25 " " 25,983.89 " " 25,326.07 " " 5,609.82 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,502.29 " " 25,983.89 " Outpatient Implant neuroelectrodes 63650 " 32,344.00 " " 11,954.34 " " 5,332.51 " " 26,628.26 " " 8,312.41 " " 21,343.81 " " 6,399.01 " " 22,039.20 " " 5,332.51 " " 6,273.54 " " 22,116.83 " " 5,821.92 " " 21,644.60 " " 5,332.51 " " 6,712.69 " " 23,290.91 " " 5,646.19 " " 6,273.54 " " 21,302.25 " " 26,628.26 " " 6,210.80 " " 6,399.01 " " 6,273.54 " " 25,875.20 " " 5,740.29 " " 24,258.00 " " 24,258.00 " " 25,551.76 " " 24,904.88 " " 5,520.72 " " 13,228.70 " " 24,258.00 " " 12,293.95 " " 14,467.47 " " 6,399.01 " " 25,551.76 " Outpatient Implant neuroelectrodes 63655 " 107,519.00 " " 39,739.02 " " 17,713.80 " " 88,519.67 " " 27,632.38 " " 70,951.79 " " 21,256.57 " " 73,263.45 " " 17,713.80 " " 20,839.77 " " 73,521.49 " " 19,353.42 " " 71,951.71 " " 17,713.80 " " 22,298.55 " " 77,424.43 " " 18,755.79 " " 20,839.77 " " 70,814.54 " " 88,519.67 " " 20,631.37 " " 21,256.57 " " 20,839.77 " " 86,015.20 " " 19,068.39 " " 80,639.25 " " 80,639.25 " " 84,940.01 " " 82,789.63 " " 18,339.00 " " 43,975.27 " " 80,639.25 " " 40,867.97 " " 48,093.25 " " 21,256.57 " " 84,940.01 " Outpatient Remove spine eltrd plate 63662 " 17,195.00 " " 6,355.27 " " 2,833.98 " " 14,156.82 " " 4,419.12 " " 11,346.98 " " 3,400.77 " " 11,716.67 " " 2,833.98 " " 3,334.09 " " 11,757.94 " " 3,095.10 " " 11,506.89 " " 2,833.98 " " 3,567.48 " " 12,382.12 " " 3,000.68 " " 3,334.09 " " 11,325.27 " " 14,156.82 " " 3,300.75 " " 3,400.77 " " 3,334.09 " " 13,756.00 " " 3,050.69 " " 12,896.25 " " 12,896.25 " " 13,584.05 " " 13,240.15 " " 2,934.00 " " 7,032.76 " " 12,896.25 " " 6,535.82 " " 7,691.32 " " 3,400.77 " " 13,584.05 " Outpatient Revise spine eltrd plate 63664 " 58,990.00 " " 21,802.70 " " 9,726.91 " " 48,566.22 " " 15,160.43 " " 38,927.50 " " 11,672.29 " " 40,195.79 " " 9,726.91 " " 11,443.42 " " 40,337.36 " " 10,618.20 " " 39,476.11 " " 9,726.91 " " 12,244.46 " " 42,478.70 " " 10,299.08 " " 11,443.42 " " 38,852.32 " " 48,566.22 " " 11,328.99 " " 11,672.29 " " 11,443.42 " " 47,192.00 " " 10,470.73 " " 44,242.50 " " 44,242.50 " " 46,602.10 " " 45,422.30 " " 10,070.21 " " 24,126.91 " " 44,242.50 " " 22,422.10 " " 26,386.23 " " 11,672.29 " " 46,602.10 " Outpatient Insrt/redo spine n generator 63685 " 154,584.00 " " 57,134.25 " " 25,465.03 " " 127,267.96 " " 39,728.09 " " 102,009.98 " " 30,558.04 " " 105,333.54 " " 25,465.03 " " 29,958.86 " " 105,704.54 " " 27,825.12 " " 103,447.61 " " 25,465.03 " " 32,055.98 " " 111,315.94 " " 26,962.97 " " 29,958.86 " " 101,812.64 " " 127,267.96 " " 29,659.27 " " 30,558.04 " " 29,958.86 " " 123,667.20 " " 27,412.36 " " 115,938.00 " " 115,938.00 " " 122,121.36 " " 119,029.68 " " 26,363.80 " " 63,224.86 " " 115,938.00 " " 58,757.38 " " 69,145.42 " " 30,558.04 " " 122,121.36 " Outpatient Revise/remove neuroreceiver 63688 " 17,195.00 " " 6,355.27 " " 2,833.98 " " 14,156.82 " " 4,419.12 " " 11,346.98 " " 3,400.77 " " 11,716.67 " " 2,833.98 " " 3,334.09 " " 11,757.94 " " 3,095.10 " " 11,506.89 " " 2,833.98 " " 3,567.48 " " 12,382.12 " " 3,000.68 " " 3,334.09 " " 11,325.27 " " 14,156.82 " " 3,300.75 " " 3,400.77 " " 3,334.09 " " 13,756.00 " " 3,050.69 " " 12,896.25 " " 12,896.25 " " 13,584.05 " " 13,240.15 " " 2,934.00 " " 7,032.76 " " 12,896.25 " " 6,535.82 " " 7,691.32 " " 3,400.77 " " 13,584.05 " Outpatient Njx aa&/strd trigeminal nrv 64400 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Njx aa&/strd gr ocpl nrv 64405 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Njx aa&/strd vagus nrv 64408 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Njx aa&/strd brach plexus 64415 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Njx aa&/strd brach plex nfs 64416 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Njx aa&/strd axillary nrv 64417 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Njx aa&/strd sprscap nrv 64418 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx aa&/strd ntrcost nrv 1 64420 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx aa&/strd ii ih nerves 64425 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx aa&/strd pudendal nerve 64430 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Njx aa&/strd sciatic nerve 64445 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx aa&/strd sciatic nrv nfs 64446 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Njx aa&/strd femoral nerve 64447 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx aa&/strd fem nerve nfs 64448 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Njx aa&/strd other pn/branch 64450 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx aa&/strd nrv nrvtg si jt 64451 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx aa&/strd gnclr nrv brnch 64454 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx aa&/strd pltr com dg nrv 64455 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Pvb thoracic single inj site 64461 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Njx aa&/strd tfrm epi c/t 1 64479 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Njx aa&/strd tfrm epi l/s 1 64483 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Inj paravert f jnt c/t 1 lev 64490 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Inj paravert f jnt l/s 1 lev 64493 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient N block stellate ganglion 64510 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient N block lumbar/thoracic 64520 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Implant neuroelectrodes 64561 " 32,344.00 " " 11,954.34 " " 5,332.51 " " 26,628.26 " " 8,312.41 " " 21,343.81 " " 6,399.01 " " 22,039.20 " " 5,332.51 " " 6,273.54 " " 22,116.83 " " 5,821.92 " " 21,644.60 " " 5,332.51 " " 6,712.69 " " 23,290.91 " " 5,646.19 " " 6,273.54 " " 21,302.25 " " 26,628.26 " " 6,210.80 " " 6,399.01 " " 6,273.54 " " 25,875.20 " " 5,740.29 " " 24,258.00 " " 24,258.00 " " 25,551.76 " " 24,904.88 " " 5,520.72 " " 13,228.70 " " 24,258.00 " " 12,293.95 " " 14,467.47 " " 6,399.01 " " 25,551.76 " Outpatient Neuroeltrd stim post tibial 64566 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Opn impltj crnl nrv nea&pg 64568 " 154,584.00 " " 57,134.25 " " 25,465.03 " " 127,267.96 " " 39,728.09 " " 102,009.98 " " 30,558.04 " " 105,333.54 " " 25,465.03 " " 29,958.86 " " 105,704.54 " " 27,825.12 " " 103,447.61 " " 25,465.03 " " 32,055.98 " " 111,315.94 " " 26,962.97 " " 29,958.86 " " 101,812.64 " " 127,267.96 " " 29,659.27 " " 30,558.04 " " 29,958.86 " " 123,667.20 " " 27,412.36 " " 115,938.00 " " 115,938.00 " " 122,121.36 " " 119,029.68 " " 26,363.80 " " 63,224.86 " " 115,938.00 " " 58,757.38 " " 69,145.42 " " 30,558.04 " " 122,121.36 " Outpatient Opn impltj nea sacral nerve 64581 " 32,344.00 " " 11,954.34 " " 5,332.51 " " 26,628.26 " " 8,312.41 " " 21,343.81 " " 6,399.01 " " 22,039.20 " " 5,332.51 " " 6,273.54 " " 22,116.83 " " 5,821.92 " " 21,644.60 " " 5,332.51 " " 6,712.69 " " 23,290.91 " " 5,646.19 " " 6,273.54 " " 21,302.25 " " 26,628.26 " " 6,210.80 " " 6,399.01 " " 6,273.54 " " 25,875.20 " " 5,740.29 " " 24,258.00 " " 24,258.00 " " 25,551.76 " " 24,904.88 " " 5,520.72 " " 13,228.70 " " 24,258.00 " " 12,293.95 " " 14,467.47 " " 6,399.01 " " 25,551.76 " Outpatient Revise/remove neuroelectrode 64585 " 17,195.00 " " 6,355.27 " " 2,833.98 " " 14,156.82 " " 4,419.12 " " 11,346.98 " " 3,400.77 " " 11,716.67 " " 2,833.98 " " 3,334.09 " " 11,757.94 " " 3,095.10 " " 11,506.89 " " 2,833.98 " " 3,567.48 " " 12,382.12 " " 3,000.68 " " 3,334.09 " " 11,325.27 " " 14,156.82 " " 3,300.75 " " 3,400.77 " " 3,334.09 " " 13,756.00 " " 3,050.69 " " 12,896.25 " " 12,896.25 " " 13,584.05 " " 13,240.15 " " 2,934.00 " " 7,032.76 " " 12,896.25 " " 6,535.82 " " 7,691.32 " " 3,400.77 " " 13,584.05 " Outpatient Insrt/redo pn/gastr stimul 64590 " 107,519.00 " " 39,739.02 " " 17,713.80 " " 88,519.67 " " 27,632.38 " " 70,951.79 " " 21,256.57 " " 73,263.45 " " 17,713.80 " " 20,839.77 " " 73,521.49 " " 19,353.42 " " 71,951.71 " " 17,713.80 " " 22,298.55 " " 77,424.43 " " 18,755.79 " " 20,839.77 " " 70,814.54 " " 88,519.67 " " 20,631.37 " " 21,256.57 " " 20,839.77 " " 86,015.20 " " 19,068.39 " " 80,639.25 " " 80,639.25 " " 84,940.01 " " 82,789.63 " " 18,339.00 " " 43,975.27 " " 80,639.25 " " 40,867.97 " " 48,093.25 " " 21,256.57 " " 84,940.01 " Outpatient Revise/rmv pn/gastr stimul 64595 " 17,195.00 " " 6,355.27 " " 2,833.98 " " 14,156.82 " " 4,419.12 " " 11,346.98 " " 3,400.77 " " 11,716.67 " " 2,833.98 " " 3,334.09 " " 11,757.94 " " 3,095.10 " " 11,506.89 " " 2,833.98 " " 3,567.48 " " 12,382.12 " " 3,000.68 " " 3,334.09 " " 11,325.27 " " 14,156.82 " " 3,300.75 " " 3,400.77 " " 3,334.09 " " 13,756.00 " " 3,050.69 " " 12,896.25 " " 12,896.25 " " 13,584.05 " " 13,240.15 " " 2,934.00 " " 7,032.76 " " 12,896.25 " " 6,535.82 " " 7,691.32 " " 3,400.77 " " 13,584.05 " Outpatient Chemodenerv saliv glands 64611 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Destroy nerve face muscle 64612 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Chemodenerv musc migraine 64615 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Chemodenerv musc neck dyston 64616 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Chemodener muscle larynx emg 64617 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Dstrj nulyt agt gnclr nrv 64624 " 9,211.00 " " 3,404.39 " " 1,519.01 " " 7,582.98 " " 2,367.23 " " 6,078.34 " " 1,822.81 " " 6,276.38 " " 1,519.01 " " 1,787.07 " " 6,298.48 " " 1,657.98 " " 6,164.00 " " 1,519.01 " " 1,912.16 " " 6,632.84 " " 1,608.36 " " 1,787.07 " " 6,066.28 " " 7,582.98 " " 1,769.20 " " 1,822.81 " " 1,787.07 " " 7,368.80 " " 1,635.17 " " 6,908.25 " " 6,908.25 " " 7,276.69 " " 7,092.47 " " 1,572.62 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,822.81 " " 7,276.69 " Outpatient Rf abltj nrv nrvtg si jt 64625 " 9,211.00 " " 3,404.39 " " 1,519.01 " " 7,582.98 " " 2,367.23 " " 6,078.34 " " 1,822.81 " " 6,276.38 " " 1,519.01 " " 1,787.07 " " 6,298.48 " " 1,657.98 " " 6,164.00 " " 1,519.01 " " 1,912.16 " " 6,632.84 " " 1,608.36 " " 1,787.07 " " 6,066.28 " " 7,582.98 " " 1,769.20 " " 1,822.81 " " 1,787.07 " " 7,368.80 " " 1,635.17 " " 6,908.25 " " 6,908.25 " " 7,276.69 " " 7,092.47 " " 1,572.62 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,822.81 " " 7,276.69 " Outpatient Destroy cerv/thor facet jnt 64633 " 9,211.00 " " 3,404.39 " " 1,519.01 " " 7,582.98 " " 2,367.23 " " 6,078.34 " " 1,822.81 " " 6,276.38 " " 1,519.01 " " 1,787.07 " " 6,298.48 " " 1,657.98 " " 6,164.00 " " 1,519.01 " " 1,912.16 " " 6,632.84 " " 1,608.36 " " 1,787.07 " " 6,066.28 " " 7,582.98 " " 1,769.20 " " 1,822.81 " " 1,787.07 " " 7,368.80 " " 1,635.17 " " 6,908.25 " " 6,908.25 " " 7,276.69 " " 7,092.47 " " 1,572.62 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,822.81 " " 7,276.69 " Outpatient Destroy lumb/sac facet jnt 64635 " 9,211.00 " " 3,404.39 " " 1,519.01 " " 7,582.98 " " 2,367.23 " " 6,078.34 " " 1,822.81 " " 6,276.38 " " 1,519.01 " " 1,787.07 " " 6,298.48 " " 1,657.98 " " 6,164.00 " " 1,519.01 " " 1,912.16 " " 6,632.84 " " 1,608.36 " " 1,787.07 " " 6,066.28 " " 7,582.98 " " 1,769.20 " " 1,822.81 " " 1,787.07 " " 7,368.80 " " 1,635.17 " " 6,908.25 " " 6,908.25 " " 7,276.69 " " 7,092.47 " " 1,572.62 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,822.81 " " 7,276.69 " Outpatient Injection treatment of nerve 64640 " 4,318.00 " " 1,595.93 " 712.13 " 3,554.93 " " 1,109.73 " " 2,849.45 " 854.56 " 2,942.29 " 712.13 837.80 " 2,952.65 " 777.24 " 2,889.61 " 712.13 896.45 " 3,109.39 " 754.02 837.80 " 2,843.90 " " 3,554.93 " 829.42 854.56 837.80 " 3,454.40 " 766.59 " 3,238.50 " " 3,238.50 " " 3,411.22 " " 3,324.86 " 737.26 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 854.56 " 3,411.22 " Outpatient Chemodenerv 1 extremity 1-4 64642 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Chemodenerv 1 extrem 5/> mus 64644 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Chemodenerv trunk musc 1-5 64646 " 3,332.00 " " 1,231.51 " 549.32 " 2,742.90 " 856.32 " 2,198.79 " 659.19 " 2,270.42 " 549.32 646.26 " 2,278.42 " 599.76 " 2,229.77 " 549.32 691.50 " 2,399.37 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,665.60 " 591.33 " 2,499.00 " " 2,499.00 " " 2,632.28 " " 2,565.64 " 568.71 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 659.19 " 2,632.28 " Outpatient Chemodenerv eccrine glands 64650 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Chemodenerv eccrine glands 64653 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Revise arm/leg nerve 64708 " 9,211.00 " " 3,404.39 " " 1,519.01 " " 7,582.98 " " 2,367.23 " " 6,078.34 " " 1,822.81 " " 6,276.38 " " 1,519.01 " " 1,787.07 " " 6,298.48 " " 1,657.98 " " 6,164.00 " " 1,519.01 " " 1,912.16 " " 6,632.84 " " 1,608.36 " " 1,787.07 " " 6,066.28 " " 7,582.98 " " 1,769.20 " " 1,822.81 " " 1,787.07 " " 7,368.80 " " 1,635.17 " " 6,908.25 " " 6,908.25 " " 7,276.69 " " 7,092.47 " " 1,572.62 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,822.81 " " 7,276.69 " Outpatient Revise ulnar nerve at elbow 64718 " 9,211.00 " " 3,404.39 " " 1,519.01 " " 7,582.98 " " 2,367.23 " " 6,078.34 " " 1,822.81 " " 6,276.38 " " 1,519.01 " " 1,787.07 " " 6,298.48 " " 1,657.98 " " 6,164.00 " " 1,519.01 " " 1,912.16 " " 6,632.84 " " 1,608.36 " " 1,787.07 " " 6,066.28 " " 7,582.98 " " 1,769.20 " " 1,822.81 " " 1,787.07 " " 7,368.80 " " 1,635.17 " " 6,908.25 " " 6,908.25 " " 7,276.69 " " 7,092.47 " " 1,572.62 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,822.81 " " 7,276.69 " Outpatient Carpal tunnel surgery 64721 " 9,211.00 " " 3,404.39 " " 1,519.01 " " 7,582.98 " " 2,367.23 " " 6,078.34 " " 1,822.81 " " 6,276.38 " " 1,519.01 " " 1,787.07 " " 6,298.48 " " 1,657.98 " " 6,164.00 " " 1,519.01 " " 1,912.16 " " 6,632.84 " " 1,608.36 " " 1,787.07 " " 6,066.28 " " 7,582.98 " " 1,769.20 " " 1,822.81 " " 1,787.07 " " 7,368.80 " " 1,635.17 " " 6,908.25 " " 6,908.25 " " 7,276.69 " " 7,092.47 " " 1,572.62 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,822.81 " " 7,276.69 " Outpatient Incision of spinal nerve 64772 " 9,211.00 " " 3,404.39 " " 1,519.01 " " 7,582.98 " " 2,367.23 " " 6,078.34 " " 1,822.81 " " 6,276.38 " " 1,519.01 " " 1,787.07 " " 6,298.48 " " 1,657.98 " " 6,164.00 " " 1,519.01 " " 1,912.16 " " 6,632.84 " " 1,608.36 " " 1,787.07 " " 6,066.28 " " 7,582.98 " " 1,769.20 " " 1,822.81 " " 1,787.07 " " 7,368.80 " " 1,635.17 " " 6,908.25 " " 6,908.25 " " 7,276.69 " " 7,092.47 " " 1,572.62 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,822.81 " " 7,276.69 " Outpatient Repair of facial nerve 64865 " 29,927.00 " " 11,061.02 " " 4,933.13 " " 24,638.34 " " 7,691.24 " " 19,748.83 " " 5,919.75 " " 20,392.26 " " 4,933.13 " " 5,803.68 " " 20,464.08 " " 5,386.86 " " 20,027.15 " " 4,933.13 " " 6,209.94 " " 21,550.43 " " 5,223.31 " " 5,803.68 " " 19,710.34 " " 24,638.34 " " 5,745.64 " " 5,919.75 " " 5,803.68 " " 23,941.60 " " 5,310.37 " " 22,445.25 " " 22,445.25 " " 23,642.33 " " 23,043.79 " " 5,107.24 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,919.75 " " 23,642.33 " Outpatient Nerve repair w/allograft 64910 " 29,927.00 " " 11,061.02 " " 4,933.13 " " 24,638.34 " " 7,691.24 " " 19,748.83 " " 5,919.75 " " 20,392.26 " " 4,933.13 " " 5,803.68 " " 20,464.08 " " 5,386.86 " " 20,027.15 " " 4,933.13 " " 6,209.94 " " 21,550.43 " " 5,223.31 " " 5,803.68 " " 19,710.34 " " 24,638.34 " " 5,745.64 " " 5,919.75 " " 5,803.68 " " 23,941.60 " " 5,310.37 " " 22,445.25 " " 22,445.25 " " 23,642.33 " " 23,043.79 " " 5,107.24 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,919.75 " " 23,642.33 " Outpatient Nervous system surgery 64999 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Remove foreign body from eye 65205 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Remove foreign body from eye 65220 " 1,419.00 " 524.46 234.79 " 1,167.95 " 364.68 936.40 281.74 966.91 234.79 276.22 970.31 255.42 949.59 234.79 295.56 " 1,021.82 " 248.60 276.22 934.35 " 1,167.95 " 273.46 281.74 276.22 " 1,135.20 " 252.74 " 1,064.25 " " 1,064.25 " " 1,121.01 " " 1,092.63 " 243.07 580.37 " 1,064.25 " 539.36 634.72 281.74 " 1,121.01 " Outpatient Remove foreign body from eye 65222 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Repair of eye wound 65280 " 20,568.00 " " 7,601.93 " " 3,387.82 " " 16,933.62 " " 5,285.98 " " 13,572.82 " " 4,065.38 " " 14,015.04 " " 3,387.82 " " 3,985.67 " " 14,064.40 " " 3,702.24 " " 13,764.11 " " 3,387.82 " " 4,264.67 " " 14,811.02 " " 3,587.10 " " 3,985.67 " " 13,546.67 " " 16,933.62 " " 3,945.81 " " 4,065.38 " " 3,985.67 " " 16,454.40 " " 3,646.89 " " 15,426.00 " " 15,426.00 " " 16,248.72 " " 15,837.36 " " 3,507.39 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,065.38 " " 16,248.72 " Outpatient Repair of eye wound 65285 " 20,568.00 " " 7,601.93 " " 3,387.82 " " 16,933.62 " " 5,285.98 " " 13,572.82 " " 4,065.38 " " 14,015.04 " " 3,387.82 " " 3,985.67 " " 14,064.40 " " 3,702.24 " " 13,764.11 " " 3,387.82 " " 4,264.67 " " 14,811.02 " " 3,587.10 " " 3,985.67 " " 13,546.67 " " 16,933.62 " " 3,945.81 " " 4,065.38 " " 3,985.67 " " 16,454.40 " " 3,646.89 " " 15,426.00 " " 15,426.00 " " 16,248.72 " " 15,837.36 " " 3,507.39 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,065.38 " " 16,248.72 " Outpatient Corneal smear 65430 " 1,419.00 " 524.46 234.79 " 1,167.95 " 364.68 936.40 281.74 966.91 234.79 276.22 970.31 255.42 949.59 234.79 295.56 " 1,021.82 " 248.60 276.22 934.35 " 1,167.95 " 273.46 281.74 276.22 " 1,135.20 " 252.74 " 1,064.25 " " 1,064.25 " " 1,121.01 " " 1,092.63 " 243.07 580.37 " 1,064.25 " 539.36 634.72 281.74 " 1,121.01 " Outpatient Curette/treat cornea 65435 " 4,250.00 " " 1,570.80 " 700.55 " 3,499.09 " " 1,092.25 " " 2,804.58 " 840.66 " 2,895.95 " 700.55 824.18 " 2,906.15 " 765.00 " 2,844.10 " 700.55 881.87 " 3,060.43 " 741.76 824.18 " 2,799.23 " " 3,499.09 " 815.94 840.66 824.18 " 3,400.00 " 754.12 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 725.28 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 840.66 " 3,357.50 " Outpatient Cover eye w/membrane 65778 " 4,250.00 " " 1,570.80 " 700.55 " 3,499.09 " " 1,092.25 " " 2,804.58 " 840.66 " 2,895.95 " 700.55 824.18 " 2,906.15 " 765.00 " 2,844.10 " 700.55 881.87 " 3,060.43 " 741.76 824.18 " 2,799.23 " " 3,499.09 " 815.94 840.66 824.18 " 3,400.00 " 754.12 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 725.28 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 840.66 " 3,357.50 " Outpatient Drainage of eye 65800 " 10,916.00 " " 4,034.55 " " 1,796.46 " " 8,986.74 " " 2,805.41 " " 7,203.47 " " 2,155.75 " " 7,438.16 " " 1,796.46 " " 2,113.48 " " 7,464.36 " " 1,964.88 " " 7,304.99 " " 1,796.46 " " 2,261.42 " " 7,860.61 " " 1,902.13 " " 2,113.48 " " 7,189.27 " " 8,986.74 " " 2,092.35 " " 2,155.75 " " 2,113.48 " " 8,732.80 " " 1,933.83 " " 8,187.00 " " 8,187.00 " " 8,623.64 " " 8,405.32 " " 1,859.86 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,155.75 " " 8,623.64 " Outpatient Trabeculoplasty laser surg 65855 " 2,645.00 " 977.59 435.36 " 2,177.83 " 679.77 " 1,745.44 " 522.43 " 1,802.30 " 435.36 512.19 " 1,808.65 " 476.10 " 1,770.03 " 435.36 548.04 " 1,904.66 " 460.97 512.19 " 1,742.24 " " 2,177.83 " 507.07 522.43 512.19 " 2,116.00 " 468.65 " 1,983.75 " " 1,983.75 " " 2,089.55 " " 2,036.65 " 450.73 " 1,081.81 " " 1,983.75 " " 1,005.36 " " 1,183.11 " 522.43 " 2,089.55 " Outpatient Aqueous shunt eye w/graft 66180 " 20,568.00 " " 7,601.93 " " 3,387.82 " " 16,933.62 " " 5,285.98 " " 13,572.82 " " 4,065.38 " " 14,015.04 " " 3,387.82 " " 3,985.67 " " 14,064.40 " " 3,702.24 " " 13,764.11 " " 3,387.82 " " 4,264.67 " " 14,811.02 " " 3,587.10 " " 3,985.67 " " 13,546.67 " " 16,933.62 " " 3,945.81 " " 4,065.38 " " 3,985.67 " " 16,454.40 " " 3,646.89 " " 15,426.00 " " 15,426.00 " " 16,248.72 " " 15,837.36 " " 3,507.39 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,065.38 " " 16,248.72 " Outpatient Revision of iris 66761 " 2,645.00 " 977.59 435.36 " 2,177.83 " 679.77 " 1,745.44 " 522.43 " 1,802.30 " 435.36 512.19 " 1,808.65 " 476.10 " 1,770.03 " 435.36 548.04 " 1,904.66 " 460.97 512.19 " 1,742.24 " " 2,177.83 " 507.07 522.43 512.19 " 2,116.00 " 468.65 " 1,983.75 " " 1,983.75 " " 2,089.55 " " 2,036.65 " 450.73 " 1,081.81 " " 1,983.75 " " 1,005.36 " " 1,183.11 " 522.43 " 2,089.55 " Outpatient After cataract laser surgery 66821 " 2,645.00 " 977.59 435.36 " 2,177.83 " 679.77 " 1,745.44 " 522.43 " 1,802.30 " 435.36 512.19 " 1,808.65 " 476.10 " 1,770.03 " 435.36 548.04 " 1,904.66 " 460.97 512.19 " 1,742.24 " " 2,177.83 " 507.07 522.43 512.19 " 2,116.00 " 468.65 " 1,983.75 " " 1,983.75 " " 2,089.55 " " 2,036.65 " 450.73 " 1,081.81 " " 1,983.75 " " 1,005.36 " " 1,183.11 " 522.43 " 2,089.55 " Outpatient Xcapsl ctrc rmvl cplx wo ecp 66982 " 10,916.00 " " 4,034.55 " " 1,796.46 " " 8,986.74 " " 2,805.41 " " 7,203.47 " " 2,155.75 " " 7,438.16 " " 1,796.46 " " 2,113.48 " " 7,464.36 " " 1,964.88 " " 7,304.99 " " 1,796.46 " " 2,261.42 " " 7,860.61 " " 1,902.13 " " 2,113.48 " " 7,189.27 " " 8,986.74 " " 2,092.35 " " 2,155.75 " " 2,113.48 " " 8,732.80 " " 1,933.83 " " 8,187.00 " " 8,187.00 " " 8,623.64 " " 8,405.32 " " 1,859.86 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,155.75 " " 8,623.64 " Outpatient Xcapsl ctrc rmvl w/o ecp 66984 " 10,916.00 " " 4,034.55 " " 1,796.46 " " 8,986.74 " " 2,805.41 " " 7,203.47 " " 2,155.75 " " 7,438.16 " " 1,796.46 " " 2,113.48 " " 7,464.36 " " 1,964.88 " " 7,304.99 " " 1,796.46 " " 2,261.42 " " 7,860.61 " " 1,902.13 " " 2,113.48 " " 7,189.27 " " 8,986.74 " " 2,092.35 " " 2,155.75 " " 2,113.48 " " 8,732.80 " " 1,933.83 " " 8,187.00 " " 8,187.00 " " 8,623.64 " " 8,405.32 " " 1,859.86 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,155.75 " " 8,623.64 " Outpatient Eye surgery procedure 66999 " 10,916.00 " " 4,034.55 " " 1,796.46 " " 8,986.74 " " 2,805.41 " " 7,203.47 " " 2,155.75 " " 7,438.16 " " 1,796.46 " " 2,113.48 " " 7,464.36 " " 1,964.88 " " 7,304.99 " " 1,796.46 " " 2,261.42 " " 7,860.61 " " 1,902.13 " " 2,113.48 " " 7,189.27 " " 8,986.74 " " 2,092.35 " " 2,155.75 " " 2,113.48 " " 8,732.80 " " 1,933.83 " " 8,187.00 " " 8,187.00 " " 8,623.64 " " 8,405.32 " " 1,859.86 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,155.75 " " 8,623.64 " Outpatient Partial removal of eye fluid 67010 " 10,916.00 " " 4,034.55 " " 1,796.46 " " 8,986.74 " " 2,805.41 " " 7,203.47 " " 2,155.75 " " 7,438.16 " " 1,796.46 " " 2,113.48 " " 7,464.36 " " 1,964.88 " " 7,304.99 " " 1,796.46 " " 2,261.42 " " 7,860.61 " " 1,902.13 " " 2,113.48 " " 7,189.27 " " 8,986.74 " " 2,092.35 " " 2,155.75 " " 2,113.48 " " 8,732.80 " " 1,933.83 " " 8,187.00 " " 8,187.00 " " 8,623.64 " " 8,405.32 " " 1,859.86 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,155.75 " " 8,623.64 " Outpatient Replace eye fluid 67025 " 10,916.00 " " 4,034.55 " " 1,796.46 " " 8,986.74 " " 2,805.41 " " 7,203.47 " " 2,155.75 " " 7,438.16 " " 1,796.46 " " 2,113.48 " " 7,464.36 " " 1,964.88 " " 7,304.99 " " 1,796.46 " " 2,261.42 " " 7,860.61 " " 1,902.13 " " 2,113.48 " " 7,189.27 " " 8,986.74 " " 2,092.35 " " 2,155.75 " " 2,113.48 " " 8,732.80 " " 1,933.83 " " 8,187.00 " " 8,187.00 " " 8,623.64 " " 8,405.32 " " 1,859.86 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,155.75 " " 8,623.64 " Outpatient Injection eye drug 67028 " 1,631.00 " 602.82 275.83 " 1,343.15 " 419.17 " 1,076.30 " 331.00 " 1,111.36 " 275.83 324.51 " 1,115.28 " 293.58 " 1,091.47 " 275.83 347.23 " 1,174.48 " 292.06 324.51 " 1,074.50 " " 1,343.15 " 321.26 331.00 324.51 " 1,304.80 " 296.93 " 1,223.25 " " 1,223.25 " " 1,288.49 " " 1,255.87 " 285.57 667.08 " 1,223.25 " 619.94 729.55 331.00 " 1,288.49 " Outpatient Removal of inner eye fluid 67036 " 20,568.00 " " 7,601.93 " " 3,387.82 " " 16,933.62 " " 5,285.98 " " 13,572.82 " " 4,065.38 " " 14,015.04 " " 3,387.82 " " 3,985.67 " " 14,064.40 " " 3,702.24 " " 13,764.11 " " 3,387.82 " " 4,264.67 " " 14,811.02 " " 3,587.10 " " 3,985.67 " " 13,546.67 " " 16,933.62 " " 3,945.81 " " 4,065.38 " " 3,985.67 " " 16,454.40 " " 3,646.89 " " 15,426.00 " " 15,426.00 " " 16,248.72 " " 15,837.36 " " 3,507.39 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,065.38 " " 16,248.72 " Outpatient Laser treatment of retina 67040 " 20,568.00 " " 7,601.93 " " 3,387.82 " " 16,933.62 " " 5,285.98 " " 13,572.82 " " 4,065.38 " " 14,015.04 " " 3,387.82 " " 3,985.67 " " 14,064.40 " " 3,702.24 " " 13,764.11 " " 3,387.82 " " 4,264.67 " " 14,811.02 " " 3,587.10 " " 3,985.67 " " 13,546.67 " " 16,933.62 " " 3,945.81 " " 4,065.38 " " 3,985.67 " " 16,454.40 " " 3,646.89 " " 15,426.00 " " 15,426.00 " " 16,248.72 " " 15,837.36 " " 3,507.39 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,065.38 " " 16,248.72 " Outpatient Vit for macular pucker 67041 " 20,568.00 " " 7,601.93 " " 3,387.82 " " 16,933.62 " " 5,285.98 " " 13,572.82 " " 4,065.38 " " 14,015.04 " " 3,387.82 " " 3,985.67 " " 14,064.40 " " 3,702.24 " " 13,764.11 " " 3,387.82 " " 4,264.67 " " 14,811.02 " " 3,587.10 " " 3,985.67 " " 13,546.67 " " 16,933.62 " " 3,945.81 " " 4,065.38 " " 3,985.67 " " 16,454.40 " " 3,646.89 " " 15,426.00 " " 15,426.00 " " 16,248.72 " " 15,837.36 " " 3,507.39 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,065.38 " " 16,248.72 " Outpatient Vit for macular hole 67042 " 20,568.00 " " 7,601.93 " " 3,387.82 " " 16,933.62 " " 5,285.98 " " 13,572.82 " " 4,065.38 " " 14,015.04 " " 3,387.82 " " 3,985.67 " " 14,064.40 " " 3,702.24 " " 13,764.11 " " 3,387.82 " " 4,264.67 " " 14,811.02 " " 3,587.10 " " 3,985.67 " " 13,546.67 " " 16,933.62 " " 3,945.81 " " 4,065.38 " " 3,985.67 " " 16,454.40 " " 3,646.89 " " 15,426.00 " " 15,426.00 " " 16,248.72 " " 15,837.36 " " 3,507.39 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,065.38 " " 16,248.72 " Outpatient Repair detached retina 67107 " 20,568.00 " " 7,601.93 " " 3,387.82 " " 16,933.62 " " 5,285.98 " " 13,572.82 " " 4,065.38 " " 14,015.04 " " 3,387.82 " " 3,985.67 " " 14,064.40 " " 3,702.24 " " 13,764.11 " " 3,387.82 " " 4,264.67 " " 14,811.02 " " 3,587.10 " " 3,985.67 " " 13,546.67 " " 16,933.62 " " 3,945.81 " " 4,065.38 " " 3,985.67 " " 16,454.40 " " 3,646.89 " " 15,426.00 " " 15,426.00 " " 16,248.72 " " 15,837.36 " " 3,507.39 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,065.38 " " 16,248.72 " Outpatient Repair detached retina 67108 " 20,568.00 " " 7,601.93 " " 3,387.82 " " 16,933.62 " " 5,285.98 " " 13,572.82 " " 4,065.38 " " 14,015.04 " " 3,387.82 " " 3,985.67 " " 14,064.40 " " 3,702.24 " " 13,764.11 " " 3,387.82 " " 4,264.67 " " 14,811.02 " " 3,587.10 " " 3,985.67 " " 13,546.67 " " 16,933.62 " " 3,945.81 " " 4,065.38 " " 3,985.67 " " 16,454.40 " " 3,646.89 " " 15,426.00 " " 15,426.00 " " 16,248.72 " " 15,837.36 " " 3,507.39 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,065.38 " " 16,248.72 " Outpatient Repair retinal detach cplx 67113 " 20,568.00 " " 7,601.93 " " 3,387.82 " " 16,933.62 " " 5,285.98 " " 13,572.82 " " 4,065.38 " " 14,015.04 " " 3,387.82 " " 3,985.67 " " 14,064.40 " " 3,702.24 " " 13,764.11 " " 3,387.82 " " 4,264.67 " " 14,811.02 " " 3,587.10 " " 3,985.67 " " 13,546.67 " " 16,933.62 " " 3,945.81 " " 4,065.38 " " 3,985.67 " " 16,454.40 " " 3,646.89 " " 15,426.00 " " 15,426.00 " " 16,248.72 " " 15,837.36 " " 3,507.39 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,065.38 " " 16,248.72 " Outpatient Remove eye implant material 67121 " 10,916.00 " " 4,034.55 " " 1,796.46 " " 8,986.74 " " 2,805.41 " " 7,203.47 " " 2,155.75 " " 7,438.16 " " 1,796.46 " " 2,113.48 " " 7,464.36 " " 1,964.88 " " 7,304.99 " " 1,796.46 " " 2,261.42 " " 7,860.61 " " 1,902.13 " " 2,113.48 " " 7,189.27 " " 8,986.74 " " 2,092.35 " " 2,155.75 " " 2,113.48 " " 8,732.80 " " 1,933.83 " " 8,187.00 " " 8,187.00 " " 8,623.64 " " 8,405.32 " " 1,859.86 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,155.75 " " 8,623.64 " Outpatient Proph rta dtchmnt pc 67145 " 2,645.00 " 977.59 435.36 " 2,177.83 " 679.77 " 1,745.44 " 522.43 " 1,802.30 " 435.36 512.19 " 1,808.65 " 476.10 " 1,770.03 " 435.36 548.04 " 1,904.66 " 460.97 512.19 " 1,742.24 " " 2,177.83 " 507.07 522.43 512.19 " 2,116.00 " 468.65 " 1,983.75 " " 1,983.75 " " 2,089.55 " " 2,036.65 " 450.73 " 1,081.81 " " 1,983.75 " " 1,005.36 " " 1,183.11 " 522.43 " 2,089.55 " Outpatient Treatment x10sv retinopathy 67228 " 2,645.00 " 977.59 435.36 " 2,177.83 " 679.77 " 1,745.44 " 522.43 " 1,802.30 " 435.36 512.19 " 1,808.65 " 476.10 " 1,770.03 " 435.36 548.04 " 1,904.66 " 460.97 512.19 " 1,742.24 " " 2,177.83 " 507.07 522.43 512.19 " 2,116.00 " 468.65 " 1,983.75 " " 1,983.75 " " 2,089.55 " " 2,036.65 " 450.73 " 1,081.81 " " 1,983.75 " " 1,005.36 " " 1,183.11 " 522.43 " 2,089.55 " Outpatient Revise eye muscle 67311 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Revise two eye muscles 67312 " 17,354.00 " " 6,414.04 " " 2,860.19 " " 14,287.13 " " 4,459.98 " " 11,451.90 " " 3,432.23 " " 11,825.02 " " 2,860.19 " " 3,364.93 " " 11,866.67 " " 3,123.72 " " 11,613.30 " " 2,860.19 " " 3,600.48 " " 12,496.62 " " 3,028.44 " " 3,364.93 " " 11,429.51 " " 14,287.13 " " 3,331.28 " " 3,432.23 " " 3,364.93 " " 13,883.20 " " 3,078.91 " " 13,015.50 " " 13,015.50 " " 13,709.66 " " 13,362.58 " " 2,961.14 " " 7,097.79 " " 13,015.50 " " 6,596.26 " " 7,762.44 " " 3,432.23 " " 13,709.66 " Outpatient Revise eye muscle 67314 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Explore/treat eye socket 67412 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Remove eyelid lesion 67800 " 1,372.00 " 507.09 226.30 " 1,129.33 " 352.60 905.38 271.55 934.88 226.30 266.23 938.17 246.96 918.14 226.30 284.87 987.98 239.61 266.23 903.45 " 1,129.33 " 263.57 271.55 266.23 " 1,097.60 " 243.60 " 1,029.00 " " 1,029.00 " " 1,083.88 " " 1,056.44 " 234.28 561.15 " 1,029.00 " 521.50 613.70 271.55 " 1,083.88 " Outpatient Biopsy eyelid & lid margin 67810 " 1,372.00 " 507.09 226.30 " 1,129.33 " 352.60 905.38 271.55 934.88 226.30 266.23 938.17 246.96 918.14 226.30 284.87 987.98 239.61 266.23 903.45 " 1,129.33 " 263.57 271.55 266.23 " 1,097.60 " 243.60 " 1,029.00 " " 1,029.00 " " 1,083.88 " " 1,056.44 " 234.28 561.15 " 1,029.00 " 521.50 613.70 271.55 " 1,083.88 " Outpatient Revise eyelashes 67820 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Revise eyelashes 67825 " 1,372.00 " 507.09 226.30 " 1,129.33 " 352.60 905.38 271.55 934.88 226.30 266.23 938.17 246.96 918.14 226.30 284.87 987.98 239.61 266.23 903.45 " 1,129.33 " 263.57 271.55 266.23 " 1,097.60 " 243.60 " 1,029.00 " " 1,029.00 " " 1,083.88 " " 1,056.44 " 234.28 561.15 " 1,029.00 " 521.50 613.70 271.55 " 1,083.88 " Outpatient Remove eyelid lesion 67840 " 4,250.00 " " 1,570.80 " 700.55 " 3,499.09 " " 1,092.25 " " 2,804.58 " 840.66 " 2,895.95 " 700.55 824.18 " 2,906.15 " 765.00 " 2,844.10 " 700.55 881.87 " 3,060.43 " 741.76 824.18 " 2,799.23 " " 3,499.09 " 815.94 840.66 824.18 " 3,400.00 " 754.12 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 725.28 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 840.66 " 3,357.50 " Outpatient Repair brow defect 67900 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Repair eyelid defect 67904 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Repair eyelid defect 67917 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Revision of eyelid 67961 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Revision of eyelid 67966 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Create tear sac drain 68720 " 17,354.00 " " 6,414.04 " " 2,860.19 " " 14,287.13 " " 4,459.98 " " 11,451.90 " " 3,432.23 " " 11,825.02 " " 2,860.19 " " 3,364.93 " " 11,866.67 " " 3,123.72 " " 11,613.30 " " 2,860.19 " " 3,600.48 " " 12,496.62 " " 3,028.44 " " 3,364.93 " " 11,429.51 " " 14,287.13 " " 3,331.28 " " 3,432.23 " " 3,364.93 " " 13,883.20 " " 3,078.91 " " 13,015.50 " " 13,015.50 " " 13,709.66 " " 13,362.58 " " 2,961.14 " " 7,097.79 " " 13,015.50 " " 6,596.26 " " 7,762.44 " " 3,432.23 " " 13,709.66 " Outpatient Close tear duct opening 68760 " 1,372.00 " 507.09 226.30 " 1,129.33 " 352.60 905.38 271.55 934.88 226.30 266.23 938.17 246.96 918.14 226.30 284.87 987.98 239.61 266.23 903.45 " 1,129.33 " 263.57 271.55 266.23 " 1,097.60 " 243.60 " 1,029.00 " " 1,029.00 " " 1,083.88 " " 1,056.44 " 234.28 561.15 " 1,029.00 " 521.50 613.70 271.55 " 1,083.88 " Outpatient Close tear duct opening 68761 " 1,372.00 " 507.09 226.30 " 1,129.33 " 352.60 905.38 271.55 934.88 226.30 266.23 938.17 246.96 918.14 226.30 284.87 987.98 239.61 266.23 903.45 " 1,129.33 " 263.57 271.55 266.23 " 1,097.60 " 243.60 " 1,029.00 " " 1,029.00 " " 1,083.88 " " 1,056.44 " 234.28 561.15 " 1,029.00 " 521.50 613.70 271.55 " 1,083.88 " Outpatient Probe nasolacrimal duct 68810 " 1,372.00 " 507.09 226.30 " 1,129.33 " 352.60 905.38 271.55 934.88 226.30 266.23 938.17 246.96 918.14 226.30 284.87 987.98 239.61 266.23 903.45 " 1,129.33 " 263.57 271.55 266.23 " 1,097.60 " 243.60 " 1,029.00 " " 1,029.00 " " 1,083.88 " " 1,056.44 " 234.28 561.15 " 1,029.00 " 521.50 613.70 271.55 " 1,083.88 " Outpatient Probe nasolacrimal duct 68815 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Biopsy of external ear 69100 " 1,111.00 " 410.63 183.02 914.58 285.53 733.15 219.63 757.04 183.02 215.32 759.70 199.98 743.48 183.02 230.39 800.03 193.79 215.32 731.65 914.58 213.17 219.63 215.32 888.80 197.02 833.25 833.25 877.69 855.47 189.48 454.40 833.25 422.29 496.95 219.63 877.69 Outpatient Biopsy of external ear canal 69105 " 7,102.00 " " 2,624.90 " " 1,170.22 " " 5,847.14 " " 1,825.21 " " 4,686.61 " " 1,404.26 " " 4,839.30 " " 1,170.22 " " 1,376.73 " " 4,856.35 " " 1,278.36 " " 4,752.66 " " 1,170.22 " " 1,473.10 " " 5,114.15 " " 1,239.06 " " 1,376.73 " " 4,677.63 " " 5,847.14 " " 1,362.96 " " 1,404.26 " " 1,376.73 " " 5,681.60 " " 1,259.71 " " 5,326.50 " " 5,326.50 " " 5,610.58 " " 5,468.54 " " 1,211.52 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,404.26 " " 5,610.58 " Outpatient Clear outer ear canal 69200 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Remove impacted ear wax uni 69209 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Remove impacted ear wax uni 69210 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Clean out mastoid cavity 69220 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Incision of eardrum 69420 " 1,111.00 " 410.63 183.02 914.58 285.53 733.15 219.63 757.04 183.02 215.32 759.70 199.98 743.48 183.02 230.39 800.03 193.79 215.32 731.65 914.58 213.17 219.63 215.32 888.80 197.02 833.25 833.25 877.69 855.47 189.48 454.40 833.25 422.29 496.95 219.63 877.69 Outpatient Remove ventilating tube 69424 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Create eardrum opening 69433 " 2,375.00 " 877.80 391.25 " 1,955.23 " 610.38 " 1,567.26 " 469.50 " 1,618.33 " 391.25 460.29 " 1,624.03 " 427.50 " 1,589.35 " 391.25 492.51 " 1,710.24 " 414.26 460.29 " 1,564.15 " " 1,955.23 " 455.69 469.50 460.29 " 1,900.00 " 421.17 " 1,781.25 " " 1,781.25 " " 1,876.25 " " 1,828.75 " 405.06 971.38 " 1,781.25 " 902.74 " 1,062.34 " 469.50 " 1,876.25 " Outpatient Create eardrum opening 69436 " 7,102.00 " " 2,624.90 " " 1,170.22 " " 5,847.14 " " 1,825.21 " " 4,686.61 " " 1,404.26 " " 4,839.30 " " 1,170.22 " " 1,376.73 " " 4,856.35 " " 1,278.36 " " 4,752.66 " " 1,170.22 " " 1,473.10 " " 5,114.15 " " 1,239.06 " " 1,376.73 " " 4,677.63 " " 5,847.14 " " 1,362.96 " " 1,404.26 " " 1,376.73 " " 5,681.60 " " 1,259.71 " " 5,326.50 " " 5,326.50 " " 5,610.58 " " 5,468.54 " " 1,211.52 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,404.26 " " 5,610.58 " Outpatient Repair of eardrum 69610 " 7,102.00 " " 2,624.90 " " 1,170.22 " " 5,847.14 " " 1,825.21 " " 4,686.61 " " 1,404.26 " " 4,839.30 " " 1,170.22 " " 1,376.73 " " 4,856.35 " " 1,278.36 " " 4,752.66 " " 1,170.22 " " 1,473.10 " " 5,114.15 " " 1,239.06 " " 1,376.73 " " 4,677.63 " " 5,847.14 " " 1,362.96 " " 1,404.26 " " 1,376.73 " " 5,681.60 " " 1,259.71 " " 5,326.50 " " 5,326.50 " " 5,610.58 " " 5,468.54 " " 1,211.52 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,404.26 " " 5,610.58 " Outpatient Repair of eardrum 69620 " 14,366.00 " " 5,309.67 " " 2,366.62 " " 11,827.50 " " 3,692.06 " " 9,480.12 " " 2,839.95 " " 9,788.99 " " 2,366.62 " " 2,784.26 " " 9,823.47 " " 2,585.88 " " 9,613.73 " " 2,366.62 " " 2,979.16 " " 10,344.96 " " 2,505.83 " " 2,784.26 " " 9,461.84 " " 11,827.50 " " 2,756.42 " " 2,839.95 " " 2,784.26 " " 11,492.80 " " 2,547.60 " " 10,774.50 " " 10,774.50 " " 11,349.14 " " 11,061.82 " " 2,450.15 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,839.95 " " 11,349.14 " Outpatient Repair eardrum structures 69631 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Rebuild eardrum structures 69632 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Rebuild eardrum structures 69633 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Revise middle ear & mastoid 69644 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Revise middle ear & mastoid 69645 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Revise middle ear bone 69661 " 26,702.00 " " 9,869.06 " " 4,399.76 " " 21,983.42 " " 6,862.41 " " 17,620.65 " " 5,279.71 " " 18,194.74 " " 4,399.76 " " 5,176.19 " " 18,258.83 " " 4,806.36 " " 17,868.98 " " 4,399.76 " " 5,538.52 " " 19,228.11 " " 4,658.57 " " 5,176.19 " " 17,586.44 " " 21,983.42 " " 5,124.43 " " 5,279.71 " " 5,176.19 " " 21,361.60 " " 4,736.21 " " 20,026.50 " " 20,026.50 " " 21,094.58 " " 20,560.54 " " 4,555.05 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,279.71 " " 21,094.58 " Outpatient Impltj oi implt skl perq esp 69714 " 64,652.00 " " 23,895.38 " " 10,667.05 " " 53,228.06 " " 16,615.56 " " 42,663.85 " " 12,800.46 " " 44,053.87 " " 10,667.05 " " 12,549.47 " " 44,209.04 " " 11,637.36 " " 43,265.12 " " 10,667.05 " " 13,427.93 " " 46,555.91 " " 11,294.52 " " 12,549.47 " " 42,581.72 " " 53,228.06 " " 12,423.98 " " 12,800.46 " " 12,549.47 " " 51,721.60 " " 11,482.77 " " 48,489.00 " " 48,489.00 " " 51,075.08 " " 49,782.04 " " 11,043.53 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,800.46 " " 51,075.08 " Outpatient Incise inner ear 69801 " 7,102.00 " " 2,624.90 " " 1,170.22 " " 5,847.14 " " 1,825.21 " " 4,686.61 " " 1,404.26 " " 4,839.30 " " 1,170.22 " " 1,376.73 " " 4,856.35 " " 1,278.36 " " 4,752.66 " " 1,170.22 " " 1,473.10 " " 5,114.15 " " 1,239.06 " " 1,376.73 " " 4,677.63 " " 5,847.14 " " 1,362.96 " " 1,404.26 " " 1,376.73 " " 5,681.60 " " 1,259.71 " " 5,326.50 " " 5,326.50 " " 5,610.58 " " 5,468.54 " " 1,211.52 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,404.26 " " 5,610.58 " Outpatient Implant cochlear device 69930 " 180,745.00 " " 66,803.35 " " 29,818.09 " " 148,806.13 " " 46,451.47 " " 119,273.63 " " 35,781.70 " " 123,159.64 " " 29,818.09 " " 35,080.10 " " 123,593.43 " " 32,534.10 " " 120,954.55 " " 29,818.09 " " 37,535.71 " " 130,154.47 " " 31,572.09 " " 35,080.10 " " 119,042.88 " " 148,806.13 " " 34,729.30 " " 35,781.70 " " 35,080.10 " " 144,596.00 " " 32,098.29 " " 135,558.75 " " 135,558.75 " " 142,788.55 " " 139,173.65 " " 30,870.49 " " 73,924.71 " " 135,558.75 " " 68,701.17 " " 80,847.24 " " 35,781.70 " " 142,788.55 " Outpatient X-ray eye for foreign body 70030 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of jaw 4/> views 70110 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of facial bones 70140 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of facial bones 70150 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of nasal bones 70160 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of eye sockets 70200 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of sinuses 70220 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of skull 70250 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of skull 70260 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of jaw joints 70330 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Magnetic image jaw joint 70336 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient X-ray exam of neck 70360 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Throat x-ray & fluoroscopy 70370 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Ct head/brain w/o dye 70450 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct head/brain w/dye 70460 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct head/brain w/o & w/dye 70470 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct orbit/ear/fossa w/o dye 70480 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct orbit/ear/fossa w/dye 70481 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct orbit/ear/fossa w/o&w/dye 70482 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct maxillofacial w/o dye 70486 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct maxillofacial w/dye 70487 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct maxillofacial w/o & w/dye 70488 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct soft tissue neck w/o dye 70490 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct soft tissue neck w/dye 70491 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct sft tsue nck w/o & w/dye 70492 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct angiography head 70496 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct angiography neck 70498 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Mri orbit/face/neck w/o dye 70540 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri orbt/fac/nck w/o &w/dye 70543 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mr angiography head w/o dye 70544 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mr angiography head w/dye 70545 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mr angiograph head w/o&w/dye 70546 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mr angiography neck w/o dye 70547 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mr angiography neck w/dye 70548 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mr angiograph neck w/o&w/dye 70549 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mri brain stem w/o dye 70551 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri brain stem w/dye 70552 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mri brain stem w/o & w/dye 70553 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient X-ray exam chest 1 view 71045 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam chest 2 views 71046 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam chest 3 views 71047 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam ribs uni 2 views 71100 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam unilat ribs/chest 71101 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam ribs/chest4/> vws 71111 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam breastbone 2/>vws 71120 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray strenoclavic jt 3/>vws 71130 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Ct thorax dx c- 71250 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct thorax dx c+ 71260 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct thorax lung cancer scr c- 71271 81.00 29.94 14.58 " 2,224.00 " 20.82 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 55.39 14.58 207.10 94.18 118.56 58.33 99.72 110.80 279.75 349.69 109.69 113.02 110.80 64.80 101.38 60.75 60.75 63.99 211.96 97.50 33.13 60.75 30.79 36.23 113.02 63.99 Outpatient Ct angiography chest 71275 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Mri chest w/o dye 71550 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri chest w/o & w/dye 71552 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient X-ray exam of spine 1 view 72020 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam neck spine 2-3 vw 72040 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam neck spine 4/5vws 72050 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam neck spine 6/>vws 72052 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam thorac spine 2vws 72070 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam thorac spine 3vws 72072 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam thoracolmb 2/> vw 72080 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam entire spi 1 vw 72081 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam entire spi 2/3 vw 72082 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam entire spi 4/5 vw 72083 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam l-s spine 2/3 vws 72100 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam l-2 spine 4/>vws 72110 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam l-s spine bending 72114 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray bend only l-s spine 72120 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct neck spine w/o dye 72125 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct neck spine w/dye 72126 " 1,933.00 " 714.44 318.56 " 2,224.00 " 496.78 " 2,153.00 " 382.28 " 2,224.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Ct chest spine w/o dye 72128 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct chest spine w/dye 72129 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct lumbar spine w/o dye 72131 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct lumbar spine w/dye 72132 " 1,933.00 " 714.44 318.56 " 2,224.00 " 496.78 " 2,153.00 " 382.28 " 2,224.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mri neck spine w/o dye 72141 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri chest spine w/o dye 72146 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri lumbar spine w/o dye 72148 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri neck spine w/o & w/dye 72156 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mri chest spine w/o & w/dye 72157 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mri lumbar spine w/o & w/dye 72158 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient X-ray exam of pelvis 72170 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of pelvis 72190 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct pelvis w/o dye 72192 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct pelvis w/dye 72193 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Mri pelvis w/o dye 72195 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri pelvis w/o & w/dye 72197 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient X-ray exam si joints 72200 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam si joints 3/> vws 72202 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam sacrum tailbone 72220 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of collar bone 73000 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of shoulder blade 73010 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of shoulder 73020 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of shoulder 73030 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Contrast x-ray of shoulder 73040 " 1,933.00 " 714.44 318.56 " 1,591.14 " 496.78 " 1,275.59 " 382.28 " 1,317.15 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient X-ray exam of shoulders 73050 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of humerus 73060 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of elbow 73070 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of elbow 73080 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of forearm 73090 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of arm infant 73092 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of wrist 73100 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of wrist 73110 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of hand 73120 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of hand 73130 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of finger(s) 73140 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Ct upper extremity w/o dye 73200 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct upper extremity w/dye 73201 " 1,933.00 " 714.44 318.56 " 2,224.00 " 496.78 " 2,153.00 " 382.28 " 2,224.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Ct angio upr extrm w/o&w/dye 73206 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Mri upper extremity w/o dye 73218 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri uppr extremity w/o&w/dye 73220 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mri joint upr extrem w/o dye 73221 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri joint upr extrem w/dye 73222 " 3,755.00 " " 1,387.85 " 618.91 " 3,091.22 " 965.04 " 2,629.00 " 742.69 " 2,715.00 " 618.91 728.13 " 2,567.67 " 675.90 " 1,830.86 " 618.91 779.10 " 2,703.98 " 655.32 728.13 " 2,472.93 " " 3,091.22 " 720.85 742.69 728.13 " 3,004.00 " 666.24 " 2,816.25 " " 2,816.25 " " 2,966.45 " " 1,873.77 " 640.75 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 742.69 " 2,966.45 " Outpatient Mri joint upr extr w/o&w/dye 73223 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient X-ray exam hip uni 1 view 73501 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam hip uni 2-3 views 73502 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam hip uni 4/> views 73503 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam hips bi 3-4 views 73522 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam hips bi 5/> views 73523 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of femur 1 73551 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of femur 2/> 73552 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of knee 1 or 2 73560 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of knee 3 73562 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam knee 4 or more 73564 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam of knees 73565 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of lower leg 73590 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of ankle 73600 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of ankle 73610 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of foot 73620 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of foot 73630 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of heel 73650 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam of toe(s) 73660 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Ct lower extremity w/o dye 73700 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct lower extremity w/dye 73701 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct angio lwr extr w/o&w/dye 73706 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Mri lower extremity w/o dye 73718 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri lwr extremity w/o&w/dye 73720 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mri jnt of lwr extre w/o dye 73721 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri joint of lwr extr w/dye 73722 " 3,755.00 " " 1,387.85 " 618.91 " 3,091.22 " 965.04 " 2,629.00 " 742.69 " 2,715.00 " 618.91 728.13 " 2,567.67 " 675.90 " 1,830.86 " 618.91 779.10 " 2,703.98 " 655.32 728.13 " 2,472.93 " " 3,091.22 " 720.85 742.69 728.13 " 3,004.00 " 666.24 " 2,816.25 " " 2,816.25 " " 2,966.45 " " 1,873.77 " 640.75 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 742.69 " 2,966.45 " Outpatient Mri joint lwr extr w/o&w/dye 73723 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient X-ray exam abdomen 1 view 74018 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-ray exam abdomen 2 views 74019 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam abdomen 3+ views 74021 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-ray exam complete abdomen 74022 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct abdomen w/o dye 74150 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct abdomen w/dye 74160 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct abdomen w/o & w/dye 74170 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct angio abd&pelv w/o&w/dye 74174 " 1,933.00 " 714.44 318.56 " 2,224.00 " 496.78 " 2,153.00 " 382.28 " 2,224.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Ct angio abdom w/o & w/dye 74175 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct abd & pelvis w/o contrast 74176 " 1,208.00 " 446.48 199.05 " 2,224.00 " 310.46 " 2,153.00 " 238.86 " 2,224.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Ct abd & pelv w/contrast 74177 " 1,933.00 " 714.44 318.56 " 2,224.00 " 496.78 " 2,153.00 " 382.28 " 2,224.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Ct abd & pelv 1/> regns 74178 " 1,933.00 " 714.44 318.56 " 2,224.00 " 496.78 " 2,153.00 " 382.28 " 2,224.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Mri abdomen w/o dye 74181 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri abdomen w/o & w/dye 74183 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient X-ray xm esophagus 1cntrst 74220 937.00 346.32 154.53 771.73 240.81 618.33 185.44 638.47 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient X-ray xm esophagus 2cntrst 74221 937.00 346.32 154.53 771.73 240.81 618.33 185.44 638.47 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient X-ray xm swlng funcj c+ 74230 937.00 346.32 154.53 771.73 240.81 618.33 185.44 638.47 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient X-ray xm upr gi trc 1cntrst 74240 937.00 346.32 154.53 771.73 240.81 618.33 185.44 638.47 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient X-ray xm upr gi trc 2cntrst 74246 937.00 346.32 154.53 771.73 240.81 618.33 185.44 638.47 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient X-ray xm sm int 1cntrst std 74250 937.00 346.32 154.53 771.73 240.81 618.33 185.44 638.47 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct colonography dx 74261 572.00 211.41 94.18 " 2,224.00 " 147.00 " 2,153.00 " 113.02 " 2,224.00 " 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ct colonography screening 74263 512.00 189.24 - " 2,224.00 " 131.58 " 2,153.00 " - " 2,224.00 " - - 350.11 92.16 342.63 - - 368.69 - - 503.94 629.93 - - 409.60 - 384.00 384.00 404.48 " 1,731.51 " - 209.41 384.00 194.61 229.02 - 404.48 Outpatient X-ray xm colon 1cntrst std 74270 937.00 346.32 154.53 771.73 240.81 618.33 185.44 638.47 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ther nma rdctj intus/obstrcj 74283 937.00 346.32 154.53 771.73 240.81 618.33 185.44 638.47 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Urography rtrgr +-kub 74420 " 1,933.00 " 714.44 318.56 " 1,591.14 " 496.78 " 1,275.59 " 382.28 " 1,317.15 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Urography antegrade rs&i 74425 " 1,933.00 " 714.44 318.56 " 1,591.14 " 496.78 " 1,275.59 " 382.28 " 1,317.15 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Contrast x-ray bladder 74430 " 1,933.00 " 714.44 318.56 " 1,591.14 " 496.78 " 1,275.59 " 382.28 " 1,317.15 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient X-ray urethra/bladder 74450 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient X-ray urethra/bladder 74455 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Mri fetal sngl/1st gestation 74712 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Cardiac mri for morph 75557 " 1,208.00 " 446.48 199.05 " 2,715.00 " 310.46 " 2,629.00 " 238.86 " 2,715.00 " 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Cardiac mri for morph w/dye 75561 " 1,933.00 " 714.44 318.56 " 2,715.00 " 496.78 " 2,629.00 " 382.28 " 2,715.00 " 318.56 374.78 " 1,321.79 " 347.94 942.39 318.56 401.01 " 1,391.95 " 337.30 374.78 " 1,272.89 " " 1,591.14 " 371.03 382.28 374.78 " 1,546.40 " 342.92 " 1,449.75 " " 1,449.75 " " 1,527.07 " 964.47 329.81 790.60 " 1,449.75 " 734.73 864.63 382.28 " 1,527.07 " Outpatient Ct hrt w/o dye w/ca test 75571 425.00 157.08 69.97 " 2,224.00 " 109.23 " 2,153.00 " 83.97 " 2,224.00 " 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Ct hrt w/3d image 75572 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct hrt c+ strux cgen hrt ds 75573 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Ct angio hrt w/3d image 75574 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Contrast exam abdominl aorta 75625 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 7,325.85 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 7,497.55 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Ct angio abdominal arteries 75635 937.00 346.32 154.53 " 2,224.00 " 240.81 " 2,153.00 " 185.44 " 2,224.00 " 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Artery x-rays spine 75705 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 12,212.15 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 12,498.37 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Artery x-rays arm/leg 75710 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 7,325.85 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 7,497.55 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Artery x-rays arms/legs 75716 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 7,325.85 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 7,497.55 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Artery x-rays abdomen 75726 " 25,044.00 " " 9,256.26 " " 4,125.31 " " 20,618.95 " " 6,436.31 " " 16,526.54 " " 4,950.37 " " 17,064.98 " " 4,125.31 " " 4,853.30 " " 17,125.09 " " 4,507.92 " " 12,212.15 " " 4,125.31 " " 5,193.03 " " 18,034.18 " " 4,367.97 " " 4,853.30 " " 16,494.88 " " 20,618.95 " " 4,804.77 " " 4,950.37 " " 4,853.30 " " 20,035.20 " " 4,440.77 " " 18,783.00 " " 18,783.00 " " 19,784.76 " " 12,498.37 " " 4,270.90 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,950.37 " " 19,784.76 " Outpatient Vein x-ray arm/leg 75820 " 7,382.00 " " 2,728.39 " " 1,216.49 " " 6,077.74 " " 1,897.17 " " 4,871.38 " " 1,459.78 " " 5,030.09 " " 1,216.49 " " 1,431.16 " " 5,047.81 " " 1,328.76 " " 3,599.72 " " 1,216.49 " " 1,531.34 " " 5,315.78 " " 1,288.04 " " 1,431.16 " " 4,862.11 " " 6,077.74 " " 1,416.85 " " 1,459.78 " " 1,431.16 " " 5,905.60 " " 1,309.51 " " 5,536.50 " " 5,536.50 " " 5,831.78 " " 3,684.09 " " 1,259.42 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,459.78 " " 5,831.78 " Outpatient Vein x-ray trunk 75825 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 7,325.85 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 7,497.55 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Vein x-ray chest 75827 " 7,382.00 " " 2,728.39 " " 1,216.49 " " 6,077.74 " " 1,897.17 " " 4,871.38 " " 1,459.78 " " 5,030.09 " " 1,216.49 " " 1,431.16 " " 5,047.81 " " 1,328.76 " " 3,599.72 " " 1,216.49 " " 1,531.34 " " 5,315.78 " " 1,288.04 " " 1,431.16 " " 4,862.11 " " 6,077.74 " " 1,416.85 " " 1,459.78 " " 1,431.16 " " 5,905.60 " " 1,309.51 " " 5,536.50 " " 5,536.50 " " 5,831.78 " " 3,684.09 " " 1,259.42 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,459.78 " " 5,831.78 " Outpatient Vein x-ray liver w/hemodynam 75889 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 7,325.85 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 7,497.55 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Follow-up angiography 75898 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 7,325.85 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 7,497.55 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Fluoroscopy <1 hr phys/qhp 76000 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient X-ray exam of fistula 76080 " 2,535.00 " 936.94 418.00 " 2,087.21 " 651.50 " 1,672.85 " 501.60 " 1,727.35 " 418.00 491.76 " 1,733.43 " 456.30 " 1,236.20 " 418.00 526.18 " 1,825.45 " 442.58 491.76 " 1,669.74 " " 2,087.21 " 486.84 501.60 491.76 " 2,028.00 " 449.96 " 1,901.25 " " 1,901.25 " " 2,002.65 " " 1,265.17 " 432.75 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 501.60 " 2,002.65 " Outpatient X-ray exam surgical specimen 76098 " 2,535.00 " 936.94 418.00 " 2,087.21 " 651.50 " 1,672.85 " 501.60 " 1,727.35 " 418.00 491.76 " 1,733.43 " 456.30 " 1,236.20 " 418.00 526.18 " 1,825.45 " 442.58 491.76 " 1,669.74 " " 2,087.21 " 486.84 501.60 491.76 " 2,028.00 " 449.96 " 1,901.25 " " 1,901.25 " " 2,002.65 " " 1,265.17 " 432.75 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 501.60 " 2,002.65 " Outpatient Cat scan follow-up study 76380 425.00 157.08 69.97 " 2,224.00 " 109.23 " 2,153.00 " 83.97 " 2,224.00 " 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Mr spectroscopy 76390 425.00 157.08 69.97 " 2,715.00 " 109.23 " 2,629.00 " 83.97 " 2,715.00 " 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Ct procedure 76497 425.00 157.08 69.97 " 2,224.00 " 109.23 " 2,153.00 " 83.97 " 2,224.00 " 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Mri procedure 76498 425.00 157.08 69.97 " 2,715.00 " 109.23 " 2,629.00 " 83.97 " 2,715.00 " 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Radiographic procedure 76499 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Echo exam of head 76506 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Oph us dx b-scan 76512 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Oph us dx ant sgm us uni/bi 76513 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Echo exam of eye thickness 76514 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 63.16 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 64.64 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Echo exam of eye 76516 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Echo exam of eye 76519 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us exam of head and neck 76536 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us exam chest 76604 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ultrasound breast complete 76641 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ultrasound breast limited 76642 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Us exam abdom complete 76700 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Echo exam of abdomen 76705 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us abdl aorta screen aaa 76706 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us exam abdo back wall comp 76770 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us exam abdo back wall lim 76775 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us exam k transpl w/doppler 76776 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us exam spinal canal 76800 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ob us < 14 wks single fetus 76801 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ob us >= 14 wks sngl fetus 76805 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ob us detailed sngl fetus 76811 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Ob us nuchal meas 1 gest 76813 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ob us limited fetus(s) 76815 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Ob us follow-up per fetus 76816 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Transvaginal us obstetric 76817 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Fetal biophys profile w/nst 76818 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Fetal biophys profil w/o nst 76819 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Umbilical artery echo 76820 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Middle cerebral artery echo 76821 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Echo exam of fetal heart 76825 " 2,535.00 " 936.94 418.00 " 2,087.21 " 651.50 " 1,672.85 " 501.60 " 1,727.35 " 418.00 491.76 " 1,733.43 " 456.30 " 1,236.20 " 418.00 526.18 " 1,825.45 " 442.58 491.76 " 1,669.74 " " 2,087.21 " 486.84 501.60 491.76 " 2,028.00 " 449.96 " 1,901.25 " " 1,901.25 " " 2,002.65 " " 1,265.17 " 432.75 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 501.60 " 2,002.65 " Outpatient Echo exam of fetal heart 76826 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Echo exam of fetal heart 76827 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Echo exam of fetal heart 76828 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Transvaginal us non-ob 76830 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Echo exam uterus 76831 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 602.94 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Us exam pelvic complete 76856 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us exam pelvic limited 76857 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us exam scrotum 76870 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us transrectal 76872 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us compl joint r-t w/img 76881 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us lmtd jt/nonvasc xtr strux 76882 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Us exam infant hips dynamic 76885 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Us trgt dyn mbubb 1st les 76978 937.00 346.32 154.53 771.73 240.81 618.33 185.44 638.47 154.53 181.80 640.72 168.66 457.09 154.53 194.53 674.73 163.62 181.80 617.38 771.73 179.98 185.44 181.80 749.60 166.35 702.75 702.75 740.23 467.80 159.98 383.23 702.75 356.15 419.12 185.44 740.23 Outpatient Use parenchyma 76981 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Breast tomosynthesis uni 77061 126.00 46.57 - 155.02 32.38 83.15 - 85.86 - - 86.16 22.68 84.32 - - 90.73 - - 124.02 155.02 - - 100.80 - 94.50 94.50 99.54 97.02 - 51.53 94.50 47.89 56.36 - 99.54 Outpatient Breast tomosynthesis bi 77062 126.00 46.57 - 155.02 32.38 83.15 - 85.86 - - 86.16 22.68 84.32 - - 90.73 - - 124.02 155.02 - - 100.80 - 94.50 94.50 99.54 97.02 - 51.53 94.50 47.89 56.36 - 99.54 Outpatient Breast tomosynthesis bi 77063 126.00 46.57 19.34 125.95 32.38 83.15 23.21 85.86 19.34 22.75 86.16 22.68 84.32 19.34 24.34 90.73 20.48 22.75 100.76 125.95 22.52 23.21 22.75 100.80 20.82 94.50 94.50 99.54 66.73 20.02 51.53 94.50 47.89 56.36 23.21 99.54 Outpatient Dx mammo incl cad uni 77065 451.00 166.69 72.35 360.80 115.91 297.61 86.82 307.31 72.35 85.12 308.39 81.18 301.81 72.35 91.08 324.77 76.61 85.12 133.75 167.19 84.27 86.82 85.12 360.80 77.88 338.25 338.25 356.29 239.52 74.91 184.46 338.25 171.43 201.73 86.82 356.29 Outpatient Dx mammo incl cad bi 77066 576.00 212.89 92.24 460.80 148.03 380.10 110.69 392.49 92.24 108.52 393.87 103.68 385.46 92.24 116.12 414.78 97.67 108.52 165.44 206.80 107.43 110.69 108.52 460.80 99.30 432.00 432.00 455.04 306.25 95.50 235.58 432.00 218.94 257.64 110.69 455.04 Outpatient Scr mammo bi incl cad 77067 476.00 175.93 76.22 380.80 122.33 314.11 91.46 324.35 76.22 89.67 325.49 85.68 318.54 76.22 95.95 342.77 80.70 89.67 126.65 158.32 88.77 91.46 89.67 380.80 82.05 357.00 357.00 376.04 253.22 78.91 194.68 357.00 180.93 212.91 91.46 376.04 Outpatient X-ray stress view 77071 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient X-rays for bone age 77072 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-rays bone length studies 77073 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-rays bone survey limited 77074 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-rays bone survey complete 77075 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient X-rays bone survey infant 77076 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Dxa bone density axial 77080 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 285.50 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Dxa bone density/peripheral 77081 425.00 157.08 69.97 349.69 109.23 280.46 83.97 289.60 69.97 82.32 290.62 76.50 207.10 69.97 88.08 306.04 74.09 82.32 279.75 349.69 81.50 83.97 82.32 340.00 75.32 318.75 318.75 335.75 211.96 72.44 173.83 318.75 161.54 190.10 83.97 335.75 Outpatient Set radiation therapy field 77280 666.00 246.15 109.77 548.38 171.16 439.49 131.72 453.81 109.77 129.14 455.41 119.88 324.79 109.77 138.18 479.59 116.23 129.14 438.69 548.38 127.85 131.72 129.14 532.80 118.16 499.50 499.50 526.14 512.82 113.64 272.39 499.50 253.15 297.90 131.72 526.14 Outpatient Set radiation therapy field 77290 " 1,778.00 " 657.15 292.95 " 1,463.88 " 456.95 " 1,173.30 " 351.54 " 1,211.53 " 292.95 344.65 " 1,215.80 " 320.04 867.02 292.95 368.78 " 1,280.34 " 310.19 344.65 " 1,171.09 " " 1,463.88 " 341.20 351.54 344.65 " 1,422.40 " 315.35 " 1,333.50 " " 1,333.50 " " 1,404.62 " " 1,369.06 " 303.29 727.20 " 1,333.50 " 675.82 795.30 351.54 " 1,404.62 " Outpatient 3-d radiotherapy plan 77295 " 6,626.00 " " 2,448.97 " " 1,092.40 " " 5,455.51 " " 1,702.88 " " 4,372.50 " " 1,310.88 " " 4,514.96 " " 1,092.40 " " 1,285.18 " " 4,530.86 " " 1,192.68 " " 3,231.18 " " 1,092.40 " " 1,375.14 " " 4,771.38 " " 1,156.66 " " 1,285.18 " " 4,364.33 " " 5,455.51 " " 1,272.33 " " 1,310.88 " " 1,285.18 " " 5,300.80 " " 1,175.94 " " 4,969.50 " " 4,969.50 " " 5,234.54 " " 5,102.02 " " 1,130.96 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,310.88 " " 5,234.54 " Outpatient Radiation therapy dose plan 77300 666.00 246.15 109.77 548.38 171.16 439.49 131.72 453.81 109.77 129.14 455.41 119.88 324.79 109.77 138.18 479.59 116.23 129.14 438.69 548.38 127.85 131.72 129.14 532.80 118.16 499.50 499.50 526.14 512.82 113.64 272.39 499.50 253.15 297.90 131.72 526.14 Outpatient Radiotherapy dose plan imrt 77301 " 6,626.00 " " 2,448.97 " " 1,092.40 " " 5,455.51 " " 1,702.88 " " 4,372.50 " " 1,310.88 " " 4,514.96 " " 1,092.40 " " 1,285.18 " " 4,530.86 " " 1,192.68 " " 3,231.18 " " 1,092.40 " " 1,375.14 " " 4,771.38 " " 1,156.66 " " 1,285.18 " " 4,364.33 " " 5,455.51 " " 1,272.33 " " 1,310.88 " " 1,285.18 " " 5,300.80 " " 1,175.94 " " 4,969.50 " " 4,969.50 " " 5,234.54 " " 5,102.02 " " 1,130.96 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,310.88 " " 5,234.54 " Outpatient Telethx isodose plan simple 77306 " 1,778.00 " 657.15 292.95 " 1,463.88 " 456.95 " 1,173.30 " 351.54 " 1,211.53 " 292.95 344.65 " 1,215.80 " 320.04 867.02 292.95 368.78 " 1,280.34 " 310.19 344.65 " 1,171.09 " " 1,463.88 " 341.20 351.54 344.65 " 1,422.40 " 315.35 " 1,333.50 " " 1,333.50 " " 1,404.62 " " 1,369.06 " 303.29 727.20 " 1,333.50 " 675.82 795.30 351.54 " 1,404.62 " Outpatient Telethx isodose plan cplx 77307 " 1,778.00 " 657.15 292.95 " 1,463.88 " 456.95 " 1,173.30 " 351.54 " 1,211.53 " 292.95 344.65 " 1,215.80 " 320.04 867.02 292.95 368.78 " 1,280.34 " 310.19 344.65 " 1,171.09 " " 1,463.88 " 341.20 351.54 344.65 " 1,422.40 " 315.35 " 1,333.50 " " 1,333.50 " " 1,404.62 " " 1,369.06 " 303.29 727.20 " 1,333.50 " 675.82 795.30 351.54 " 1,404.62 " Outpatient Brachytx isodose plan simple 77316 " 1,778.00 " 657.15 292.95 " 1,463.88 " 456.95 " 1,173.30 " 351.54 " 1,211.53 " 292.95 344.65 " 1,215.80 " 320.04 867.02 292.95 368.78 " 1,280.34 " 310.19 344.65 " 1,171.09 " " 1,463.88 " 341.20 351.54 344.65 " 1,422.40 " 315.35 " 1,333.50 " " 1,333.50 " " 1,404.62 " " 1,369.06 " 303.29 727.20 " 1,333.50 " 675.82 795.30 351.54 " 1,404.62 " Outpatient Special teletx port plan 77321 " 1,778.00 " 657.15 292.95 " 1,463.88 " 456.95 " 1,173.30 " 351.54 " 1,211.53 " 292.95 344.65 " 1,215.80 " 320.04 867.02 292.95 368.78 " 1,280.34 " 310.19 344.65 " 1,171.09 " " 1,463.88 " 341.20 351.54 344.65 " 1,422.40 " 315.35 " 1,333.50 " " 1,333.50 " " 1,404.62 " " 1,369.06 " 303.29 727.20 " 1,333.50 " 675.82 795.30 351.54 " 1,404.62 " Outpatient Special radiation dosimetry 77331 666.00 246.15 109.77 548.38 171.16 439.49 131.72 453.81 109.77 129.14 455.41 119.88 324.79 109.77 138.18 479.59 116.23 129.14 438.69 548.38 127.85 131.72 129.14 532.80 118.16 499.50 499.50 526.14 512.82 113.64 272.39 499.50 253.15 297.90 131.72 526.14 Outpatient Radiation treatment aid(s) 77332 666.00 246.15 109.77 548.38 171.16 439.49 131.72 453.81 109.77 129.14 455.41 119.88 324.79 109.77 138.18 479.59 116.23 129.14 438.69 548.38 127.85 131.72 129.14 532.80 118.16 499.50 499.50 526.14 512.82 113.64 272.39 499.50 253.15 297.90 131.72 526.14 Outpatient Radiation treatment aid(s) 77333 666.00 246.15 109.77 548.38 171.16 439.49 131.72 453.81 109.77 129.14 455.41 119.88 324.79 109.77 138.18 479.59 116.23 129.14 438.69 548.38 127.85 131.72 129.14 532.80 118.16 499.50 499.50 526.14 512.82 113.64 272.39 499.50 253.15 297.90 131.72 526.14 Outpatient Radiation treatment aid(s) 77334 " 1,778.00 " 657.15 292.95 " 1,463.88 " 456.95 " 1,173.30 " 351.54 " 1,211.53 " 292.95 344.65 " 1,215.80 " 320.04 867.02 292.95 368.78 " 1,280.34 " 310.19 344.65 " 1,171.09 " " 1,463.88 " 341.20 351.54 344.65 " 1,422.40 " 315.35 " 1,333.50 " " 1,333.50 " " 1,404.62 " " 1,369.06 " 303.29 727.20 " 1,333.50 " 675.82 795.30 351.54 " 1,404.62 " Outpatient Radiation physics consult 77336 666.00 246.15 109.77 548.38 171.16 439.49 131.72 453.81 109.77 129.14 455.41 119.88 324.79 109.77 138.18 479.59 116.23 129.14 438.69 548.38 127.85 131.72 129.14 532.80 118.16 499.50 499.50 526.14 512.82 113.64 272.39 499.50 253.15 297.90 131.72 526.14 Outpatient Design mlc device for imrt 77338 " 1,778.00 " 657.15 292.95 " 1,463.88 " 456.95 " 1,173.30 " 351.54 " 1,211.53 " 292.95 344.65 " 1,215.80 " 320.04 867.02 292.95 368.78 " 1,280.34 " 310.19 344.65 " 1,171.09 " " 1,463.88 " 341.20 351.54 344.65 " 1,422.40 " 315.35 " 1,333.50 " " 1,333.50 " " 1,404.62 " " 1,369.06 " 303.29 727.20 " 1,333.50 " 675.82 795.30 351.54 " 1,404.62 " Outpatient Radiation physics consult 77370 666.00 246.15 109.77 548.38 171.16 439.49 131.72 453.81 109.77 129.14 455.41 119.88 324.79 109.77 138.18 479.59 116.23 129.14 438.69 548.38 127.85 131.72 129.14 532.80 118.16 499.50 499.50 526.14 512.82 113.64 272.39 499.50 253.15 297.90 131.72 526.14 Outpatient Srs multisource 77371 " 40,807.00 " " 15,082.27 " " 6,728.04 " " 33,596.17 " " 10,487.40 " " 26,928.54 " " 8,073.65 " " 27,805.89 " " 6,728.04 " " 7,915.34 " " 27,903.83 " " 7,345.26 " " 19,898.27 " " 6,728.04 " " 8,469.41 " " 29,385.12 " " 7,123.81 " " 7,915.34 " " 26,876.48 " " 33,596.17 " " 7,836.19 " " 8,073.65 " " 7,915.34 " " 32,645.60 " " 7,242.54 " " 30,605.25 " " 30,605.25 " " 32,237.53 " " 31,421.39 " " 6,965.50 " " 16,690.06 " " 30,605.25 " " 15,510.74 " " 18,252.97 " " 8,073.65 " " 32,237.53 " Outpatient Sbrt delivery 77373 " 9,102.00 " " 3,364.10 " " 1,500.35 " " 7,493.72 " " 2,339.21 " " 6,006.41 " " 1,800.42 " " 6,202.10 " " 1,500.35 " " 1,765.12 " " 6,223.95 " " 1,638.36 " " 4,438.37 " " 1,500.35 " " 1,888.68 " " 6,554.35 " " 1,588.61 " " 1,765.12 " " 5,994.88 " " 7,493.72 " " 1,747.47 " " 1,800.42 " " 1,765.12 " " 7,281.60 " " 1,615.08 " " 6,826.50 " " 6,826.50 " " 7,190.58 " " 7,008.54 " " 1,553.31 " " 3,722.72 " " 6,826.50 " " 3,459.67 " " 4,071.32 " " 1,800.42 " " 7,190.58 " Outpatient Ntsty modul rad tx dlvr smpl 77385 " 2,848.00 " " 1,052.62 " 469.36 " 2,345.04 " 731.94 " 1,879.40 " 563.23 " 1,940.63 " 469.36 552.19 " 1,947.46 " 512.64 " 1,388.93 " 469.36 590.84 " 2,050.84 " 496.97 552.19 " 1,876.00 " " 2,345.04 " 546.67 563.23 552.19 " 2,278.40 " 505.25 " 2,136.00 " " 2,136.00 " " 2,249.92 " " 2,192.96 " 485.93 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 563.23 " 2,249.92 " Outpatient Ntsty modul rad tx dlvr cplx 77386 " 2,848.00 " " 1,052.62 " 469.36 " 2,345.04 " 731.94 " 1,879.40 " 563.23 " 1,940.63 " 469.36 552.19 " 1,947.46 " 512.64 " 1,388.93 " 469.36 590.84 " 2,050.84 " 496.97 552.19 " 1,876.00 " " 2,345.04 " 546.67 563.23 552.19 " 2,278.40 " 505.25 " 2,136.00 " " 2,136.00 " " 2,249.92 " " 2,192.96 " 485.93 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 563.23 " 2,249.92 " Outpatient External radiation dosimetry 77399 666.00 246.15 109.77 548.38 171.16 439.49 131.72 453.81 109.77 129.14 455.41 119.88 324.79 109.77 138.18 479.59 116.23 129.14 438.69 548.38 127.85 131.72 129.14 532.80 118.16 499.50 499.50 526.14 512.82 113.64 272.39 499.50 253.15 297.90 131.72 526.14 Outpatient Radiation treatment delivery 77402 633.00 233.96 103.62 521.01 162.68 417.72 124.35 431.33 103.62 121.91 432.85 113.94 308.58 103.62 130.44 455.82 109.72 121.91 416.80 521.01 120.69 124.35 121.91 506.40 111.55 474.75 474.75 500.07 487.41 107.28 258.90 474.75 240.60 283.14 124.35 500.07 Outpatient Radiation treatment delivery 77412 " 1,269.00 " 469.02 209.11 " 1,044.62 " 326.13 837.41 250.93 864.70 209.11 246.01 867.74 228.42 618.70 209.11 263.23 913.81 221.41 246.01 835.68 " 1,044.62 " 243.55 250.93 246.01 " 1,015.20 " 225.10 951.75 951.75 " 1,002.51 " 977.13 216.49 519.02 951.75 482.35 567.62 250.93 " 1,002.51 " Outpatient Special radiation treatment 77470 " 2,848.00 " " 1,052.62 " 469.36 " 2,345.04 " 731.94 " 1,879.40 " 563.23 " 1,940.63 " 469.36 552.19 " 1,947.46 " 512.64 " 1,388.93 " 469.36 590.84 " 2,050.84 " 496.97 552.19 " 1,876.00 " " 2,345.04 " 546.67 563.23 552.19 " 2,278.40 " 505.25 " 2,136.00 " " 2,136.00 " " 2,249.92 " " 2,192.96 " 485.93 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 563.23 " 2,249.92 " Outpatient Hdr rdncl ntrstl/icav brchtx 77770 " 3,719.00 " " 1,374.54 " 613.68 " 3,062.17 " 955.78 " 2,454.17 " 736.42 " 2,534.13 " 613.68 721.98 " 2,543.05 " 669.42 " 1,813.66 " 613.68 772.52 " 2,678.05 " 649.78 721.98 " 2,449.70 " " 3,062.17 " 714.76 736.42 721.98 " 2,975.20 " 660.61 " 2,789.25 " " 2,789.25 " " 2,938.01 " " 2,863.63 " 635.34 " 1,521.07 " " 2,789.25 " " 1,413.59 " " 1,663.51 " 736.42 " 2,938.01 " Outpatient Thyroid imaging w/blood flow 78013 " 1,980.00 " 731.81 326.10 " 1,630.03 " 508.86 " 1,306.60 " 391.32 " 1,349.17 " 326.10 383.65 " 1,353.92 " 356.40 965.43 326.10 410.51 " 1,425.80 " 345.29 383.65 " 1,304.00 " " 1,630.03 " 379.81 391.32 383.65 " 1,584.00 " 351.04 " 1,485.00 " " 1,485.00 " " 1,564.20 " 988.05 337.61 809.82 " 1,485.00 " 752.60 885.65 391.32 " 1,564.20 " Outpatient Thyroid imaging w/blood flow 78014 " 1,980.00 " 731.81 326.10 " 1,630.03 " 508.86 " 1,306.60 " 391.32 " 1,349.17 " 326.10 383.65 " 1,353.92 " 356.40 965.43 326.10 410.51 " 1,425.80 " 345.29 383.65 " 1,304.00 " " 1,630.03 " 379.81 391.32 383.65 " 1,584.00 " 351.04 " 1,485.00 " " 1,485.00 " " 1,564.20 " 988.05 337.61 809.82 " 1,485.00 " 752.60 885.65 391.32 " 1,564.20 " Outpatient Thyroid met imaging body 78018 " 2,569.00 " 949.50 423.33 " 2,115.33 " 660.23 " 1,695.28 " 508.00 " 1,750.52 " 423.33 498.04 " 1,756.68 " 462.42 " 1,252.86 " 423.33 532.90 " 1,849.94 " 448.24 498.04 " 1,692.23 " " 2,115.33 " 493.06 508.00 498.04 " 2,055.20 " 455.71 " 1,926.75 " " 1,926.75 " " 2,029.51 " " 1,282.23 " 438.28 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 508.00 " 2,029.51 " Outpatient Parathyrd planar w/spect&ct 78072 " 2,569.00 " 949.50 423.33 " 2,115.33 " 660.23 " 1,695.28 " 508.00 " 1,750.52 " 423.33 498.04 " 1,756.68 " 462.42 " 1,252.86 " 423.33 532.90 " 1,849.94 " 448.24 498.04 " 1,692.23 " " 2,115.33 " 493.06 508.00 498.04 " 2,055.20 " 455.71 " 1,926.75 " " 1,926.75 " " 2,029.51 " " 1,282.23 " 438.28 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 508.00 " 2,029.51 " Outpatient Lymph system imaging 78195 " 2,569.00 " 949.50 423.33 " 2,115.33 " 660.23 " 1,695.28 " 508.00 " 1,750.52 " 423.33 498.04 " 1,756.68 " 462.42 " 1,252.86 " 423.33 532.90 " 1,849.94 " 448.24 498.04 " 1,692.23 " " 2,115.33 " 493.06 508.00 498.04 " 2,055.20 " 455.71 " 1,926.75 " " 1,926.75 " " 2,029.51 " " 1,282.23 " 438.28 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 508.00 " 2,029.51 " Outpatient Liver imaging 78201 " 2,569.00 " 949.50 423.33 " 2,115.33 " 660.23 " 1,695.28 " 508.00 " 1,750.52 " 423.33 498.04 " 1,756.68 " 462.42 " 1,252.86 " 423.33 532.90 " 1,849.94 " 448.24 498.04 " 1,692.23 " " 2,115.33 " 493.06 508.00 498.04 " 2,055.20 " 455.71 " 1,926.75 " " 1,926.75 " " 2,029.51 " " 1,282.23 " 438.28 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 508.00 " 2,029.51 " Outpatient Gastric emptying imag study 78264 " 1,980.00 " 731.81 326.10 " 1,630.03 " 508.86 " 1,306.60 " 391.32 " 1,349.17 " 326.10 383.65 " 1,353.92 " 356.40 965.43 326.10 410.51 " 1,425.80 " 345.29 383.65 " 1,304.00 " " 1,630.03 " 379.81 391.32 383.65 " 1,584.00 " 351.04 " 1,485.00 " " 1,485.00 " " 1,564.20 " 988.05 337.61 809.82 " 1,485.00 " 752.60 885.65 391.32 " 1,564.20 " Outpatient Meckels divert exam 78290 " 1,980.00 " 731.81 326.10 " 1,630.03 " 508.86 " 1,306.60 " 391.32 " 1,349.17 " 326.10 383.65 " 1,353.92 " 356.40 965.43 326.10 410.51 " 1,425.80 " 345.29 383.65 " 1,304.00 " " 1,630.03 " 379.81 391.32 383.65 " 1,584.00 " 351.04 " 1,485.00 " " 1,485.00 " " 1,564.20 " 988.05 337.61 809.82 " 1,485.00 " 752.60 885.65 391.32 " 1,564.20 " Outpatient Bone imaging whole body 78306 " 1,980.00 " 731.81 326.10 " 1,630.03 " 508.86 " 1,306.60 " 391.32 " 1,349.17 " 326.10 383.65 " 1,353.92 " 356.40 965.43 326.10 410.51 " 1,425.80 " 345.29 383.65 " 1,304.00 " " 1,630.03 " 379.81 391.32 383.65 " 1,584.00 " 351.04 " 1,485.00 " " 1,485.00 " " 1,564.20 " 988.05 337.61 809.82 " 1,485.00 " 752.60 885.65 391.32 " 1,564.20 " Outpatient Bone imaging 3 phase 78315 " 1,980.00 " 731.81 326.10 " 1,630.03 " 508.86 " 1,306.60 " 391.32 " 1,349.17 " 326.10 383.65 " 1,353.92 " 356.40 965.43 326.10 410.51 " 1,425.80 " 345.29 383.65 " 1,304.00 " " 1,630.03 " 379.81 391.32 383.65 " 1,584.00 " 351.04 " 1,485.00 " " 1,485.00 " " 1,564.20 " 988.05 337.61 809.82 " 1,485.00 " 752.60 885.65 391.32 " 1,564.20 " Outpatient Myocrd img pet rst&strs ct 78431 " 11,815.00 " " 4,366.82 " " 1,906.27 " " 9,727.31 " " 3,036.46 " " 7,796.72 " " 2,287.52 " " 8,050.74 " " 1,906.27 " " 2,242.67 " " 8,079.10 " " 2,126.70 " " 5,761.28 " " 1,906.27 " " 2,399.66 " " 8,507.98 " " 2,018.40 " " 2,242.67 " " 7,781.71 " " 9,727.31 " " 2,220.24 " " 2,287.52 " " 2,242.67 " " 9,452.00 " " 2,052.04 " " 8,861.25 " " 8,861.25 " " 9,333.85 " " 5,896.31 " " 1,973.55 " " 4,832.34 " " 8,861.25 " " 4,490.88 " " 5,284.85 " " 2,287.52 " " 9,333.85 " Outpatient Ht muscle image spect sing 78451 " 6,856.00 " " 2,533.98 " " 1,130.48 " " 5,644.66 " " 1,761.99 " " 4,524.27 " " 1,356.58 " " 4,671.68 " " 1,130.48 " " 1,329.98 " " 4,688.13 " " 1,234.08 " " 3,343.21 " " 1,130.48 " " 1,423.08 " " 4,937.01 " " 1,196.98 " " 1,329.98 " " 4,515.65 " " 5,644.66 " " 1,316.68 " " 1,356.58 " " 1,329.98 " " 5,484.80 " " 1,216.93 " " 5,142.00 " " 5,142.00 " " 5,416.24 " " 3,421.56 " " 1,170.38 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,356.58 " " 5,416.24 " Outpatient Ht muscle image spect mult 78452 " 6,856.00 " " 2,533.98 " " 1,130.48 " " 5,644.66 " " 1,761.99 " " 4,524.27 " " 1,356.58 " " 4,671.68 " " 1,130.48 " " 1,329.98 " " 4,688.13 " " 1,234.08 " " 3,343.21 " " 1,130.48 " " 1,423.08 " " 4,937.01 " " 1,196.98 " " 1,329.98 " " 4,515.65 " " 5,644.66 " " 1,316.68 " " 1,356.58 " " 1,329.98 " " 5,484.80 " " 1,216.93 " " 5,142.00 " " 5,142.00 " " 5,416.24 " " 3,421.56 " " 1,170.38 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,356.58 " " 5,416.24 " Outpatient Lung perfusion imaging 78580 " 1,980.00 " 731.81 326.10 " 1,630.03 " 508.86 " 1,306.60 " 391.32 " 1,349.17 " 326.10 383.65 " 1,353.92 " 356.40 965.43 326.10 410.51 " 1,425.80 " 345.29 383.65 " 1,304.00 " " 1,630.03 " 379.81 391.32 383.65 " 1,584.00 " 351.04 " 1,485.00 " " 1,485.00 " " 1,564.20 " 988.05 337.61 809.82 " 1,485.00 " 752.60 885.65 391.32 " 1,564.20 " Outpatient Lung perfusion differential 78597 " 1,980.00 " 731.81 326.10 " 1,630.03 " 508.86 " 1,306.60 " 391.32 " 1,349.17 " 326.10 383.65 " 1,353.92 " 356.40 965.43 326.10 410.51 " 1,425.80 " 345.29 383.65 " 1,304.00 " " 1,630.03 " 379.81 391.32 383.65 " 1,584.00 " 351.04 " 1,485.00 " " 1,485.00 " " 1,564.20 " 988.05 337.61 809.82 " 1,485.00 " 752.60 885.65 391.32 " 1,564.20 " Outpatient Brain imaging (pet) 78608 " 7,772.00 " " 2,872.53 " " 1,280.36 " " 6,398.47 " " 1,997.40 " " 5,128.74 " " 1,536.43 " " 5,295.84 " " 1,280.36 " " 1,506.30 " " 5,314.49 " " 1,398.96 " " 3,789.67 " " 1,280.36 " " 1,611.74 " " 5,596.62 " " 1,355.67 " " 1,506.30 " " 5,118.69 " " 6,398.47 " " 1,491.24 " " 1,536.43 " " 1,506.30 " " 6,217.60 " " 1,378.26 " " 5,829.00 " " 5,829.00 " " 6,139.88 " " 3,878.49 " " 1,325.54 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,536.43 " " 6,139.88 " Outpatient K flow/funct image w/o drug 78707 " 2,569.00 " 949.50 423.33 " 2,115.33 " 660.23 " 1,695.28 " 508.00 " 1,750.52 " 423.33 498.04 " 1,756.68 " 462.42 " 1,252.86 " 423.33 532.90 " 1,849.94 " 448.24 498.04 " 1,692.23 " " 2,115.33 " 493.06 508.00 498.04 " 2,055.20 " 455.71 " 1,926.75 " " 1,926.75 " " 2,029.51 " " 1,282.23 " 438.28 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 508.00 " 2,029.51 " Outpatient K flow/funct image multiple 78709 " 2,569.00 " 949.50 423.33 " 2,115.33 " 660.23 " 1,695.28 " 508.00 " 1,750.52 " 423.33 498.04 " 1,756.68 " 462.42 " 1,252.86 " 423.33 532.90 " 1,849.94 " 448.24 498.04 " 1,692.23 " " 2,115.33 " 493.06 508.00 498.04 " 2,055.20 " 455.71 " 1,926.75 " " 1,926.75 " " 2,029.51 " " 1,282.23 " 438.28 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 508.00 " 2,029.51 " Outpatient Ureteral reflux study 78740 " 1,980.00 " 731.81 326.10 " 1,630.03 " 508.86 " 1,306.60 " 391.32 " 1,349.17 " 326.10 383.65 " 1,353.92 " 356.40 965.43 326.10 410.51 " 1,425.80 " 345.29 383.65 " 1,304.00 " " 1,630.03 " 379.81 391.32 383.65 " 1,584.00 " 351.04 " 1,485.00 " " 1,485.00 " " 1,564.20 " 988.05 337.61 809.82 " 1,485.00 " 752.60 885.65 391.32 " 1,564.20 " Outpatient Rp loclzj tum spect 1 area 78803 " 6,856.00 " " 2,533.98 " " 1,130.48 " " 5,644.66 " " 1,761.99 " " 4,524.27 " " 1,356.58 " " 4,671.68 " " 1,130.48 " " 1,329.98 " " 4,688.13 " " 1,234.08 " " 3,343.21 " " 1,130.48 " " 1,423.08 " " 4,937.01 " " 1,196.98 " " 1,329.98 " " 4,515.65 " " 5,644.66 " " 1,316.68 " " 1,356.58 " " 1,329.98 " " 5,484.80 " " 1,216.93 " " 5,142.00 " " 5,142.00 " " 5,416.24 " " 3,421.56 " " 1,170.38 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,356.58 " " 5,416.24 " Outpatient Rp loclzj tum whbdy 2+d img 78804 " 6,856.00 " " 2,533.98 " " 1,130.48 " " 5,644.66 " " 1,761.99 " " 4,524.27 " " 1,356.58 " " 4,671.68 " " 1,130.48 " " 1,329.98 " " 4,688.13 " " 1,234.08 " " 3,343.21 " " 1,130.48 " " 1,423.08 " " 4,937.01 " " 1,196.98 " " 1,329.98 " " 4,515.65 " " 5,644.66 " " 1,316.68 " " 1,356.58 " " 1,329.98 " " 5,484.80 " " 1,216.93 " " 5,142.00 " " 5,142.00 " " 5,416.24 " " 3,421.56 " " 1,170.38 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,356.58 " " 5,416.24 " Outpatient Pet image skull-thigh 78812 " 7,772.00 " " 2,872.53 " " 1,280.36 " " 6,398.47 " " 1,997.40 " " 5,128.74 " " 1,536.43 " " 5,295.84 " " 1,280.36 " " 1,506.30 " " 5,314.49 " " 1,398.96 " " 3,789.67 " " 1,280.36 " " 1,611.74 " " 5,596.62 " " 1,355.67 " " 1,506.30 " " 5,118.69 " " 6,398.47 " " 1,491.24 " " 1,536.43 " " 1,506.30 " " 6,217.60 " " 1,378.26 " " 5,829.00 " " 5,829.00 " " 6,139.88 " " 3,878.49 " " 1,325.54 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,536.43 " " 6,139.88 " Outpatient Pet image full body 78813 " 7,772.00 " " 2,872.53 " " 1,280.36 " " 6,398.47 " " 1,997.40 " " 5,128.74 " " 1,536.43 " " 5,295.84 " " 1,280.36 " " 1,506.30 " " 5,314.49 " " 1,398.96 " " 3,789.67 " " 1,280.36 " " 1,611.74 " " 5,596.62 " " 1,355.67 " " 1,506.30 " " 5,118.69 " " 6,398.47 " " 1,491.24 " " 1,536.43 " " 1,506.30 " " 6,217.60 " " 1,378.26 " " 5,829.00 " " 5,829.00 " " 6,139.88 " " 3,878.49 " " 1,325.54 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,536.43 " " 6,139.88 " Outpatient Pet image w/ct lmtd 78814 " 7,772.00 " " 2,872.53 " " 1,280.36 " " 6,398.47 " " 1,997.40 " " 5,128.74 " " 1,536.43 " " 5,295.84 " " 1,280.36 " " 1,506.30 " " 5,314.49 " " 1,398.96 " " 3,789.67 " " 1,280.36 " " 1,611.74 " " 5,596.62 " " 1,355.67 " " 1,506.30 " " 5,118.69 " " 6,398.47 " " 1,491.24 " " 1,536.43 " " 1,506.30 " " 6,217.60 " " 1,378.26 " " 5,829.00 " " 5,829.00 " " 6,139.88 " " 3,878.49 " " 1,325.54 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,536.43 " " 6,139.88 " Outpatient Pet image w/ct full body 78816 " 7,772.00 " " 2,872.53 " " 1,280.36 " " 6,398.47 " " 1,997.40 " " 5,128.74 " " 1,536.43 " " 5,295.84 " " 1,280.36 " " 1,506.30 " " 5,314.49 " " 1,398.96 " " 3,789.67 " " 1,280.36 " " 1,611.74 " " 5,596.62 " " 1,355.67 " " 1,506.30 " " 5,118.69 " " 6,398.47 " " 1,491.24 " " 1,536.43 " " 1,506.30 " " 6,217.60 " " 1,378.26 " " 5,829.00 " " 5,829.00 " " 6,139.88 " " 3,878.49 " " 1,325.54 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,536.43 " " 6,139.88 " Outpatient Rp loclzj tum spect w/ct 1 78830 " 6,856.00 " " 2,533.98 " " 1,130.48 " " 5,644.66 " " 1,761.99 " " 4,524.27 " " 1,356.58 " " 4,671.68 " " 1,130.48 " " 1,329.98 " " 4,688.13 " " 1,234.08 " " 3,343.21 " " 1,130.48 " " 1,423.08 " " 4,937.01 " " 1,196.98 " " 1,329.98 " " 4,515.65 " " 5,644.66 " " 1,316.68 " " 1,356.58 " " 1,329.98 " " 5,484.80 " " 1,216.93 " " 5,142.00 " " 5,142.00 " " 5,416.24 " " 3,421.56 " " 1,170.38 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,356.58 " " 5,416.24 " Outpatient Rp loclzj tum spect w/ct 2 78832 " 7,772.00 " " 2,872.53 " " 1,280.36 " " 6,398.47 " " 1,997.40 " " 5,128.74 " " 1,536.43 " " 5,295.84 " " 1,280.36 " " 1,506.30 " " 5,314.49 " " 1,398.96 " " 3,789.67 " " 1,280.36 " " 1,611.74 " " 5,596.62 " " 1,355.67 " " 1,506.30 " " 5,118.69 " " 6,398.47 " " 1,491.24 " " 1,536.43 " " 1,506.30 " " 6,217.60 " " 1,378.26 " " 5,829.00 " " 5,829.00 " " 6,139.88 " " 3,878.49 " " 1,325.54 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,536.43 " " 6,139.88 " Outpatient Nuclear rx oral admin 79005 " 1,311.00 " 484.55 218.89 " 1,078.92 " 336.93 865.13 262.67 893.32 218.89 257.52 896.46 235.98 639.03 218.89 275.55 944.05 231.77 257.52 863.12 " 1,078.92 " 254.94 262.67 257.52 " 1,048.80 " 235.63 983.25 983.25 " 1,035.69 " 654.00 226.62 536.20 983.25 498.31 586.41 262.67 " 1,035.69 " Outpatient Nuclear rx iv admin 79101 " 1,311.00 " 484.55 218.89 " 1,078.92 " 336.93 865.13 262.67 893.32 218.89 257.52 896.46 235.98 639.03 218.89 275.55 944.05 231.77 257.52 863.12 " 1,078.92 " 254.94 262.67 257.52 " 1,048.80 " 235.63 983.25 983.25 " 1,035.69 " 654.00 226.62 536.20 983.25 498.31 586.41 262.67 " 1,035.69 " Outpatient Nuclear rx intra-arterial 79445 " 1,311.00 " 484.55 218.89 " 1,078.92 " 336.93 865.13 262.67 893.32 218.89 257.52 896.46 235.98 639.03 218.89 275.55 944.05 231.77 257.52 863.12 " 1,078.92 " 254.94 262.67 257.52 " 1,048.80 " 235.63 983.25 983.25 " 1,035.69 " 654.00 226.62 536.20 983.25 498.31 586.41 262.67 " 1,035.69 " Outpatient Metabolic panel total ca 80048 44.00 16.26 7.19 49.28 11.31 47.78 8.63 49.28 7.19 8.46 30.09 7.92 21.66 7.19 9.05 31.68 7.61 8.46 29.01 36.27 8.38 8.63 8.46 35.20 7.74 33.00 33.00 34.76 22.17 7.44 18.00 33.00 16.72 19.68 8.63 34.76 Outpatient General health panel 80050 513.00 189.60 - 631.16 131.84 338.53 - 349.56 - - 350.79 92.34 343.30 - - 369.41 - - 504.93 631.16 - - 410.40 - 384.75 384.75 405.27 395.01 - 209.82 384.75 194.99 229.46 - 405.27 Outpatient Electrolyte panel 80051 37.00 13.68 5.96 40.86 9.51 39.62 7.15 40.86 5.96 7.01 25.30 6.66 17.95 5.96 7.50 26.64 6.31 7.01 24.04 30.05 6.94 7.15 7.01 29.60 6.41 27.75 27.75 29.23 18.37 6.17 15.13 27.75 14.06 16.55 7.15 29.23 Outpatient Comprehen metabolic panel 80053 55.00 20.33 8.98 61.53 14.14 59.66 10.77 61.53 8.98 10.56 37.61 9.90 27.03 8.98 11.30 39.61 9.50 10.56 36.22 45.27 10.45 10.77 10.56 44.00 9.66 41.25 41.25 43.45 27.67 9.29 22.50 41.25 20.91 24.60 10.77 43.45 Outpatient Renal function panel 80069 46.00 17.00 7.38 50.60 11.82 49.06 8.85 50.60 7.38 8.68 31.45 8.28 22.22 7.38 9.29 33.12 7.81 8.68 29.77 37.21 8.59 8.85 8.68 36.80 7.94 34.50 34.50 36.34 22.74 7.64 18.81 34.50 17.48 20.58 8.85 36.34 Outpatient Hepatic function panel 80076 43.00 15.89 6.94 47.57 11.05 46.12 8.33 47.57 6.94 8.17 29.40 7.74 20.92 6.94 8.74 30.96 7.35 8.17 28.02 35.02 8.09 8.33 8.17 34.40 7.48 32.25 32.25 33.97 21.41 7.19 17.59 32.25 16.34 19.23 8.33 33.97 Outpatient Drug assay acetaminophen 80143 544.00 201.06 15.84 435.20 139.81 358.99 19.01 370.68 15.84 18.64 371.99 97.92 47.72 15.84 19.94 391.73 16.78 18.64 63.93 79.91 18.45 19.01 18.64 435.20 17.06 408.00 408.00 429.76 48.84 16.40 222.50 408.00 206.77 243.33 19.01 429.76 Outpatient Drug assay adalimumab 80145 202.00 74.66 32.78 165.35 51.91 133.30 39.34 137.64 32.78 38.57 138.13 36.36 98.74 32.78 41.27 145.46 34.71 38.57 132.28 165.35 38.18 39.34 38.57 161.60 35.29 151.50 151.50 159.58 101.05 33.94 82.62 151.50 76.78 90.35 39.34 159.58 Outpatient Assay carbamazepine total 80156 76.00 28.09 12.38 84.84 19.53 82.26 14.86 84.84 12.38 14.57 51.97 13.68 37.30 12.38 15.59 54.73 13.11 14.57 49.97 62.46 14.42 14.86 14.57 60.80 13.33 57.00 57.00 60.04 38.17 12.82 31.08 57.00 28.89 33.99 14.86 60.04 Outpatient Drug assay cyclosporine 80158 95.00 35.11 15.34 105.17 24.42 101.97 18.41 105.17 15.34 18.05 64.96 17.10 46.21 15.34 19.31 68.41 16.25 18.05 61.90 77.38 17.87 18.41 18.05 76.00 16.52 71.25 71.25 75.05 47.29 15.88 38.86 71.25 36.11 42.49 18.41 75.05 Outpatient Assay of digoxin total 80162 70.00 25.87 11.29 77.37 17.99 75.02 13.55 77.37 11.29 13.28 47.87 12.60 34.00 11.29 14.21 50.41 11.95 13.28 45.54 56.93 13.15 13.55 13.28 56.00 12.15 52.50 52.50 55.30 34.79 11.69 28.63 52.50 26.61 31.31 13.55 55.30 Outpatient Assay dipropylacetic acd tot 80164 71.00 26.24 11.51 78.95 18.25 76.55 13.81 78.95 11.51 13.54 48.55 12.78 34.66 11.51 14.49 51.13 12.19 13.54 46.44 58.04 13.40 13.81 13.54 56.80 12.39 53.25 53.25 56.09 35.47 11.92 29.04 53.25 26.99 31.76 13.81 56.09 Outpatient Dipropylacetic acid free 80165 71.00 26.24 11.51 58.04 18.25 46.85 13.81 48.38 11.51 13.54 48.55 12.78 34.66 11.51 14.49 51.13 12.19 13.54 46.44 58.04 13.40 13.81 13.54 56.80 12.39 53.25 53.25 56.09 35.47 11.92 29.04 53.25 26.99 31.76 13.81 56.09 Outpatient Assay of ethosuximide 80168 86.00 31.79 13.89 95.22 22.10 92.32 16.67 95.22 13.89 16.34 58.81 15.48 41.83 13.89 17.48 61.93 14.71 16.34 56.04 70.05 16.18 16.67 16.34 68.80 14.95 64.50 64.50 67.94 42.81 14.38 35.17 64.50 32.69 38.47 16.67 67.94 Outpatient Drug screen quan lamotrigine 80175 70.00 25.87 11.26 77.24 17.99 74.89 13.52 77.24 11.26 13.25 47.87 12.60 33.92 11.26 14.18 50.41 11.93 13.25 45.44 56.80 13.12 13.52 13.25 56.00 12.12 52.50 52.50 55.30 34.72 11.66 28.63 52.50 26.61 31.31 13.52 55.30 Outpatient Drug scrn quan levetiracetam 80177 70.00 25.87 11.26 77.24 17.99 74.89 13.52 77.24 11.26 13.25 47.87 12.60 33.92 11.26 14.18 50.41 11.93 13.25 45.44 56.80 13.12 13.52 13.25 56.00 12.12 52.50 52.50 55.30 34.72 11.66 28.63 52.50 26.61 31.31 13.52 55.30 Outpatient Assay of lithium 80178 35.00 12.94 5.62 38.52 9.00 37.34 6.74 38.52 5.62 6.61 23.93 6.30 16.92 5.62 7.07 25.20 5.95 6.61 22.67 28.34 6.54 6.74 6.61 28.00 6.05 26.25 26.25 27.65 17.32 5.82 14.32 26.25 13.30 15.66 6.74 27.65 Outpatient Drug assay salicylate 80179 98.00 36.22 15.84 79.91 25.19 64.67 19.01 66.78 15.84 18.64 67.01 17.64 47.72 15.84 19.94 70.57 16.78 18.64 63.93 79.91 18.45 19.01 18.64 78.40 17.06 73.50 73.50 77.42 48.84 16.40 40.08 73.50 37.25 43.84 19.01 77.42 Outpatient Drug scrn quan mycophenolate 80180 95.00 35.11 15.34 105.17 24.42 101.97 18.41 105.17 15.34 18.05 64.96 17.10 46.21 15.34 19.31 68.41 16.25 18.05 61.90 77.38 17.87 18.41 18.05 76.00 16.52 71.25 71.25 75.05 47.29 15.88 38.86 71.25 36.11 42.49 18.41 75.05 Outpatient Drug scrn quant oxcarbazepin 80183 70.00 25.87 11.26 77.24 17.99 74.89 13.52 77.24 11.26 13.25 47.87 12.60 33.92 11.26 14.18 50.41 11.93 13.25 45.44 56.80 13.12 13.52 13.25 56.00 12.12 52.50 52.50 55.30 34.72 11.66 28.63 52.50 26.61 31.31 13.52 55.30 Outpatient Assay of phenobarbital 80184 80.00 29.57 13.01 66.70 20.56 64.67 15.61 66.70 13.01 15.30 54.70 14.40 39.17 13.01 16.37 57.61 13.77 15.30 52.47 65.59 15.15 15.61 15.30 64.00 14.00 60.00 60.00 63.20 40.09 13.46 32.72 60.00 30.41 35.78 15.61 63.20 Outpatient Assay of phenytoin total 80185 70.00 25.87 11.26 77.24 17.99 74.89 13.52 77.24 11.26 13.25 47.87 12.60 33.92 11.26 14.18 50.41 11.93 13.25 45.44 56.80 13.12 13.52 13.25 56.00 12.12 52.50 52.50 55.30 34.72 11.66 28.63 52.50 26.61 31.31 13.52 55.30 Outpatient Drug assay posaconazole 80187 573.00 211.78 23.04 458.40 147.26 378.12 27.65 390.44 23.04 27.11 391.82 103.14 69.40 23.04 29.01 412.62 24.40 27.11 92.97 116.22 26.84 27.65 27.11 458.40 24.81 429.75 429.75 452.67 71.03 23.86 234.36 429.75 217.80 256.30 27.65 452.67 Outpatient Drug assay itraconazole 80189 142.00 52.48 23.04 116.22 36.49 93.71 27.65 96.76 23.04 27.11 97.10 25.56 69.40 23.04 29.01 102.25 24.40 27.11 92.97 116.22 26.84 27.65 27.11 113.60 24.81 106.50 106.50 112.18 71.03 23.86 58.08 106.50 53.97 63.52 27.65 112.18 Outpatient Drug assay leflunomide 80193 202.00 74.66 32.78 165.35 51.91 133.30 39.34 137.64 32.78 38.57 138.13 36.36 98.74 32.78 41.27 145.46 34.71 38.57 132.28 165.35 38.18 39.34 38.57 161.60 35.29 151.50 151.50 159.58 101.05 33.94 82.62 151.50 76.78 90.35 39.34 159.58 Outpatient Assay of sirolimus 80195 72.00 26.61 11.67 79.98 18.50 77.54 14.00 79.98 11.67 13.73 49.23 12.96 35.15 11.67 14.69 51.85 12.36 13.73 47.09 58.86 13.59 14.00 13.73 57.60 12.56 54.00 54.00 56.88 35.97 12.08 29.45 54.00 27.37 32.21 14.00 56.88 Outpatient Assay of tacrolimus 80197 72.00 26.61 11.67 79.98 18.50 77.54 14.00 79.98 11.67 13.73 49.23 12.96 35.15 11.67 14.69 51.85 12.36 13.73 47.09 58.86 13.59 14.00 13.73 57.60 12.56 54.00 54.00 56.88 35.97 12.08 29.45 54.00 27.37 32.21 14.00 56.88 Outpatient Assay of topiramate 80201 63.00 23.28 10.13 69.47 16.19 67.36 12.16 69.47 10.13 11.92 43.08 11.34 30.52 10.13 12.75 45.37 10.73 11.92 40.88 51.10 11.80 12.16 11.92 50.40 10.91 47.25 47.25 49.77 31.23 10.49 25.77 47.25 23.95 28.18 12.16 49.77 Outpatient Assay of vancomycin 80202 71.00 26.24 11.51 78.95 18.25 76.55 13.81 78.95 11.51 13.54 48.55 12.78 34.66 11.51 14.49 51.13 12.19 13.54 46.44 58.04 13.40 13.81 13.54 56.80 12.39 53.25 53.25 56.09 35.47 11.92 29.04 53.25 26.99 31.76 13.81 56.09 Outpatient Drug screen quant zonisamide 80203 450.00 166.32 11.26 360.00 115.65 74.89 13.52 77.24 11.26 13.25 307.71 81.00 33.92 11.26 14.18 324.05 11.93 13.25 45.44 56.80 13.12 13.52 13.25 360.00 12.12 337.50 337.50 355.50 34.72 11.66 184.05 337.50 171.05 201.29 13.52 355.50 Outpatient Drug assay infliximab 80230 202.00 74.66 32.78 165.35 51.91 133.30 39.34 137.64 32.78 38.57 138.13 36.36 98.74 32.78 41.27 145.46 34.71 38.57 132.28 165.35 38.18 39.34 38.57 161.60 35.29 151.50 151.50 159.58 101.05 33.94 82.62 151.50 76.78 90.35 39.34 159.58 Outpatient Drug assay lacosamide 80235 214.00 79.09 23.04 171.20 55.00 141.22 27.65 145.82 23.04 27.11 146.33 38.52 69.40 23.04 29.01 154.10 24.40 27.11 92.97 116.22 26.84 27.65 27.11 171.20 24.81 160.50 160.50 169.06 71.03 23.86 87.53 160.50 81.34 95.72 27.65 169.06 Outpatient Drug assay voriconazole 80285 671.00 248.00 23.04 536.80 172.45 442.79 27.65 457.22 23.04 27.11 458.83 120.78 69.40 23.04 29.01 483.19 24.40 27.11 92.97 116.22 26.84 27.65 27.11 536.80 24.81 503.25 503.25 530.09 71.03 23.86 274.44 503.25 255.05 300.14 27.65 530.09 Outpatient Urinalysis auto w/scope 81001 17.00 6.28 2.69 18.45 4.37 17.88 3.23 18.45 2.69 3.17 11.62 3.06 8.12 2.69 3.39 12.24 2.85 3.17 10.87 13.59 3.14 3.23 3.17 13.60 2.90 12.75 12.75 13.43 8.31 2.79 6.95 12.75 6.46 7.60 3.23 13.43 Outpatient Urinalysis nonauto w/o scope 81002 18.00 6.65 2.96 14.92 4.63 14.45 3.55 14.90 2.96 3.48 12.31 3.24 8.91 2.96 3.72 12.96 3.13 3.48 11.93 14.92 3.45 3.55 3.48 14.40 3.18 13.50 13.50 14.22 9.12 3.06 7.36 13.50 6.84 8.05 3.55 14.22 Outpatient Urinalysis auto w/o scope 81003 12.00 4.44 1.91 13.07 3.08 12.67 2.30 13.07 1.91 2.25 8.21 2.16 5.76 1.91 2.41 8.64 2.03 2.25 7.72 9.65 2.23 2.30 2.25 9.60 2.06 9.00 9.00 9.48 5.90 1.98 4.91 9.00 4.56 5.37 2.30 9.48 Outpatient Microscopic exam of urine 81015 16.00 5.91 2.59 17.72 4.11 17.18 3.11 17.72 2.59 3.05 10.94 2.88 7.81 2.59 3.26 11.52 2.75 3.05 10.46 13.08 3.02 3.11 3.05 12.80 2.79 12.00 12.00 12.64 7.99 2.68 6.54 12.00 6.08 7.16 3.11 12.64 Outpatient Urine pregnancy test 81025 45.00 16.63 7.32 36.91 11.57 35.73 8.78 36.85 7.32 8.61 30.77 8.10 22.04 7.32 9.21 32.40 7.75 8.61 29.53 36.91 8.52 8.78 8.61 36.00 7.88 33.75 33.75 35.55 22.56 7.58 18.41 33.75 17.10 20.13 8.78 35.55 Outpatient Idh1 common variants 81120 " 1,015.00 " 375.14 164.26 828.44 260.86 669.80 197.12 691.62 164.26 193.25 694.06 182.70 494.72 164.26 206.78 730.90 173.93 193.25 662.75 828.44 191.32 197.12 193.25 812.00 176.82 761.25 761.25 801.85 506.32 170.06 415.14 761.25 385.80 454.01 197.12 801.85 Outpatient Idh2 common variants 81121 " 1,553.00 " 573.99 251.42 " 1,268.02 " 399.12 " 1,024.82 " 301.71 " 1,058.21 " 251.42 295.79 " 1,061.94 " 279.54 757.22 251.42 316.50 " 1,118.32 " 266.21 295.79 " 1,014.41 " " 1,268.02 " 292.83 301.71 295.79 " 1,242.40 " 270.65 " 1,164.75 " " 1,164.75 " " 1,226.87 " 774.97 260.30 635.18 " 1,164.75 " 590.30 694.66 301.71 " 1,226.87 " Outpatient Abl1 gene 81170 " 1,575.00 " 582.12 255.00 " 1,286.07 " 404.78 " 1,039.34 " 306.00 " 1,073.21 " 255.00 300.00 " 1,076.99 " 283.50 768.00 255.00 321.00 " 1,134.16 " 270.00 300.00 " 1,028.85 " " 1,286.07 " 297.00 306.00 300.00 " 1,260.00 " 274.50 " 1,181.25 " " 1,181.25 " " 1,244.25 " 786.00 264.00 644.18 " 1,181.25 " 598.66 704.50 306.00 " 1,244.25 " Outpatient Bcr/abl1 gene major bp 81206 861.00 318.23 139.37 955.16 221.28 926.08 167.24 955.16 139.37 163.96 588.75 154.98 419.74 139.37 175.44 620.01 147.56 163.96 562.30 702.88 162.32 167.24 163.96 688.80 150.02 645.75 645.75 680.19 429.58 144.28 352.15 645.75 327.27 385.13 167.24 680.19 Outpatient Calr gene com variants 81219 639.00 236.17 103.39 521.42 164.22 421.68 124.06 435.41 103.39 121.63 436.95 115.02 311.37 103.39 130.14 460.14 109.47 121.63 417.13 521.42 120.41 124.06 121.63 511.20 111.29 479.25 479.25 504.81 318.67 107.03 261.35 479.25 242.88 285.82 124.06 504.81 Outpatient Cytog alys chrml abnr snpcgh 81229 " 6,090.00 " " 2,250.86 " 986.00 " 4,972.80 " " 1,565.13 " " 4,018.79 " " 1,183.20 " " 4,149.73 " 986.00 " 1,160.00 " " 4,164.34 " " 1,096.20 " " 2,969.60 " 986.00 " 1,241.20 " " 4,385.41 " " 1,044.00 " " 1,160.00 " " 3,978.22 " " 4,972.80 " " 1,148.40 " " 1,183.20 " " 1,160.00 " " 4,872.00 " " 1,061.40 " " 4,567.50 " " 4,567.50 " " 4,811.10 " " 3,039.20 " " 1,020.80 " " 2,490.81 " " 4,567.50 " " 2,314.81 " " 2,724.06 " " 1,183.20 " " 4,811.10 " Outpatient F2 gene 81240 345.00 127.51 55.84 286.65 88.67 277.92 67.00 286.65 55.84 65.69 235.91 62.10 168.17 55.84 70.29 248.43 59.12 65.69 225.28 281.61 65.03 67.00 65.69 276.00 60.11 258.75 258.75 272.55 172.11 57.81 141.11 258.75 131.13 154.32 67.00 272.55 Outpatient F5 gene 81241 385.00 142.30 62.36 355.99 98.95 345.15 74.84 355.99 62.36 73.37 263.26 69.30 187.83 62.36 78.51 277.24 66.03 73.37 251.62 314.53 72.64 74.84 73.37 308.00 67.13 288.75 288.75 304.15 192.23 64.57 157.47 288.75 146.34 172.21 74.84 304.15 Outpatient Flt3 gene 81245 869.00 321.18 140.68 709.52 223.33 686.91 168.82 708.48 140.68 165.51 594.22 156.42 423.71 140.68 177.10 625.77 148.96 165.51 567.62 709.52 163.85 168.82 165.51 695.20 151.44 651.75 651.75 686.51 433.64 145.65 355.42 651.75 330.31 388.70 168.82 686.51 Outpatient Flt3 gene analysis 81246 436.00 161.15 70.55 355.81 112.05 287.72 84.66 297.09 70.55 83.00 298.14 78.48 212.48 70.55 88.81 313.96 74.70 83.00 284.65 355.81 82.17 84.66 83.00 348.80 75.95 327.00 327.00 344.44 217.46 73.04 178.32 327.00 165.72 195.02 84.66 344.44 Outpatient Chimerism anal no cell selec 81267 " 1,089.00 " 402.49 176.34 " 1,208.54 " 279.87 " 1,171.74 " 211.61 " 1,208.54 " 176.34 207.46 744.66 196.02 531.10 176.34 221.98 784.19 186.71 207.46 711.48 889.36 205.39 211.61 207.46 871.20 189.83 816.75 816.75 860.31 543.55 182.56 445.40 816.75 413.93 487.11 211.61 860.31 Outpatient Chimerism anal w/cell select 81268 " 1,369.00 " 505.98 221.67 " 1,519.18 " 351.83 " 1,472.93 " 266.01 " 1,519.18 " 221.67 260.79 936.12 246.42 667.62 221.67 279.05 985.82 234.71 260.79 894.38 " 1,117.98 " 258.18 266.01 260.79 " 1,095.20 " 238.62 " 1,026.75 " " 1,026.75 " " 1,081.51 " 683.27 229.50 559.92 " 1,026.75 " 520.36 612.35 266.01 " 1,081.51 " Outpatient Hba1/hba2 gene dup/del vrnts 81269 " 1,063.00 " 392.88 172.04 867.67 273.19 701.47 206.45 724.33 172.04 202.40 726.88 191.34 518.14 172.04 216.57 765.47 182.16 202.40 694.13 867.67 200.38 206.45 202.40 850.40 185.20 797.25 797.25 839.77 530.29 178.11 434.77 797.25 404.05 475.48 206.45 839.77 Outpatient Jak2 gene 81270 481.00 177.78 77.91 534.01 123.62 517.75 93.49 534.01 77.91 91.66 328.91 86.58 234.65 77.91 98.08 346.37 82.49 91.66 314.35 392.94 90.74 93.49 91.66 384.80 83.87 360.75 360.75 379.99 240.15 80.66 196.73 360.75 182.83 215.15 93.49 379.99 Outpatient Jak2 gene trgt sequence alys 81279 972.00 359.25 157.42 793.93 249.80 641.42 188.90 662.32 157.42 185.20 664.65 174.96 474.11 157.42 198.16 699.94 166.68 185.20 635.14 793.93 183.35 188.90 185.20 777.60 169.46 729.00 729.00 767.88 485.22 162.98 397.55 729.00 369.46 434.78 188.90 767.88 Outpatient Nudt15 gene common variants 81306 " 1,530.00 " 565.49 247.66 " 1,249.03 " 393.21 " 1,009.65 " 297.19 " 1,042.54 " 247.66 291.36 " 1,046.21 " 275.40 745.88 247.66 311.76 " 1,101.75 " 262.22 291.36 999.22 " 1,249.03 " 288.45 297.19 291.36 " 1,224.00 " 266.59 " 1,147.50 " " 1,147.50 " " 1,208.70 " 763.36 256.40 625.77 " 1,147.50 " 581.55 684.37 297.19 " 1,208.70 " Outpatient Npm1 gene 81310 " 1,294.00 " 478.26 209.54 " 1,056.81 " 332.56 " 1,023.16 " 251.45 " 1,055.29 " 209.54 246.52 884.84 232.92 631.09 209.54 263.78 931.81 221.87 246.52 845.44 " 1,056.81 " 244.05 251.45 246.52 " 1,035.20 " 225.57 970.50 970.50 " 1,022.26 " 645.88 216.94 529.25 970.50 491.85 578.81 251.45 " 1,022.26 " Outpatient Pml/raralpha com breakpoints 81315 " 1,088.00 " 402.12 176.21 " 1,207.68 " 279.62 " 1,170.92 " 211.46 " 1,207.68 " 176.21 207.31 743.97 195.84 530.71 176.21 221.82 783.47 186.58 207.31 710.97 888.72 205.24 211.46 207.31 870.40 189.69 816.00 816.00 859.52 543.15 182.43 444.99 816.00 413.55 486.66 211.46 859.52 Outpatient Tpmt gene com variants 81335 918.00 339.29 148.59 749.39 235.93 605.79 178.31 625.53 148.59 174.81 627.73 165.24 447.51 148.59 187.05 661.05 157.33 174.81 599.51 749.39 173.06 178.31 174.81 734.40 159.95 688.50 688.50 725.22 458.00 153.83 375.46 688.50 348.93 410.62 178.31 725.22 Outpatient Trb@ gene rearrange amplify 81340 " 1,097.00 " 405.45 177.58 " 1,217.04 " 281.93 " 1,179.98 " 213.10 " 1,217.04 " 177.58 208.92 750.13 197.46 534.84 177.58 223.54 789.95 188.03 208.92 716.49 895.62 206.83 213.10 208.92 877.60 191.16 822.75 822.75 866.63 547.37 183.85 448.67 822.75 416.97 490.69 213.10 866.63 Outpatient Trg gene rearrangement anal 81342 " 1,058.00 " 391.04 171.28 " 1,173.82 " 271.91 " 1,138.09 " 205.53 " 1,173.82 " 171.28 201.50 723.46 190.44 515.84 171.28 215.61 761.87 181.35 201.50 691.04 863.81 199.49 205.53 201.50 846.40 184.37 793.50 793.50 835.82 527.93 177.32 432.72 793.50 402.15 473.24 205.53 835.82 Outpatient Hla i & ii typing lr 81370 " 2,111.00 " 780.23 341.80 " 2,342.52 " 542.53 " 2,271.20 " 410.16 " 2,342.52 " 341.80 402.12 " 1,443.50 " 379.98 " 1,029.43 " 341.80 430.27 " 1,520.13 " 361.91 402.12 " 1,379.07 " " 1,723.85 " 398.10 410.16 402.12 " 1,688.80 " 367.94 " 1,583.25 " " 1,583.25 " " 1,667.69 " " 1,053.55 " 353.87 863.40 " 1,583.25 " 802.39 944.25 410.16 " 1,667.69 " Outpatient Hla i typing complete lr 81372 " 2,119.00 " 783.18 343.05 " 1,730.15 " 544.58 " 1,247.63 " 411.66 " 1,286.81 " 343.05 403.59 " 1,448.97 " 381.42 " 1,033.19 " 343.05 431.84 " 1,525.89 " 363.23 403.59 " 1,384.11 " " 1,730.15 " 399.55 411.66 403.59 " 1,695.20 " 369.28 " 1,589.25 " " 1,589.25 " " 1,674.01 " " 1,057.41 " 355.16 866.67 " 1,589.25 " 805.43 947.83 411.66 " 1,674.01 " Outpatient Hla i typing 1 antigen lr 81374 390.00 144.14 63.18 423.80 100.23 410.90 75.82 423.80 63.18 74.33 266.68 70.20 190.28 63.18 79.53 280.84 66.90 74.33 254.91 318.65 73.59 75.82 74.33 312.00 68.01 292.50 292.50 308.10 194.74 65.41 159.51 292.50 148.24 174.45 75.82 308.10 Outpatient Hla ii typing 1 locus lr 81376 642.00 237.28 103.89 711.98 164.99 690.30 124.66 711.98 103.89 122.22 439.00 115.56 312.88 103.89 130.78 462.30 110.00 122.22 419.15 523.94 121.00 124.66 122.22 513.60 111.83 481.50 481.50 507.18 320.22 107.55 262.58 481.50 244.02 287.17 124.66 507.18 Outpatient Hla i & ii typing hr 81378 " 1,814.00 " 670.45 293.73 " 2,013.05 " 466.20 " 1,951.76 " 352.48 " 2,013.05 " 293.73 345.57 " 1,240.41 " 326.52 884.66 293.73 369.76 " 1,306.26 " 311.01 345.57 " 1,185.13 " " 1,481.42 " 342.11 352.48 345.57 " 1,451.20 " 316.20 " 1,360.50 " " 1,360.50 " " 1,433.06 " 905.39 304.10 741.93 " 1,360.50 " 689.50 811.40 352.48 " 1,433.06 " Outpatient Hla ii typing 1 loc hr 81382 649.00 239.87 105.13 720.48 166.79 698.54 126.15 720.48 105.13 123.68 443.79 116.82 316.62 105.13 132.34 467.34 111.31 123.68 424.16 530.20 122.44 126.15 123.68 519.20 113.17 486.75 486.75 512.71 324.04 108.84 265.44 486.75 246.68 290.30 126.15 512.71 Outpatient Ftl cgen abnor four anal 81511 806.00 297.90 130.48 658.04 207.14 531.88 156.57 549.21 130.48 153.50 551.14 145.08 392.96 130.48 164.25 580.40 138.15 153.50 526.43 658.04 151.97 156.57 153.50 644.80 140.45 604.50 604.50 636.74 402.17 135.08 329.65 604.50 306.36 360.52 156.57 636.74 Outpatient Nfct ds chrnc hcv 6 assays 81596 379.00 140.08 61.36 309.47 97.40 250.10 73.63 258.25 61.36 72.19 259.16 68.22 184.81 61.36 77.24 272.92 64.97 72.19 247.58 309.47 71.47 73.63 72.19 303.20 66.05 284.25 284.25 299.41 189.14 63.53 155.01 284.25 144.06 169.53 73.63 299.41 Outpatient Acetone assay 82010 43.00 15.89 6.94 41.89 11.05 40.61 8.33 41.89 6.94 8.17 29.40 7.74 20.92 6.94 8.74 30.96 7.35 8.17 28.02 35.02 8.09 8.33 8.17 34.40 7.48 32.25 32.25 33.97 21.41 7.19 17.59 32.25 16.34 19.23 8.33 33.97 Outpatient Acylcarnitines qual 82016 87.00 32.16 14.02 80.75 22.36 78.29 16.82 80.75 14.02 16.49 59.49 15.66 42.21 14.02 17.64 62.65 14.84 16.49 56.55 70.69 16.33 16.82 16.49 69.60 15.09 65.25 65.25 68.73 43.20 14.51 35.58 65.25 33.07 38.92 16.82 68.73 Outpatient Acylcarnitines quant 82017 89.00 32.89 14.34 98.25 22.87 95.26 17.21 98.25 14.34 16.87 60.86 16.02 43.19 14.34 18.05 64.09 15.18 16.87 57.86 72.32 16.70 17.21 16.87 71.20 15.44 66.75 66.75 70.31 44.20 14.85 36.40 66.75 33.83 39.81 17.21 70.31 Outpatient Assay of acth 82024 203.00 75.03 32.83 225.03 52.17 218.18 39.39 225.03 32.83 38.62 138.81 36.54 98.87 32.83 41.32 146.18 34.76 38.62 132.45 165.56 38.23 39.39 38.62 162.40 35.34 152.25 152.25 160.37 101.18 33.99 83.03 152.25 77.16 90.80 39.39 160.37 Outpatient Assay of serum albumin 82040 26.00 9.61 4.21 28.82 6.68 27.95 5.05 28.82 4.21 4.95 17.78 4.68 12.67 4.21 5.30 18.72 4.46 4.95 16.98 21.22 4.90 5.05 4.95 20.80 4.53 19.50 19.50 20.54 12.97 4.36 10.63 19.50 9.88 11.63 5.05 20.54 Outpatient Other source albumin quan ea 82042 41.00 15.15 6.61 33.35 10.54 9.98 7.94 10.29 6.61 7.78 28.04 7.38 19.92 6.61 8.32 29.52 7.00 7.78 26.68 33.35 7.70 7.94 7.78 32.80 7.12 30.75 30.75 32.39 20.38 6.85 16.77 30.75 15.58 18.34 7.94 32.39 Outpatient Ur albumin quantitative 82043 30.00 11.09 4.91 33.69 7.71 32.66 5.90 33.69 4.91 5.78 20.51 5.40 14.80 4.91 6.18 21.60 5.20 5.78 19.82 24.78 5.72 5.90 5.78 24.00 5.29 22.50 22.50 23.70 15.14 5.09 12.27 22.50 11.40 13.42 5.90 23.70 Outpatient Assay spec xcp ur&breath ia 82077 601.00 222.13 14.68 480.80 154.46 396.60 17.62 409.52 14.68 17.27 410.96 108.18 44.21 14.68 18.48 432.78 15.54 17.27 59.23 74.03 17.10 17.62 17.27 480.80 15.80 450.75 450.75 474.79 45.25 15.20 245.81 450.75 228.44 268.83 17.62 474.79 Outpatient Assay of aldolase 82085 51.00 18.85 8.25 56.53 13.11 54.81 9.90 56.53 8.25 9.71 34.87 9.18 24.86 8.25 10.39 36.73 8.74 9.71 33.30 41.63 9.61 9.90 9.71 40.80 8.88 38.25 38.25 40.29 25.44 8.54 20.86 38.25 19.39 22.81 9.90 40.29 Outpatient Assay of aldosterone 82088 214.00 79.09 34.64 237.41 55.00 230.18 41.57 237.41 34.64 40.75 146.33 38.52 104.32 34.64 43.60 154.10 36.68 40.75 139.75 174.69 40.34 41.57 40.75 171.20 37.29 160.50 160.50 169.06 106.77 35.86 87.53 160.50 81.34 95.72 41.57 169.06 Outpatient Alpha-1-antitrypsin pheno 82104 76.00 28.09 12.29 84.25 19.53 81.68 14.75 84.25 12.29 14.46 51.97 13.68 37.02 12.29 15.47 54.73 13.01 14.46 49.59 61.99 14.32 14.75 14.46 60.80 13.23 57.00 57.00 60.04 37.89 12.72 31.08 57.00 28.89 33.99 14.75 60.04 Outpatient Alpha-fetoprotein serum 82105 88.00 32.52 14.25 97.74 22.62 94.76 17.11 97.74 14.25 16.77 60.17 15.84 42.93 14.25 17.94 63.37 15.09 16.77 57.51 71.89 16.60 17.11 16.77 70.40 15.34 66.00 66.00 69.52 43.94 14.76 35.99 66.00 33.45 39.36 17.11 69.52 Outpatient Alpha-fetoprotein l3 82107 338.00 124.92 54.75 375.25 86.87 363.82 65.70 375.25 54.75 64.41 231.12 60.84 164.89 54.75 68.92 243.39 57.97 64.41 220.89 276.12 63.77 65.70 64.41 270.40 58.94 253.50 253.50 267.02 168.75 56.68 138.24 253.50 128.47 151.19 65.70 267.02 Outpatient Assay of aluminum 82108 134.00 49.53 21.66 148.43 34.44 143.91 25.99 148.43 21.66 25.48 91.63 24.12 65.23 21.66 27.26 96.49 22.93 25.48 87.38 109.23 25.23 25.99 25.48 107.20 23.31 100.50 100.50 105.86 66.76 22.42 54.81 100.50 50.93 59.94 25.99 105.86 Outpatient Amino acids mult qual 82128 73.00 26.98 11.79 80.75 18.76 78.29 14.15 80.75 11.79 13.87 49.92 13.14 35.51 11.79 14.84 52.57 12.48 13.87 47.57 59.46 13.73 14.15 13.87 58.40 12.69 54.75 54.75 57.67 36.34 12.21 29.86 54.75 27.75 32.65 14.15 57.67 Outpatient Assay of ammonia 82140 76.00 28.09 12.38 84.89 19.53 82.30 14.86 84.89 12.38 14.57 51.97 13.68 37.30 12.38 15.59 54.73 13.11 14.57 49.97 62.46 14.42 14.86 14.57 60.80 13.33 57.00 57.00 60.04 38.17 12.82 31.08 57.00 28.89 33.99 14.86 60.04 Outpatient Assay of amylase 82150 34.00 12.57 5.51 37.75 8.74 36.60 6.61 37.75 5.51 6.48 23.25 6.12 16.59 5.51 6.93 24.48 5.83 6.48 22.22 27.78 6.42 6.61 6.48 27.20 5.93 25.50 25.50 26.86 16.98 5.70 13.91 25.50 12.92 15.21 6.61 26.86 Outpatient Angiotensin i enzyme test 82164 77.00 28.46 12.41 85.06 19.79 82.47 14.89 85.06 12.41 14.60 52.65 13.86 37.38 12.41 15.62 55.45 13.14 14.60 50.07 62.59 14.45 14.89 14.60 61.60 13.36 57.75 57.75 60.83 38.25 12.85 31.49 57.75 29.27 34.44 14.89 60.83 Outpatient Assay of arsenic 82175 100.00 36.96 16.12 110.55 25.70 107.18 19.35 110.55 16.12 18.97 68.38 18.00 48.56 16.12 20.30 72.01 17.07 18.97 65.06 81.32 18.78 19.35 18.97 80.00 17.36 75.00 75.00 79.00 49.70 16.69 40.90 75.00 38.01 44.73 19.35 79.00 Outpatient Assay of ascorbic acid 82180 52.00 19.22 8.41 57.56 13.36 55.81 10.09 57.56 8.41 9.89 35.56 9.36 25.32 8.41 10.58 37.45 8.90 9.89 33.92 42.40 9.79 10.09 9.89 41.60 9.05 39.00 39.00 41.08 25.91 8.70 21.27 39.00 19.77 23.26 10.09 41.08 Outpatient Assay of beta-2 protein 82232 85.00 31.42 13.75 94.24 21.85 91.37 16.50 94.24 13.75 16.18 58.12 15.30 41.42 13.75 17.31 61.21 14.56 16.18 55.49 69.36 16.02 16.50 16.18 68.00 14.80 63.75 63.75 67.15 42.39 14.24 34.77 63.75 32.31 38.02 16.50 67.15 Outpatient Bile acids total 82239 90.00 33.26 14.55 99.79 23.13 96.75 17.46 99.79 14.55 17.12 61.54 16.20 43.83 14.55 18.32 64.81 15.41 17.12 58.71 73.39 16.95 17.46 17.12 72.00 15.66 67.50 67.50 71.10 44.85 15.07 36.81 67.50 34.21 40.26 17.46 71.10 Outpatient Bilirubin total 82247 26.00 9.61 4.27 29.21 6.68 28.32 5.12 29.21 4.27 5.02 17.78 4.68 12.85 4.27 5.37 18.72 4.52 5.02 17.22 21.52 4.97 5.12 5.02 20.80 4.59 19.50 19.50 20.54 13.15 4.42 10.63 19.50 9.88 11.63 5.12 20.54 Outpatient Bilirubin direct 82248 26.00 9.61 4.27 29.21 6.68 28.32 5.12 29.21 4.27 5.02 17.78 4.68 12.85 4.27 5.37 18.72 4.52 5.02 17.22 21.52 4.97 5.12 5.02 20.80 4.59 19.50 19.50 20.54 13.15 4.42 10.63 19.50 9.88 11.63 5.12 20.54 Outpatient Occult blood feces 82270 23.00 8.50 3.72 18.96 5.91 18.38 4.47 18.96 3.72 4.38 15.73 4.14 11.21 3.72 4.69 16.56 3.94 4.38 15.02 18.78 4.34 4.47 4.38 18.40 4.01 17.25 17.25 18.17 11.48 3.85 9.41 17.25 8.74 10.29 4.47 18.17 Outpatient Occult bld feces 1-3 tests 82272 22.00 8.13 3.60 18.96 5.65 18.38 4.31 18.96 3.60 4.23 15.04 3.96 10.83 3.60 4.53 15.84 3.81 4.23 14.51 18.13 4.19 4.31 4.23 17.60 3.87 16.50 16.50 17.38 11.08 3.72 9.00 16.50 8.36 9.84 4.31 17.38 Outpatient Assay test for blood fecal 82274 84.00 31.05 13.53 92.66 21.59 89.84 16.24 92.66 13.53 15.92 57.44 15.12 40.76 13.53 17.03 60.49 14.33 15.92 54.60 68.25 15.76 16.24 15.92 67.20 14.57 63.00 63.00 66.36 41.71 14.01 34.36 63.00 31.93 37.57 16.24 66.36 Outpatient Vitamin d 25 hydroxy 82306 155.00 57.29 25.16 172.51 39.84 167.26 30.19 172.51 25.16 29.60 105.99 27.90 75.78 25.16 31.67 111.62 26.64 29.60 101.51 126.89 29.30 30.19 29.60 124.00 27.08 116.25 116.25 122.45 77.55 26.05 63.40 116.25 58.92 69.33 30.19 122.45 Outpatient Assay of calcitonin 82308 141.00 52.11 22.77 156.03 36.24 151.28 27.33 156.03 22.77 26.79 96.42 25.38 68.58 22.77 28.67 101.53 24.11 26.79 91.88 114.85 26.52 27.33 26.79 112.80 24.51 105.75 105.75 111.39 70.19 23.58 57.67 105.75 53.59 63.07 27.33 111.39 Outpatient Assay of calcium 82310 27.00 9.98 4.39 30.06 6.94 29.15 5.26 30.06 4.39 5.16 18.46 4.86 13.21 4.39 5.52 19.44 4.64 5.16 17.70 22.12 5.11 5.26 5.16 21.60 4.72 20.25 20.25 21.33 13.52 4.54 11.04 20.25 10.26 12.08 5.26 21.33 Outpatient Assay of calcium 82330 72.00 26.61 11.63 79.64 18.50 77.21 13.95 79.64 11.63 13.68 49.23 12.96 35.02 11.63 14.64 51.85 12.31 13.68 46.92 58.64 13.54 13.95 13.68 57.60 12.52 54.00 54.00 56.88 35.84 12.04 29.45 54.00 27.37 32.21 13.95 56.88 Outpatient Assay of calcium in urine 82340 32.00 11.83 5.13 35.14 8.22 34.07 6.15 35.14 5.13 6.03 21.88 5.76 15.44 5.13 6.45 23.04 5.43 6.03 20.68 25.85 5.97 6.15 6.03 25.60 5.52 24.00 24.00 25.28 15.80 5.31 13.09 24.00 12.16 14.31 6.15 25.28 Outpatient Calculus spectroscopy 82365 68.00 25.13 10.97 75.11 17.48 72.82 13.16 75.11 10.97 12.90 46.50 12.24 33.02 10.97 13.80 48.97 11.61 12.90 44.24 55.30 12.77 13.16 12.90 54.40 11.80 51.00 51.00 53.72 33.80 11.35 27.81 51.00 25.85 30.42 13.16 53.72 Outpatient Assay carboxyhb quant 82375 65.00 24.02 10.47 52.81 16.71 29.48 12.57 30.40 10.47 12.32 44.45 11.70 31.54 10.47 13.18 46.81 11.09 12.32 42.25 52.81 12.20 12.57 12.32 52.00 11.27 48.75 48.75 51.35 32.28 10.84 26.59 48.75 24.71 29.07 12.57 51.35 Outpatient Carcinoembryonic antigen 82378 100.00 36.96 16.12 110.51 25.70 107.14 19.34 110.51 16.12 18.96 68.38 18.00 48.54 16.12 20.29 72.01 17.06 18.96 65.02 81.28 18.77 19.34 18.96 80.00 17.35 75.00 75.00 79.00 49.68 16.68 40.90 75.00 38.01 44.73 19.34 79.00 Outpatient Assay of carnitine 82379 89.00 32.89 14.34 98.25 22.87 95.26 17.21 98.25 14.34 16.87 60.86 16.02 43.19 14.34 18.05 64.09 15.18 16.87 57.86 72.32 16.70 17.21 16.87 71.20 15.44 66.75 66.75 70.31 44.20 14.85 36.40 66.75 33.83 39.81 17.21 70.31 Outpatient Assay three catecholamines 82384 133.00 49.16 21.46 147.10 34.18 142.62 25.76 147.10 21.46 25.25 90.95 23.94 64.64 21.46 27.02 95.77 22.73 25.25 86.59 108.24 25.00 25.76 25.25 106.40 23.10 99.75 99.75 105.07 66.16 22.22 54.40 99.75 50.55 59.49 25.76 105.07 Outpatient Assay of ceruloplasmin 82390 56.00 20.70 9.13 62.56 14.39 60.65 10.95 62.56 9.13 10.74 38.29 10.08 27.49 9.13 11.49 40.33 9.67 10.74 36.83 46.04 10.63 10.95 10.74 44.80 9.83 42.00 42.00 44.24 28.14 9.45 22.90 42.00 21.29 25.05 10.95 44.24 Outpatient Assay of urine chloride 82436 30.00 11.09 4.89 29.29 7.71 28.40 5.87 29.29 4.89 5.75 20.51 5.40 14.72 4.89 6.15 21.60 5.18 5.75 19.72 24.65 5.69 5.87 5.75 24.00 5.26 22.50 22.50 23.70 15.07 5.06 12.27 22.50 11.40 13.42 5.87 23.70 Outpatient Assay other fluid chlorides 82438 26.00 9.61 4.25 28.48 6.68 27.61 5.10 28.48 4.25 5.00 17.78 4.68 12.80 4.25 5.35 18.72 4.50 5.00 17.15 21.43 4.95 5.10 5.00 20.80 4.58 19.50 19.50 20.54 13.10 4.40 10.63 19.50 9.88 11.63 5.10 20.54 Outpatient Assay bld/serum cholesterol 82465 23.00 8.50 3.70 25.32 5.91 24.55 4.44 25.32 3.70 4.35 15.73 4.14 11.14 3.70 4.65 16.56 3.92 4.35 14.92 18.65 4.31 4.44 4.35 18.40 3.98 17.25 17.25 18.17 11.40 3.83 9.41 17.25 8.74 10.29 4.44 18.17 Outpatient Assay of chromium 82495 106.00 39.18 17.24 86.94 27.24 39.50 20.69 40.74 17.24 20.28 72.48 19.08 51.92 17.24 21.70 76.33 18.25 20.28 69.55 86.94 20.08 20.69 20.28 84.80 18.56 79.50 79.50 83.74 53.13 17.85 43.35 79.50 40.29 47.41 20.69 83.74 Outpatient Assay of citrate 82507 146.00 53.96 23.63 161.96 37.52 157.03 28.36 161.96 23.63 27.80 99.83 26.28 71.17 23.63 29.75 105.13 25.02 27.80 95.34 119.18 27.52 28.36 27.80 116.80 25.44 109.50 109.50 115.34 72.84 24.46 59.71 109.50 55.49 65.31 28.36 115.34 Outpatient Collagen crosslinks 82523 98.00 36.22 15.88 80.08 25.19 61.35 19.05 63.28 15.88 18.68 67.01 17.64 47.82 15.88 19.99 70.57 16.81 18.68 64.06 80.08 18.49 19.05 18.68 78.40 17.09 73.50 73.50 77.42 48.94 16.44 40.08 73.50 37.25 43.84 19.05 77.42 Outpatient Assay of copper 82525 65.00 24.02 10.55 72.29 16.71 70.09 12.66 72.29 10.55 12.41 44.45 11.70 31.77 10.55 13.28 46.81 11.17 12.41 42.56 53.20 12.29 12.66 12.41 52.00 11.36 48.75 48.75 51.35 32.51 10.92 26.59 48.75 24.71 29.07 12.66 51.35 Outpatient Cortisol free 82530 88.00 32.52 14.20 97.36 22.62 94.39 17.04 97.36 14.20 16.71 60.17 15.84 42.78 14.20 17.88 63.37 15.04 16.71 57.31 71.63 16.54 17.04 16.71 70.40 15.29 66.00 66.00 69.52 43.78 14.70 35.99 66.00 33.45 39.36 17.04 69.52 Outpatient Total cortisol 82533 86.00 31.79 13.86 94.96 22.10 92.07 16.63 94.96 13.86 16.30 58.81 15.48 41.73 13.86 17.44 61.93 14.67 16.30 55.90 69.88 16.14 16.63 16.30 68.80 14.91 64.50 64.50 67.94 42.71 14.34 35.17 64.50 32.69 38.47 16.63 67.94 Outpatient Assay of ck (cpk) 82550 34.00 12.57 5.53 37.92 8.74 36.76 6.64 37.92 5.53 6.51 23.25 6.12 16.67 5.53 6.97 24.48 5.86 6.51 22.33 27.91 6.44 6.64 6.51 27.20 5.96 25.50 25.50 26.86 17.06 5.73 13.91 25.50 12.92 15.21 6.64 26.86 Outpatient Assay of cpk in blood 82552 70.00 25.87 11.38 78.06 17.99 75.68 13.66 78.06 11.38 13.39 47.87 12.60 34.28 11.38 14.33 50.41 12.05 13.39 45.92 57.40 13.26 13.66 13.39 56.00 12.25 52.50 52.50 55.30 35.08 11.78 28.63 52.50 26.61 31.31 13.66 55.30 Outpatient Creatine mb fraction 82553 61.00 22.55 9.82 49.51 15.68 43.51 11.78 44.88 9.82 11.55 41.71 10.98 29.57 9.82 12.36 43.93 10.40 11.55 39.61 49.51 11.43 11.78 11.55 48.80 10.57 45.75 45.75 48.19 30.26 10.16 24.95 45.75 23.19 27.29 11.78 48.19 Outpatient Assay of creatinine 82565 27.00 9.98 4.35 29.85 6.94 28.94 5.22 29.85 4.35 5.12 18.46 4.86 13.11 4.35 5.48 19.44 4.61 5.12 17.56 21.95 5.07 5.22 5.12 21.60 4.68 20.25 20.25 21.33 13.41 4.51 11.04 20.25 10.26 12.08 5.22 21.33 Outpatient Assay of urine creatinine 82570 27.00 9.98 4.40 30.15 6.94 29.23 5.28 30.15 4.40 5.18 18.46 4.86 13.26 4.40 5.54 19.44 4.66 5.18 17.76 22.21 5.13 5.28 5.18 21.60 4.74 20.25 20.25 21.33 13.57 4.56 11.04 20.25 10.26 12.08 5.28 21.33 Outpatient Creatinine clearance test 82575 50.00 18.48 8.04 55.04 12.85 53.36 9.65 55.04 8.04 9.46 34.19 9.00 24.22 8.04 10.12 36.01 8.51 9.46 32.44 40.55 9.37 9.65 9.46 40.00 8.66 37.50 37.50 39.50 24.79 8.32 20.45 37.50 19.01 22.37 9.65 39.50 Outpatient Assay of cryoglobulin 82595 34.00 12.57 5.50 37.70 8.74 36.56 6.60 37.70 5.50 6.47 23.25 6.12 16.56 5.50 6.92 24.48 5.82 6.47 22.19 27.74 6.41 6.60 6.47 27.20 5.92 25.50 25.50 26.86 16.95 5.69 13.91 25.50 12.92 15.21 6.60 26.86 Outpatient Vitamin b-12 82607 79.00 29.20 12.82 87.79 20.30 85.12 15.38 87.79 12.82 15.08 54.02 14.22 38.60 12.82 16.14 56.89 13.57 15.08 51.72 64.65 14.93 15.38 15.08 63.20 13.80 59.25 59.25 62.41 39.51 13.27 32.31 59.25 30.03 35.34 15.38 62.41 Outpatient Dehydroepiandrosterone 82627 117.00 43.24 18.90 129.51 30.07 125.57 22.67 129.51 18.90 22.23 80.00 21.06 56.91 18.90 23.79 84.25 20.01 22.23 76.24 95.30 22.01 22.67 22.23 93.60 20.34 87.75 87.75 92.43 58.24 19.56 47.85 87.75 44.47 52.33 22.67 92.43 Outpatient Desoxycorticosterone 82633 163.00 60.24 26.33 180.45 41.89 174.96 31.60 180.45 26.33 30.98 111.46 29.34 79.31 26.33 33.15 117.38 27.88 30.98 106.25 132.81 30.67 31.60 30.98 130.40 28.35 122.25 122.25 128.77 81.17 27.26 66.67 122.25 61.96 72.91 31.60 128.77 Outpatient Deoxycortisol 82634 154.00 56.92 24.89 125.52 39.58 105.07 29.87 108.37 24.89 29.28 105.31 27.72 74.96 24.89 31.33 110.90 26.35 29.28 100.42 125.52 28.99 29.87 29.28 123.20 26.79 115.50 115.50 121.66 76.71 25.77 62.99 115.50 58.54 68.88 29.87 121.66 Outpatient Dihydrotestosterone 82642 154.00 56.92 24.89 125.52 39.58 101.62 29.87 104.94 24.89 29.28 105.31 27.72 74.96 24.89 31.33 110.90 26.35 29.28 100.42 125.52 28.99 29.87 29.28 123.20 26.79 115.50 115.50 121.66 76.71 25.77 62.99 115.50 58.54 68.88 29.87 121.66 Outpatient Vit d 1 25-dihydroxy 82652 224.00 82.79 32.73 224.30 57.57 217.47 39.27 224.30 32.73 38.50 153.17 40.32 98.56 32.73 41.20 161.30 34.65 38.50 132.04 165.05 38.12 39.27 38.50 179.20 35.23 168.00 168.00 176.96 100.87 33.88 91.62 168.00 85.14 100.20 39.27 176.96 Outpatient El-1 fecal qual/semiq 82656 839.00 310.09 9.80 671.20 215.62 62.18 11.76 64.14 9.80 11.53 573.71 151.02 29.52 9.80 12.34 604.16 10.38 11.53 39.54 49.43 11.41 11.76 11.53 671.20 10.55 629.25 629.25 662.81 30.21 10.15 343.15 629.25 318.90 375.28 11.76 662.81 Outpatient Assay of erythropoietin 82668 99.00 36.59 15.97 101.33 25.44 98.24 19.17 101.33 15.97 18.79 67.70 17.82 48.10 15.97 20.11 71.29 16.91 18.79 64.44 80.55 18.60 19.17 18.79 79.20 17.19 74.25 74.25 78.21 49.23 16.54 40.49 74.25 37.63 44.28 19.17 78.21 Outpatient Assay of estrogens 82671 170.00 62.83 27.46 188.18 43.69 182.45 32.95 188.18 27.46 32.30 116.25 30.60 82.69 27.46 34.56 122.42 29.07 32.30 110.77 138.47 31.98 32.95 32.30 136.00 29.55 127.50 127.50 134.30 84.63 28.42 69.53 127.50 64.62 76.04 32.95 134.30 Outpatient Fats/lipids feces qual 82705 27.00 9.98 4.34 29.63 6.94 28.73 5.20 29.63 4.34 5.10 18.46 4.86 13.06 4.34 5.46 19.44 4.59 5.10 17.49 21.86 5.05 5.20 5.10 21.60 4.67 20.25 20.25 21.33 13.36 4.49 11.04 20.25 10.26 12.08 5.20 21.33 Outpatient Fats/lipids feces quant 82710 88.00 32.52 14.28 97.91 22.62 94.93 17.14 97.91 14.28 16.80 60.17 15.84 43.01 14.28 17.98 63.37 15.12 16.80 57.62 72.02 16.63 17.14 16.80 70.40 15.37 66.00 66.00 69.52 44.02 14.78 35.99 66.00 33.45 39.36 17.14 69.52 Outpatient Assay of ferritin 82728 72.00 26.61 11.59 79.38 18.50 76.96 13.90 79.38 11.59 13.63 49.23 12.96 34.89 11.59 14.58 51.85 12.27 13.63 46.74 58.43 13.49 13.90 13.63 57.60 12.47 54.00 54.00 56.88 35.71 11.99 29.45 54.00 27.37 32.21 13.90 56.88 Outpatient Assay of folic acid serum 82746 77.00 28.46 12.50 85.66 19.79 83.05 14.99 85.66 12.50 14.70 52.65 13.86 37.63 12.50 15.73 55.45 13.23 14.70 50.41 63.02 14.55 14.99 14.70 61.60 13.45 57.75 57.75 60.83 38.51 12.94 31.49 57.75 29.27 34.44 14.99 60.83 Outpatient Assay of folic acid rbc 82747 93.00 34.37 15.00 100.35 23.90 97.29 18.00 100.35 15.00 17.65 63.59 16.74 45.18 15.00 18.89 66.97 15.89 17.65 60.53 75.66 17.47 18.00 17.65 74.40 16.15 69.75 69.75 73.47 46.24 15.53 38.04 69.75 35.35 41.60 18.00 73.47 Outpatient Assay of ige 82785 86.00 31.79 13.99 95.95 22.10 93.03 16.79 95.95 13.99 16.46 58.81 15.48 42.14 13.99 17.61 61.93 14.81 16.46 56.45 70.56 16.30 16.79 16.46 68.80 15.06 64.50 64.50 67.94 43.13 14.48 35.17 64.50 32.69 38.47 16.79 67.94 Outpatient Igg 1 2 3 or 4 each 82787 42.00 15.52 6.82 46.71 10.79 45.29 8.18 46.71 6.82 8.02 28.72 7.56 20.53 6.82 8.58 30.24 7.22 8.02 27.50 34.38 7.94 8.18 8.02 33.60 7.34 31.50 31.50 33.18 21.01 7.06 17.18 31.50 15.96 18.79 8.18 33.18 Outpatient Blood gases any combination 82803 137.00 50.64 22.16 112.73 35.21 109.30 26.59 112.73 22.16 26.07 93.68 24.66 66.74 22.16 27.89 98.65 23.46 26.07 89.41 111.76 25.81 26.59 26.07 109.60 23.85 102.75 102.75 108.23 68.30 22.94 56.03 102.75 52.07 61.28 26.59 108.23 Outpatient Blood gases w/o2 saturation 82805 414.00 153.01 66.95 337.68 106.40 160.26 80.35 165.29 66.95 78.77 283.09 74.52 201.65 66.95 84.28 298.12 70.89 78.77 270.14 337.68 77.98 80.35 78.77 331.20 72.07 310.50 310.50 327.06 206.38 69.32 169.33 310.50 157.36 185.18 80.35 327.06 Outpatient Assay of gastrin 82941 93.00 34.37 14.99 102.74 23.90 99.61 17.98 102.74 14.99 17.63 63.59 16.74 45.13 14.99 18.86 66.97 15.87 17.63 60.46 75.58 17.45 17.98 17.63 74.40 16.13 69.75 69.75 73.47 46.19 15.51 38.04 69.75 35.35 41.60 17.98 73.47 Outpatient Glucose other fluid 82945 21.00 7.76 3.34 22.89 5.40 22.19 4.01 22.89 3.34 3.93 14.36 3.78 10.06 3.34 4.21 15.12 3.54 3.93 13.48 16.85 3.89 4.01 3.93 16.80 3.60 15.75 15.75 16.59 10.30 3.46 8.59 15.75 7.98 9.39 4.01 16.59 Outpatient Assay glucose blood quant 82947 21.00 7.76 3.34 22.89 5.40 22.19 4.01 22.89 3.34 3.93 14.36 3.78 10.06 3.34 4.21 15.12 3.54 3.93 13.48 16.85 3.89 4.01 3.93 16.80 3.60 15.75 15.75 16.59 10.30 3.46 8.59 15.75 7.98 9.39 4.01 16.59 Outpatient Glucose test 82950 25.00 9.24 4.04 27.67 6.43 26.83 4.85 27.67 4.04 4.75 17.10 4.50 12.16 4.04 5.08 18.00 4.28 4.75 16.29 20.36 4.70 4.85 4.75 20.00 4.35 18.75 18.75 19.75 12.45 4.18 10.23 18.75 9.50 11.18 4.85 19.75 Outpatient Glucose tolerance test (gtt) 82951 68.00 25.13 10.94 74.98 17.48 72.70 13.13 74.98 10.94 12.87 46.50 12.24 32.95 10.94 13.77 48.97 11.58 12.87 44.14 55.17 12.74 13.13 12.87 54.40 11.78 51.00 51.00 53.72 33.72 11.33 27.81 51.00 25.85 30.42 13.13 53.72 Outpatient Gtt-added samples 82952 21.00 7.76 3.33 16.80 5.40 16.27 4.00 16.78 3.33 3.92 14.36 3.78 10.04 3.33 4.19 15.12 3.53 3.92 13.44 16.80 3.88 4.00 3.92 16.80 3.59 15.75 15.75 16.59 10.27 3.45 8.59 15.75 7.98 9.39 4.00 16.59 Outpatient Assay of g6pd enzyme 82955 51.00 18.85 8.25 56.45 13.11 54.73 9.89 56.45 8.25 9.70 34.87 9.18 24.83 8.25 10.38 36.73 8.73 9.70 33.27 41.58 9.60 9.89 9.70 40.80 8.88 38.25 38.25 40.29 25.41 8.54 20.86 38.25 19.39 22.81 9.89 40.29 Outpatient Glucose blood test 82962 17.00 6.28 2.79 14.06 4.37 13.25 3.35 13.66 2.79 3.28 11.62 3.06 8.40 2.79 3.51 12.24 2.95 3.28 11.25 14.06 3.25 3.35 3.28 13.60 3.00 12.75 12.75 13.43 8.59 2.89 6.95 12.75 6.46 7.60 3.35 13.43 Outpatient Assay of ggt 82977 38.00 14.04 6.12 41.93 9.77 40.65 7.34 41.93 6.12 7.20 25.98 6.84 18.43 6.12 7.70 27.36 6.48 7.20 24.69 30.87 7.13 7.34 7.20 30.40 6.59 28.50 28.50 30.02 18.86 6.34 15.54 28.50 14.44 17.00 7.34 30.02 Outpatient Assay of glycated protein 82985 88.00 32.52 14.25 84.55 22.62 81.97 17.10 84.55 14.25 16.76 60.17 15.84 42.91 14.25 17.93 63.37 15.08 16.76 57.48 71.85 16.59 17.10 16.76 70.40 15.34 66.00 66.00 69.52 43.91 14.75 35.99 66.00 33.45 39.36 17.10 69.52 Outpatient Assay of gonadotropin (fsh) 83001 98.00 36.22 15.79 108.24 25.19 104.95 18.95 108.24 15.79 18.58 67.01 17.64 47.56 15.79 19.88 70.57 16.72 18.58 63.72 79.65 18.39 18.95 18.58 78.40 17.00 73.50 73.50 77.42 48.68 16.35 40.08 73.50 37.25 43.84 18.95 77.42 Outpatient Assay of gonadotropin (lh) 83002 97.00 35.85 15.74 107.86 24.93 104.58 18.89 107.86 15.74 18.52 66.33 17.46 47.41 15.74 19.82 69.85 16.67 18.52 63.51 79.39 18.33 18.89 18.52 77.60 16.95 72.75 72.75 76.63 48.52 16.30 39.67 72.75 36.87 43.39 18.89 76.63 Outpatient Assay growth hormone (hgh) 83003 88.00 32.52 14.17 97.19 22.62 94.23 17.00 97.19 14.17 16.67 60.17 15.84 42.68 14.17 17.84 63.37 15.00 16.67 57.17 71.46 16.50 17.00 16.67 70.40 15.25 66.00 66.00 69.52 43.68 14.67 35.99 66.00 33.45 39.36 17.00 69.52 Outpatient Assay of haptoglobin quant 83010 66.00 24.39 10.69 73.27 16.96 71.04 12.83 73.27 10.69 12.58 45.13 11.88 32.20 10.69 13.46 47.53 11.32 12.58 43.14 53.93 12.45 12.83 12.58 52.80 11.51 49.50 49.50 52.14 32.96 11.07 26.99 49.50 25.09 29.52 12.83 52.14 Outpatient Hemoglobin electrophoresis 83020 68.00 25.13 10.94 74.30 17.48 72.04 13.13 74.30 10.94 12.87 46.50 12.24 32.95 10.94 13.77 48.97 11.58 12.87 44.14 55.17 12.74 13.13 12.87 54.40 11.78 51.00 51.00 53.72 33.72 11.33 27.81 51.00 25.85 30.42 13.13 53.72 Outpatient Hemoglobin chromotography 83021 95.00 35.11 15.35 105.17 24.42 101.97 18.42 105.17 15.35 18.06 64.96 17.10 46.23 15.35 19.32 68.41 16.25 18.06 61.94 77.42 17.88 18.42 18.06 76.00 16.52 71.25 71.25 75.05 47.32 15.89 38.86 71.25 36.11 42.49 18.42 75.05 Outpatient Glycosylated hb home device 83037 51.00 18.85 8.25 56.53 13.11 54.81 9.90 56.53 8.25 9.71 34.87 9.18 24.86 8.25 10.39 36.73 8.74 9.71 33.30 41.63 9.61 9.90 9.71 40.80 8.88 38.25 38.25 40.29 25.44 8.54 20.86 38.25 19.39 22.81 9.90 40.29 Outpatient Assay of plasma hemoglobin 83051 38.00 14.04 6.21 31.34 9.77 26.25 7.46 27.07 6.21 7.31 25.98 6.84 18.71 6.21 7.82 27.36 6.58 7.31 25.07 31.34 7.24 7.46 7.31 30.40 6.69 28.50 28.50 30.02 19.15 6.43 15.54 28.50 14.44 17.00 7.46 30.02 Outpatient Assay of homocystine 83090 94.00 34.74 15.23 98.25 24.16 95.26 18.28 98.25 15.23 17.92 64.28 16.92 45.88 15.23 19.17 67.69 16.13 17.92 61.46 76.82 17.74 18.28 17.92 75.20 16.40 70.50 70.50 74.26 46.95 15.77 38.45 70.50 35.73 42.05 18.28 74.26 Outpatient Assay of homovanillic acid 83150 118.00 43.61 19.05 96.07 30.33 65.74 22.86 67.81 19.05 22.41 80.69 21.24 57.37 19.05 23.98 84.97 20.17 22.41 76.86 96.07 22.19 22.86 22.41 94.40 20.51 88.50 88.50 93.22 58.71 19.72 48.26 88.50 44.85 52.78 22.86 93.22 Outpatient Assay of 5-hiaa 83497 68.00 25.13 10.97 74.30 17.48 72.04 13.16 74.30 10.97 12.90 46.50 12.24 33.02 10.97 13.80 48.97 11.61 12.90 44.24 55.30 12.77 13.16 12.90 54.40 11.80 51.00 51.00 53.72 33.80 11.35 27.81 51.00 25.85 30.42 13.16 53.72 Outpatient Assay of insulin 83525 60.00 22.18 9.72 66.57 15.42 64.54 11.66 66.57 9.72 11.43 41.03 10.80 29.26 9.72 12.23 43.21 10.29 11.43 39.20 49.00 11.32 11.66 11.43 48.00 10.46 45.00 45.00 47.40 29.95 10.06 24.54 45.00 22.81 26.84 11.66 47.40 Outpatient Iron binding test 83550 46.00 17.00 7.43 50.94 11.82 49.39 8.91 50.94 7.43 8.74 31.45 8.28 22.37 7.43 9.35 33.12 7.87 8.74 29.97 37.47 8.65 8.91 8.74 36.80 8.00 34.50 34.50 36.34 22.90 7.69 18.81 34.50 17.48 20.58 8.91 36.34 Outpatient Assay of lactic acid 83605 61.00 22.55 9.83 62.21 15.68 60.32 11.80 62.21 9.83 11.57 41.71 10.98 29.62 9.83 12.38 43.93 10.41 11.57 39.68 49.60 11.45 11.80 11.57 48.80 10.59 45.75 45.75 48.19 30.31 10.18 24.95 45.75 23.19 27.29 11.80 48.19 Outpatient Lactate (ld) (ldh) enzyme 83615 32.00 11.83 5.13 35.14 8.22 34.07 6.16 35.14 5.13 6.04 21.88 5.76 15.46 5.13 6.46 23.04 5.44 6.04 20.71 25.89 5.98 6.16 6.04 25.60 5.53 24.00 24.00 25.28 15.82 5.32 13.09 24.00 12.16 14.31 6.16 25.28 Outpatient Assay of ldh enzymes 83625 67.00 24.76 10.87 74.55 17.22 72.28 13.05 74.55 10.87 12.79 45.81 12.06 32.74 10.87 13.69 48.25 11.51 12.79 43.86 54.83 12.66 13.05 12.79 53.60 11.70 50.25 50.25 52.93 33.51 11.26 27.40 50.25 25.47 29.97 13.05 52.93 Outpatient Lactoferrin fecal (quant) 83631 737.00 272.40 16.69 589.60 189.41 110.87 20.02 114.35 16.69 19.63 503.96 132.66 50.25 16.69 21.00 530.71 17.67 19.63 67.32 84.15 19.43 20.02 19.63 589.60 17.96 552.75 552.75 582.23 51.43 17.27 301.43 552.75 280.13 329.66 20.02 582.23 Outpatient Assay of lead 83655 64.00 23.65 10.29 70.54 16.45 68.39 12.35 70.54 10.29 12.11 43.76 11.52 31.00 10.29 12.96 46.09 10.90 12.11 41.53 51.91 11.99 12.35 12.11 51.20 11.08 48.00 48.00 50.56 31.73 10.66 26.18 48.00 24.33 28.63 12.35 50.56 Outpatient Assay of lipase 83690 36.00 13.31 5.86 40.14 9.25 38.92 7.03 40.14 5.86 6.89 24.62 6.48 17.64 5.86 7.37 25.92 6.20 6.89 23.63 29.54 6.82 7.03 6.89 28.80 6.30 27.00 27.00 28.44 18.05 6.06 14.72 27.00 13.68 16.10 7.03 28.44 Outpatient Assay of lipoprotein(a) 83695 75.00 27.72 12.17 75.41 19.28 73.11 14.61 75.41 12.17 14.32 51.29 13.50 36.66 12.17 15.32 54.01 12.89 14.32 49.11 61.39 14.18 14.61 14.32 60.00 13.10 56.25 56.25 59.25 37.52 12.60 30.68 56.25 28.51 33.55 14.61 59.25 Outpatient Assay of lipoprotein 83718 43.00 15.89 6.96 47.70 11.05 46.24 8.35 47.70 6.96 8.19 29.40 7.74 20.97 6.96 8.76 30.96 7.37 8.19 28.09 35.11 8.11 8.35 8.19 34.40 7.49 32.25 32.25 33.97 21.46 7.21 17.59 32.25 16.34 19.23 8.35 33.97 Outpatient Assay of blood lipoprotein 83721 55.00 20.33 8.93 55.60 14.14 53.90 10.71 55.60 8.93 10.50 37.61 9.90 26.88 8.93 11.24 39.61 9.45 10.50 36.01 45.01 10.40 10.71 10.50 44.00 9.61 41.25 41.25 43.45 27.51 9.24 22.50 41.25 20.91 24.60 10.71 43.45 Outpatient Assay of mercury 83825 85.00 31.42 13.82 94.71 21.85 91.83 16.59 94.71 13.82 16.26 58.12 15.30 41.63 13.82 17.40 61.21 14.63 16.26 55.76 69.70 16.10 16.59 16.26 68.00 14.88 63.75 63.75 67.15 42.60 14.31 34.77 63.75 32.31 38.02 16.59 67.15 Outpatient Assay of metanephrines 83835 89.00 32.89 14.40 98.68 22.87 95.68 17.28 98.68 14.40 16.94 60.86 16.02 43.37 14.40 18.13 64.09 15.25 16.94 58.10 72.62 16.77 17.28 16.94 71.20 15.50 66.75 66.75 70.31 44.38 14.91 36.40 66.75 33.83 39.81 17.28 70.31 Outpatient Assay of myoglobin 83874 68.00 25.13 10.98 75.24 17.48 72.95 13.18 75.24 10.98 12.92 46.50 12.24 33.08 10.98 13.82 48.97 11.63 12.92 44.31 55.39 12.79 13.18 12.92 54.40 11.82 51.00 51.00 53.72 33.85 11.37 27.81 51.00 25.85 30.42 13.18 53.72 Outpatient Assay of natriuretic peptide 83880 206.00 76.14 33.37 197.74 52.94 191.72 40.05 197.74 33.37 39.26 140.86 37.08 100.51 33.37 42.01 148.34 35.33 39.26 134.64 168.30 38.87 40.05 39.26 164.80 35.92 154.50 154.50 162.74 102.86 34.55 84.25 154.50 78.30 92.14 40.05 162.74 Outpatient Oligoclonal bands 83916 144.00 53.22 23.28 117.42 37.01 113.56 27.94 117.13 23.28 27.39 98.47 25.92 70.12 23.28 29.31 103.69 24.65 27.39 93.93 117.42 27.12 27.94 27.39 115.20 25.06 108.00 108.00 113.76 71.76 24.10 58.90 108.00 54.73 64.41 27.94 113.76 Outpatient Organic acids total quant 83918 834.00 308.25 20.06 667.20 214.34 92.94 24.07 95.86 20.06 23.60 570.29 150.12 60.42 20.06 25.25 600.56 21.24 23.60 80.94 101.17 23.36 24.07 23.60 667.20 21.59 625.50 625.50 658.86 61.83 20.77 341.11 625.50 317.00 373.05 24.07 658.86 Outpatient Assay of blood osmolality 83930 35.00 12.94 5.62 38.52 9.00 37.34 6.74 38.52 5.62 6.61 23.93 6.30 16.92 5.62 7.07 25.20 5.95 6.61 22.67 28.34 6.54 6.74 6.61 28.00 6.05 26.25 26.25 27.65 17.32 5.82 14.32 26.25 13.30 15.66 6.74 27.65 Outpatient Assay of urine osmolality 83935 36.00 13.31 5.80 39.71 9.25 38.50 6.96 39.71 5.80 6.82 24.62 6.48 17.46 5.80 7.30 25.92 6.14 6.82 23.39 29.24 6.75 6.96 6.82 28.80 6.24 27.00 27.00 28.44 17.87 6.00 14.72 27.00 13.68 16.10 6.96 28.44 Outpatient Assay of oxalate 83945 76.00 28.09 12.28 74.98 19.53 72.70 14.74 74.98 12.28 14.45 51.97 13.68 36.99 12.28 15.46 54.73 13.01 14.45 49.56 61.95 14.31 14.74 14.45 60.80 13.22 57.00 57.00 60.04 37.86 12.72 31.08 57.00 28.89 33.99 14.74 60.04 Outpatient Oncoprotein dcp 83951 338.00 124.92 54.75 375.25 86.87 363.82 65.70 375.25 54.75 64.41 231.12 60.84 164.89 54.75 68.92 243.39 57.97 64.41 220.89 276.12 63.77 65.70 64.41 270.40 58.94 253.50 253.50 267.02 168.75 56.68 138.24 253.50 128.47 151.19 65.70 267.02 Outpatient Assay of parathormone 83970 217.00 80.20 35.09 240.44 55.77 233.12 42.11 240.44 35.09 41.28 148.38 39.06 105.68 35.09 44.17 156.26 37.15 41.28 141.57 176.96 40.87 42.11 41.28 173.60 37.77 162.75 162.75 171.43 108.15 36.33 88.75 162.75 82.48 97.06 42.11 171.43 Outpatient Assay ph body fluid nos 83986 19.00 7.02 3.04 16.23 4.88 15.73 3.65 16.23 3.04 3.58 12.99 3.42 9.16 3.04 3.83 13.68 3.22 3.58 12.28 15.35 3.54 3.65 3.58 15.20 3.28 14.25 14.25 15.01 9.38 3.15 7.77 14.25 7.22 8.50 3.65 15.01 Outpatient Assay for calprotectin fecal 83993 242.00 89.44 16.69 193.60 62.19 110.87 20.02 114.35 16.69 19.63 165.48 43.56 50.25 16.69 21.00 174.26 17.67 19.63 67.32 84.15 19.43 20.02 19.63 193.60 17.96 181.50 181.50 191.18 51.43 17.27 98.98 181.50 91.98 108.25 20.02 191.18 Outpatient Assay prostate phosphatase 84066 51.00 18.85 8.21 56.28 13.11 54.57 9.85 56.28 8.21 9.66 34.87 9.18 24.73 8.21 10.34 36.73 8.69 9.66 33.13 41.41 9.56 9.85 9.66 40.80 8.84 38.25 38.25 40.29 25.31 8.50 20.86 38.25 19.39 22.81 9.85 40.29 Outpatient Assay alkaline phosphatases 84080 78.00 28.83 12.56 86.13 20.05 83.50 15.08 86.13 12.56 14.78 53.34 14.04 37.84 12.56 15.81 56.17 13.30 14.78 50.69 63.36 14.63 15.08 14.78 62.40 13.52 58.50 58.50 61.62 38.72 13.01 31.90 58.50 29.65 34.89 15.08 61.62 Outpatient Assay of phosphorus 84100 25.00 9.24 4.03 27.58 6.43 26.74 4.83 27.58 4.03 4.74 17.10 4.50 12.13 4.03 5.07 18.00 4.27 4.74 16.26 20.32 4.69 4.83 4.74 20.00 4.34 18.75 18.75 19.75 12.42 4.17 10.23 18.75 9.50 11.18 4.83 19.75 Outpatient Assay of urine phosphorus 84105 30.00 11.09 4.91 30.15 7.71 29.23 5.90 30.15 4.91 5.78 20.51 5.40 14.80 4.91 6.18 21.60 5.20 5.78 19.82 24.78 5.72 5.90 5.78 24.00 5.29 22.50 22.50 23.70 15.14 5.09 12.27 22.50 11.40 13.42 5.90 23.70 Outpatient Assay of serum potassium 84132 25.00 9.24 4.05 26.77 6.43 25.96 4.86 26.77 4.05 4.76 17.10 4.50 12.19 4.05 5.09 18.00 4.28 4.76 16.32 20.41 4.71 4.86 4.76 20.00 4.36 18.75 18.75 19.75 12.47 4.19 10.23 18.75 9.50 11.18 4.86 19.75 Outpatient Assay of urine potassium 84133 25.00 9.24 4.02 25.06 6.43 24.30 4.82 25.06 4.02 4.73 17.10 4.50 12.11 4.02 5.06 18.00 4.26 4.73 16.22 20.28 4.68 4.82 4.73 20.00 4.33 18.75 18.75 19.75 12.39 4.16 10.23 18.75 9.50 11.18 4.82 19.75 Outpatient Assay of prealbumin 84134 77.00 28.46 12.40 84.93 19.79 82.34 14.88 84.93 12.40 14.59 52.65 13.86 37.35 12.40 15.61 55.45 13.13 14.59 50.04 62.55 14.44 14.88 14.59 61.60 13.35 57.75 57.75 60.83 38.23 12.84 31.49 57.75 29.27 34.44 14.88 60.83 Outpatient Assay of 17-hydroxypregneno 84143 120.00 44.35 19.39 132.93 30.84 128.88 23.27 132.93 19.39 22.81 82.06 21.60 58.39 19.39 24.41 86.41 20.53 22.81 78.23 97.78 22.58 23.27 22.81 96.00 20.87 90.00 90.00 94.80 59.76 20.07 49.08 90.00 45.61 53.68 23.27 94.80 Outpatient Assay of progesterone 84144 110.00 40.66 17.73 121.52 28.27 117.82 21.28 121.52 17.73 20.86 75.22 19.80 53.40 17.73 22.32 79.21 18.77 20.86 71.54 89.42 20.65 21.28 20.86 88.00 19.09 82.50 82.50 86.90 54.65 18.36 44.99 82.50 41.81 49.20 21.28 86.90 Outpatient Procalcitonin (pct) 84145 143.00 52.85 23.14 156.03 36.75 151.28 27.76 156.03 23.14 27.22 97.78 25.74 69.68 23.14 29.13 102.97 24.50 27.22 93.35 116.69 26.95 27.76 27.22 114.40 24.91 107.25 107.25 112.97 71.32 23.95 58.49 107.25 54.35 63.96 27.76 112.97 Outpatient Assay of prolactin 84146 102.00 37.70 16.47 112.90 26.21 109.46 19.77 112.90 16.47 19.38 69.75 18.36 49.61 16.47 20.74 73.45 17.44 19.38 66.46 83.08 19.19 19.77 19.38 81.60 17.73 76.50 76.50 80.58 50.78 17.05 41.72 76.50 38.77 45.62 19.77 80.58 Outpatient Assay of psa free 84154 97.00 35.85 15.63 107.13 24.93 103.87 18.76 107.13 15.63 18.39 66.33 17.46 47.08 15.63 19.68 69.85 16.55 18.39 63.07 78.84 18.21 18.76 18.39 77.60 16.83 72.75 72.75 76.63 48.18 16.18 39.67 72.75 36.87 43.39 18.76 76.63 Outpatient Assay of protein serum 84155 19.00 7.02 3.12 21.35 4.88 20.70 3.74 21.35 3.12 3.67 12.99 3.42 9.40 3.12 3.93 13.68 3.30 3.67 12.59 15.73 3.63 3.74 3.67 15.20 3.36 14.25 14.25 15.01 9.62 3.23 7.77 14.25 7.22 8.50 3.74 15.01 Outpatient Assay of protein other 84157 21.00 7.76 3.40 21.35 5.40 20.70 4.08 21.35 3.40 4.00 14.36 3.78 10.24 3.40 4.28 15.12 3.60 4.00 13.72 17.15 3.96 4.08 4.00 16.80 3.66 15.75 15.75 16.59 10.48 3.52 8.59 15.75 7.98 9.39 4.08 16.59 Outpatient Pappa serum 84163 79.00 29.20 12.79 84.50 20.30 81.93 15.35 84.50 12.79 15.05 54.02 14.22 38.53 12.79 16.10 56.89 13.55 15.05 51.61 64.52 14.90 15.35 15.05 63.20 13.77 59.25 59.25 62.41 39.43 13.24 32.31 59.25 30.03 35.34 15.35 62.41 Outpatient Protein e-phoresis/urine/csf 84166 94.00 34.74 15.16 103.89 24.16 100.73 18.19 103.89 15.16 17.83 64.28 16.92 45.64 15.16 19.08 67.69 16.05 17.83 61.15 76.44 17.65 18.19 17.83 75.20 16.31 70.50 70.50 74.26 46.71 15.69 38.45 70.50 35.73 42.05 18.19 74.26 Outpatient Assay of proinsulin 84206 140.00 51.74 22.69 114.42 35.98 100.60 27.22 103.76 22.69 26.69 95.73 25.20 68.33 22.69 28.56 100.81 24.02 26.69 91.53 114.42 26.42 27.22 26.69 112.00 24.42 105.00 105.00 110.60 69.93 23.49 57.26 105.00 53.21 62.62 27.22 110.60 Outpatient Assay nonendocrine receptor 84238 192.00 70.96 31.08 213.03 49.34 206.54 37.30 213.03 31.08 36.57 131.29 34.56 93.62 31.08 39.13 138.26 32.91 36.57 125.42 156.77 36.20 37.30 36.57 153.60 33.46 144.00 144.00 151.68 95.81 32.18 78.53 144.00 72.98 85.88 37.30 151.68 Outpatient Assay of renin 84244 115.00 42.50 18.69 128.14 29.56 124.24 22.43 128.14 18.69 21.99 78.64 20.70 56.29 18.69 23.53 82.81 19.79 21.99 75.41 94.27 21.77 22.43 21.99 92.00 20.12 86.25 86.25 90.85 57.61 19.35 47.04 86.25 43.71 51.44 22.43 90.85 Outpatient Assay of vitamin b-2 84252 106.00 39.18 17.20 117.89 27.24 114.31 20.64 117.89 17.20 20.24 72.48 19.08 51.81 17.20 21.66 76.33 18.22 20.24 69.41 86.77 20.04 20.64 20.24 84.80 18.52 79.50 79.50 83.74 53.03 17.81 43.35 79.50 40.29 47.41 20.64 83.74 Outpatient Assay of selenium 84255 134.00 49.53 21.70 148.72 34.44 144.20 26.04 148.72 21.70 25.53 91.63 24.12 65.36 21.70 27.32 96.49 22.98 25.53 87.56 109.44 25.27 26.04 25.53 107.20 23.36 100.50 100.50 105.86 66.89 22.47 54.81 100.50 50.93 59.94 26.04 105.86 Outpatient Assay of serotonin 84260 163.00 60.24 26.33 180.45 41.89 174.96 31.60 180.45 26.33 30.98 111.46 29.34 79.31 26.33 33.15 117.38 27.88 30.98 106.25 132.81 30.67 31.60 30.98 130.40 28.35 122.25 122.25 128.77 81.17 27.26 66.67 122.25 61.96 72.91 31.60 128.77 Outpatient Assay of sex hormone globul 84270 114.00 42.13 18.47 114.95 29.30 111.45 22.16 114.95 18.47 21.73 77.95 20.52 55.63 18.47 23.25 82.09 19.56 21.73 74.52 93.15 21.51 22.16 21.73 91.20 19.88 85.50 85.50 90.06 56.93 19.12 46.63 85.50 43.33 50.99 22.16 90.06 Outpatient Assay of serum sodium 84295 25.00 9.24 4.09 28.01 6.43 27.16 4.91 28.01 4.09 4.81 17.10 4.50 12.31 4.09 5.15 18.00 4.33 4.81 16.50 20.62 4.76 4.91 4.81 20.00 4.40 18.75 18.75 19.75 12.60 4.23 10.23 18.75 9.50 11.18 4.91 19.75 Outpatient Assay of urine sodium 84300 27.00 9.98 4.30 28.35 6.94 27.49 5.16 28.35 4.30 5.06 18.46 4.86 12.95 4.30 5.41 19.44 4.55 5.06 17.35 21.69 5.01 5.16 5.06 21.60 4.63 20.25 20.25 21.33 13.26 4.45 11.04 20.25 10.26 12.08 5.16 21.33 Outpatient Assay of somatomedin 84305 112.00 41.40 18.07 114.44 28.78 110.95 21.69 114.44 18.07 21.26 76.59 20.16 54.43 18.07 22.75 80.65 19.13 21.26 72.91 91.14 21.05 21.69 21.26 89.60 19.45 84.00 84.00 88.48 55.70 18.71 45.81 84.00 42.57 50.10 21.69 88.48 Outpatient Assay of urine sulfate 84392 29.00 10.72 4.67 27.67 7.45 26.83 5.60 27.67 4.67 5.49 19.83 5.22 14.05 4.67 5.87 20.88 4.94 5.49 18.83 23.54 5.44 5.60 5.49 23.20 5.02 21.75 21.75 22.91 14.38 4.83 11.86 21.75 11.02 12.97 5.60 22.91 Outpatient Assay of vitamin b-1 84425 111.00 41.03 18.05 123.66 28.53 119.89 21.65 123.66 18.05 21.23 75.90 19.98 54.35 18.05 22.72 79.93 19.11 21.23 72.81 91.01 21.02 21.65 21.23 88.80 19.43 83.25 83.25 87.69 55.62 18.68 45.40 83.25 42.19 49.65 21.65 87.69 Outpatient Assay of thyroglobulin 84432 84.00 31.05 13.65 93.56 21.59 90.71 16.38 93.56 13.65 16.06 57.44 15.12 41.11 13.65 17.18 60.49 14.45 16.06 55.08 68.85 15.90 16.38 16.06 67.20 14.69 63.00 63.00 66.36 42.08 14.13 34.36 63.00 31.93 37.57 16.38 66.36 Outpatient Assay of total thyroxine 84436 36.00 13.31 5.84 40.01 9.25 38.79 7.01 40.01 5.84 6.87 24.62 6.48 17.59 5.84 7.35 25.92 6.18 6.87 23.56 29.45 6.80 7.01 6.87 28.80 6.29 27.00 27.00 28.44 18.00 6.05 14.72 27.00 13.68 16.10 7.01 28.44 Outpatient Assay of free thyroxine 84439 47.00 17.37 7.67 52.52 12.08 50.92 9.20 52.52 7.67 9.02 32.14 8.46 23.09 7.67 9.65 33.84 8.12 9.02 30.93 38.67 8.93 9.20 9.02 37.60 8.25 35.25 35.25 37.13 23.63 7.94 19.22 35.25 17.86 21.02 9.20 37.13 Outpatient Assay thyroid stim hormone 84443 88.00 32.52 14.28 97.91 22.62 94.93 17.14 97.91 14.28 16.80 60.17 15.84 43.01 14.28 17.98 63.37 15.12 16.80 57.62 72.02 16.63 17.14 16.80 70.40 15.37 66.00 66.00 69.52 44.02 14.78 35.99 66.00 33.45 39.36 17.14 69.52 Outpatient Assay of tsi globulin 84445 267.00 98.68 43.23 296.25 68.62 287.23 51.88 296.25 43.23 50.86 182.57 48.06 130.20 43.23 54.42 192.27 45.77 50.86 174.42 218.03 50.35 51.88 50.86 213.60 46.54 200.25 200.25 210.93 133.25 44.76 109.20 200.25 101.49 119.43 51.88 210.93 Outpatient Assay of vitamin e 84446 74.00 27.35 12.05 82.58 19.02 80.07 14.46 82.58 12.05 14.18 50.60 13.32 36.30 12.05 15.17 53.29 12.76 14.18 48.63 60.79 14.04 14.46 14.18 59.20 12.97 55.50 55.50 58.46 37.15 12.48 30.27 55.50 28.13 33.10 14.46 58.46 Outpatient Transferase (ast) (sgot) 84450 27.00 9.98 4.40 30.15 6.94 29.23 5.28 30.15 4.40 5.18 18.46 4.86 13.26 4.40 5.54 19.44 4.66 5.18 17.76 22.21 5.13 5.28 5.18 21.60 4.74 20.25 20.25 21.33 13.57 4.56 11.04 20.25 10.26 12.08 5.28 21.33 Outpatient Alanine amino (alt) (sgpt) 84460 28.00 10.35 4.51 30.83 7.20 29.89 5.41 30.83 4.51 5.30 19.15 5.04 13.57 4.51 5.67 20.16 4.77 5.30 18.18 22.72 5.25 5.41 5.30 22.40 4.85 21.00 21.00 22.12 13.89 4.66 11.45 21.00 10.64 12.52 5.41 22.12 Outpatient Assay of transferrin 84466 67.00 24.76 10.85 74.38 17.22 72.12 13.02 74.38 10.85 12.76 45.81 12.06 32.67 10.85 13.65 48.25 11.48 12.76 43.76 54.70 12.63 13.02 12.76 53.60 11.68 50.25 50.25 52.93 33.43 11.23 27.40 50.25 25.47 29.97 13.02 52.93 Outpatient Assay of triglycerides 84478 30.00 11.09 4.88 33.48 7.71 32.46 5.85 33.48 4.88 5.74 20.51 5.40 14.69 4.88 6.14 21.60 5.17 5.74 19.69 24.61 5.68 5.85 5.74 24.00 5.25 22.50 22.50 23.70 15.04 5.05 12.27 22.50 11.40 13.42 5.85 23.70 Outpatient Assay triiodothyronine (t3) 84480 74.00 27.35 12.05 82.58 19.02 80.07 14.46 82.58 12.05 14.18 50.60 13.32 36.30 12.05 15.17 53.29 12.76 14.18 48.63 60.79 14.04 14.46 14.18 59.20 12.97 55.50 55.50 58.46 37.15 12.48 30.27 55.50 28.13 33.10 14.46 58.46 Outpatient T3 reverse 84482 354.00 130.84 13.40 283.20 90.98 89.01 16.08 91.81 13.40 15.76 242.07 63.72 40.35 13.40 16.86 254.92 14.18 15.76 54.05 67.56 15.60 16.08 15.76 283.20 14.42 265.50 265.50 279.66 41.29 13.87 144.79 265.50 134.56 158.34 16.08 279.66 Outpatient Assay of troponin quant 84484 65.00 24.02 10.60 53.46 16.71 49.22 12.72 50.77 10.60 12.47 44.45 11.70 31.92 10.60 13.34 46.81 11.22 12.47 42.77 53.46 12.35 12.72 12.47 52.00 11.41 48.75 48.75 51.35 32.67 10.97 26.59 48.75 24.71 29.07 12.72 51.35 Outpatient Assay of urea nitrogen 84520 21.00 7.76 3.36 23.02 5.40 22.31 4.03 23.02 3.36 3.95 14.36 3.78 10.11 3.36 4.23 15.12 3.56 3.95 13.55 16.93 3.91 4.03 3.95 16.80 3.61 15.75 15.75 16.59 10.35 3.48 8.59 15.75 7.98 9.39 4.03 16.59 Outpatient Assay of urine/urea-n 84540 29.00 10.72 4.73 27.67 7.45 26.83 5.67 27.67 4.73 5.56 19.83 5.22 14.23 4.73 5.95 20.88 5.00 5.56 19.07 23.84 5.50 5.67 5.56 23.20 5.09 21.75 21.75 22.91 14.57 4.89 11.86 21.75 11.02 12.97 5.67 22.91 Outpatient Assay of blood/uric acid 84550 24.00 8.87 3.84 26.30 6.17 25.50 4.61 26.30 3.84 4.52 16.41 4.32 11.57 3.84 4.84 17.28 4.07 4.52 15.50 19.38 4.47 4.61 4.52 19.20 4.14 18.00 18.00 18.96 11.84 3.98 9.82 18.00 9.12 10.74 4.61 18.96 Outpatient Assay of urine/uric acid 84560 27.00 9.98 4.32 21.78 6.94 19.50 5.18 20.11 4.32 5.08 18.46 4.86 13.00 4.32 5.44 19.44 4.57 5.08 17.42 21.78 5.03 5.18 5.08 21.60 4.65 20.25 20.25 21.33 13.31 4.47 11.04 20.25 10.26 12.08 5.18 21.33 Outpatient Assay of urine vma 84585 81.00 29.94 13.18 90.27 20.82 87.52 15.81 90.27 13.18 15.50 55.39 14.58 39.68 13.18 16.59 58.33 13.95 15.50 53.16 66.45 15.35 15.81 15.50 64.80 14.18 60.75 60.75 63.99 40.61 13.64 33.13 60.75 30.79 36.23 15.81 63.99 Outpatient Assay of vip 84586 185.00 68.38 30.03 205.81 47.55 199.55 36.04 205.81 30.03 35.33 126.50 33.30 90.44 30.03 37.80 133.22 31.80 35.33 121.16 151.46 34.98 36.04 35.33 148.00 32.33 138.75 138.75 146.15 92.56 31.09 75.67 138.75 70.32 82.75 36.04 146.15 Outpatient Assay of vitamin a 84590 61.00 22.55 9.87 67.59 15.68 65.54 11.84 67.59 9.87 11.61 41.71 10.98 29.72 9.87 12.42 43.93 10.45 11.61 39.82 49.77 11.49 11.84 11.61 48.80 10.62 45.75 45.75 48.19 30.42 10.22 24.95 45.75 23.19 27.29 11.84 48.19 Outpatient Assay of vitamin k 84597 882.00 325.99 11.66 705.60 226.67 77.46 13.99 79.89 11.66 13.72 603.11 158.76 35.12 11.66 14.68 635.13 12.35 13.72 47.05 58.82 13.58 13.99 13.72 705.60 12.55 661.50 661.50 696.78 35.95 12.07 360.74 661.50 335.25 394.52 13.99 696.78 Outpatient Assay of zinc 84630 60.00 22.18 9.68 66.31 15.42 64.29 11.62 66.31 9.68 11.39 41.03 10.80 29.16 9.68 12.19 43.21 10.25 11.39 39.06 48.83 11.28 11.62 11.39 48.00 10.42 45.00 45.00 47.40 29.84 10.02 24.54 45.00 22.81 26.84 11.62 47.40 Outpatient Assay of c-peptide 84681 109.00 40.29 17.69 121.23 28.01 117.53 21.23 121.23 17.69 20.81 74.53 19.62 53.27 17.69 22.27 78.49 18.73 20.81 71.37 89.21 20.60 21.23 20.81 87.20 19.04 81.75 81.75 86.11 54.52 18.31 44.58 81.75 41.43 48.76 21.23 86.11 Outpatient Chorionic gonadotropin assay 84703 39.00 14.41 6.39 43.81 10.02 42.48 7.67 43.81 6.39 7.52 26.67 7.02 19.25 6.39 8.05 28.08 6.77 7.52 25.79 32.24 7.44 7.67 7.52 31.20 6.88 29.25 29.25 30.81 19.70 6.62 15.95 29.25 14.82 17.44 7.67 30.81 Outpatient Hcg free betachain test 84704 80.00 29.57 13.00 84.50 20.56 81.93 15.60 84.50 13.00 15.29 54.70 14.40 39.14 13.00 16.36 57.61 13.76 15.29 52.44 65.55 15.14 15.60 15.29 64.00 13.99 60.00 60.00 63.20 40.06 13.46 32.72 60.00 30.41 35.78 15.60 63.20 Outpatient Hemoglobin 85018 12.00 4.44 2.01 13.79 3.08 13.37 2.42 13.79 2.01 2.37 8.21 2.16 6.07 2.01 2.54 8.64 2.13 2.37 8.13 10.16 2.35 2.42 2.37 9.60 2.17 9.00 9.00 9.48 6.21 2.09 4.91 9.00 4.56 5.37 2.42 9.48 Outpatient Complete cbc w/auto diff wbc 85025 41.00 15.15 6.60 45.30 10.54 43.93 7.93 45.30 6.60 7.77 28.04 7.38 19.89 6.60 8.31 29.52 6.99 7.77 26.65 33.31 7.69 7.93 7.77 32.80 7.11 30.75 30.75 32.39 20.36 6.84 16.77 30.75 15.58 18.34 7.93 32.39 Outpatient Complete cbc automated 85027 34.00 12.57 5.50 37.70 8.74 36.56 6.60 37.70 5.50 6.47 23.25 6.12 16.56 5.50 6.92 24.48 5.82 6.47 22.19 27.74 6.41 6.60 6.47 27.20 5.92 25.50 25.50 26.86 16.95 5.69 13.91 25.50 12.92 15.21 6.60 26.86 Outpatient Manual cell count each 85032 23.00 8.50 3.66 25.06 5.91 24.30 4.40 25.06 3.66 4.31 15.73 4.14 11.03 3.66 4.61 16.56 3.88 4.31 14.78 18.48 4.27 4.40 4.31 18.40 3.94 17.25 17.25 18.17 11.29 3.79 9.41 17.25 8.74 10.29 4.40 18.17 Outpatient Reticyte/hgb concentrate 85046 29.00 10.72 4.73 32.49 7.45 31.51 5.68 32.49 4.73 5.57 19.83 5.22 14.26 4.73 5.96 20.88 5.01 5.57 19.10 23.88 5.51 5.68 5.57 23.20 5.10 21.75 21.75 22.91 14.59 4.90 11.86 21.75 11.02 12.97 5.68 22.91 Outpatient Automated platelet count 85049 24.00 8.87 3.81 26.09 6.17 25.30 4.57 26.09 3.81 4.48 16.41 4.32 11.47 3.81 4.79 17.28 4.03 4.48 15.36 19.21 4.44 4.57 4.48 19.20 4.10 18.00 18.00 18.96 11.74 3.94 9.82 18.00 9.12 10.74 4.57 18.96 Outpatient Reticulated platelet assay 85055 188.00 69.48 30.38 155.98 48.32 151.23 36.45 155.98 30.38 35.74 128.55 33.84 91.49 30.38 38.24 135.38 32.17 35.74 122.57 153.21 35.38 36.45 35.74 150.40 32.70 141.00 141.00 148.52 93.64 31.45 76.89 141.00 71.46 84.09 36.45 148.52 Outpatient Bone marrow interpretation 85097 " 3,445.00 " " 1,273.27 " 566.92 " 2,836.08 " 885.37 " 2,273.36 " 680.30 " 2,347.42 " 566.92 666.96 " 2,355.69 " 620.10 " 1,679.74 " 566.92 713.65 " 2,480.74 " 600.26 666.96 " 2,268.82 " " 2,836.08 " 660.29 680.30 666.96 " 2,756.00 " 610.27 " 2,583.75 " " 2,583.75 " " 2,721.55 " " 1,719.11 " 586.92 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 680.30 " 2,721.55 " Outpatient Clot factor ii prothrom spec 85210 68.00 25.13 11.03 55.64 17.48 32.58 13.24 33.60 11.03 12.98 46.50 12.24 33.23 11.03 13.89 48.97 11.68 12.98 44.51 55.64 12.85 13.24 12.98 54.40 11.88 51.00 51.00 53.72 34.01 11.42 27.81 51.00 25.85 30.42 13.24 53.72 Outpatient Blooc clot factor v test 85220 93.00 34.37 15.00 102.78 23.90 99.65 18.00 102.78 15.00 17.65 63.59 16.74 45.18 15.00 18.89 66.97 15.89 17.65 60.53 75.66 17.47 18.00 17.65 74.40 16.15 69.75 69.75 73.47 46.24 15.53 38.04 69.75 35.35 41.60 18.00 73.47 Outpatient Clot factor viii vw ristoctn 85245 120.00 44.35 19.50 133.65 30.84 129.58 23.40 133.65 19.50 22.94 82.06 21.60 58.73 19.50 24.55 86.41 20.65 22.94 78.67 98.34 22.71 23.40 22.94 96.00 20.99 90.00 90.00 94.80 60.10 20.19 49.08 90.00 45.61 53.68 23.40 94.80 Outpatient Clot factor ix ptc/chrstmas 85250 100.00 36.96 16.18 110.89 25.70 107.52 19.42 110.89 16.18 19.04 68.38 18.00 48.74 16.18 20.37 72.01 17.14 19.04 65.30 81.62 18.85 19.42 19.04 80.00 17.42 75.00 75.00 79.00 49.88 16.76 40.90 75.00 38.01 44.73 19.42 79.00 Outpatient Clot factor x stuart-power 85260 94.00 34.74 15.22 104.32 24.16 101.14 18.26 104.32 15.22 17.90 64.28 16.92 45.82 15.22 19.15 67.69 16.11 17.90 61.39 76.74 17.72 18.26 17.90 75.20 16.38 70.50 70.50 74.26 46.90 15.75 38.45 70.50 35.73 42.05 18.26 74.26 Outpatient Clot factor xi pta 85270 94.00 34.74 15.22 104.32 24.16 101.14 18.26 104.32 15.22 17.90 64.28 16.92 45.82 15.22 19.15 67.69 16.11 17.90 61.39 76.74 17.72 18.26 17.90 75.20 16.38 70.50 70.50 74.26 46.90 15.75 38.45 70.50 35.73 42.05 18.26 74.26 Outpatient Antithrombin iii activity 85300 62.00 22.92 10.07 50.94 15.93 49.39 12.09 50.94 10.07 11.85 42.40 11.16 30.34 10.07 12.68 44.65 10.67 11.85 40.64 50.80 11.73 12.09 11.85 49.60 10.84 46.50 46.50 48.98 31.05 10.43 25.36 46.50 23.57 27.73 12.09 48.98 Outpatient Clot inhibit prot c activity 85303 73.00 26.98 11.76 80.57 18.76 78.12 14.12 80.57 11.76 13.84 49.92 13.14 35.43 11.76 14.81 52.57 12.46 13.84 47.46 59.33 13.70 14.12 13.84 58.40 12.66 54.75 54.75 57.67 36.26 12.18 29.86 54.75 27.75 32.65 14.12 57.67 Outpatient Clot inhibit prot s total 85305 61.00 22.55 9.87 67.59 15.68 65.54 11.84 67.59 9.87 11.61 41.71 10.98 29.72 9.87 12.42 43.93 10.45 11.61 39.82 49.77 11.49 11.84 11.61 48.80 10.62 45.75 45.75 48.19 30.42 10.22 24.95 45.75 23.19 27.29 11.84 48.19 Outpatient Clot inhibit prot s free 85306 80.00 29.57 13.02 89.29 20.56 86.57 15.63 89.29 13.02 15.32 54.70 14.40 39.22 13.02 16.39 57.61 13.79 15.32 52.54 65.68 15.17 15.63 15.32 64.00 14.02 60.00 60.00 63.20 40.14 13.48 32.72 60.00 30.41 35.78 15.63 63.20 Outpatient Assay activated protein c 85307 80.00 29.57 13.02 89.29 20.56 86.57 15.63 89.29 13.02 15.32 54.70 14.40 39.22 13.02 16.39 57.61 13.79 15.32 52.54 65.68 15.17 15.63 15.32 64.00 14.02 60.00 60.00 63.20 40.14 13.48 32.72 60.00 30.41 35.78 15.63 63.20 Outpatient Coagulation time activated 85347 22.00 8.13 3.64 24.81 5.65 24.05 4.37 24.81 3.64 4.28 15.04 3.96 10.96 3.64 4.58 15.84 3.85 4.28 14.68 18.35 4.24 4.37 4.28 17.60 3.92 16.50 16.50 17.38 11.21 3.77 9.00 16.50 8.36 9.84 4.37 17.38 Outpatient Fibrin degradation quant 85379 53.00 19.59 8.65 47.18 13.62 45.75 10.38 47.18 8.65 10.18 36.24 9.54 26.06 8.65 10.89 38.17 9.16 10.18 34.91 43.64 10.08 10.38 10.18 42.40 9.31 39.75 39.75 41.87 26.67 8.96 21.68 39.75 20.15 23.71 10.38 41.87 Outpatient Fibrinogen activity 85384 51.00 18.85 8.26 49.45 13.11 47.94 9.91 49.45 8.26 9.72 34.87 9.18 24.88 8.26 10.40 36.73 8.75 9.72 33.33 41.67 9.62 9.91 9.72 40.80 8.89 38.25 38.25 40.29 25.47 8.55 20.86 38.25 19.39 22.81 9.91 40.29 Outpatient Clotting funct activity 85397 162.00 59.88 26.23 133.65 41.63 129.58 31.48 133.65 26.23 30.86 110.78 29.16 79.00 26.23 33.02 116.66 27.77 30.86 105.83 132.29 30.55 31.48 30.86 129.60 28.24 121.50 121.50 127.98 80.85 27.16 66.26 121.50 61.58 72.46 31.48 127.98 Outpatient Heparin assay 85520 69.00 25.50 11.13 56.12 17.73 32.58 13.35 33.60 11.13 13.09 47.18 12.42 33.51 11.13 14.01 49.69 11.78 13.09 44.89 56.12 12.96 13.35 13.09 55.20 11.98 51.75 51.75 54.51 34.30 11.52 28.22 51.75 26.23 30.86 13.35 54.51 Outpatient Muramidase 85549 98.00 36.22 15.94 84.55 25.19 81.97 19.13 84.55 15.94 18.75 67.01 17.64 48.00 15.94 20.06 70.57 16.88 18.75 64.30 80.38 18.56 19.13 18.75 78.40 17.16 73.50 73.50 77.42 49.13 16.50 40.08 73.50 37.25 43.84 19.13 77.42 Outpatient Blood platelet aggregation 85576 131.00 48.42 21.17 125.15 33.67 121.34 25.41 125.15 21.17 24.91 89.58 23.58 63.77 21.17 26.65 94.33 22.42 24.91 85.43 106.79 24.66 25.41 24.91 104.80 22.79 98.25 98.25 103.49 65.26 21.92 53.58 98.25 49.79 58.60 25.41 103.49 Outpatient Hexagnal phosph pltlt neutrl 85598 94.00 34.74 15.28 104.70 24.16 101.51 18.34 104.70 15.28 17.98 64.28 16.92 46.03 15.28 19.24 67.69 16.18 17.98 61.66 77.08 17.80 18.34 17.98 75.20 16.45 70.50 70.50 74.26 47.11 15.82 38.45 70.50 35.73 42.05 18.34 74.26 Outpatient Prothrombin time 85610 23.00 8.50 3.65 22.93 5.91 22.23 4.38 22.93 3.65 4.29 15.73 4.14 10.98 3.65 4.59 16.56 3.86 4.29 14.71 18.39 4.25 4.38 4.29 18.40 3.93 17.25 17.25 18.17 11.24 3.78 9.41 17.25 8.74 10.29 4.38 18.17 Outpatient Russell viper venom diluted 85613 50.00 18.48 8.14 55.77 12.85 54.07 9.77 55.77 8.14 9.58 34.19 9.00 24.52 8.14 10.25 36.01 8.62 9.58 32.85 41.07 9.48 9.77 9.58 40.00 8.77 37.50 37.50 39.50 25.10 8.43 20.45 37.50 19.01 22.37 9.77 39.50 Outpatient Rbc sed rate automated 85652 14.00 5.17 2.30 15.76 3.60 15.28 2.75 15.76 2.30 2.70 9.57 2.52 6.91 2.30 2.89 10.08 2.43 2.70 9.26 11.57 2.67 2.75 2.70 11.20 2.47 10.50 10.50 11.06 7.07 2.38 5.73 10.50 5.32 6.26 2.75 11.06 Outpatient Rbc sickle cell test 85660 29.00 10.72 4.68 29.98 7.45 29.06 5.62 29.98 4.68 5.51 19.83 5.22 14.11 4.68 5.90 20.88 4.96 5.51 18.90 23.62 5.45 5.62 5.51 23.20 5.04 21.75 21.75 22.91 14.44 4.85 11.86 21.75 11.02 12.97 5.62 22.91 Outpatient Thrombin time plasma 85670 30.00 11.09 4.90 33.60 7.71 32.58 5.89 33.60 4.90 5.77 20.51 5.40 14.77 4.90 6.17 21.60 5.19 5.77 19.79 24.74 5.71 5.89 5.77 24.00 5.28 22.50 22.50 23.70 15.12 5.08 12.27 22.50 11.40 13.42 5.89 23.70 Outpatient Thromboplastin time partial 85730 32.00 11.83 5.11 34.97 8.22 33.91 6.13 34.97 5.11 6.01 21.88 5.76 15.39 5.11 6.43 23.04 5.41 6.01 20.61 25.76 5.95 6.13 6.01 25.60 5.50 24.00 24.00 25.28 15.75 5.29 13.09 24.00 12.16 14.31 6.13 25.28 Outpatient Blood viscosity examination 85810 61.00 22.55 9.92 67.98 15.68 65.91 11.90 67.98 9.92 11.67 41.71 10.98 29.88 9.92 12.49 43.93 10.50 11.67 40.02 50.03 11.55 11.90 11.67 48.80 10.68 45.75 45.75 48.19 30.58 10.27 24.95 45.75 23.19 27.29 11.90 48.19 Outpatient Hematology procedure 85999 40.00 14.78 - 32.00 10.28 26.40 - 27.26 - - 27.35 7.20 26.77 - - 28.80 - - - - - - - 32.00 - 30.00 30.00 31.60 30.80 - 16.36 30.00 15.20 17.89 - 31.60 Outpatient Allg spec ige crude xtrc ea 86003 27.00 9.98 4.44 30.40 6.94 29.48 5.32 30.40 4.44 5.22 18.46 4.86 13.36 4.44 5.59 19.44 4.70 5.22 17.90 22.38 5.17 5.32 5.22 21.60 4.78 20.25 20.25 21.33 13.68 4.59 11.04 20.25 10.26 12.08 5.32 21.33 Outpatient Allg spec ige recomb ea 86008 94.00 34.74 15.24 76.86 24.16 62.03 18.29 64.05 15.24 17.93 64.28 16.92 45.90 15.24 19.19 67.69 16.14 17.93 61.49 76.86 17.75 18.29 17.93 75.20 16.41 70.50 70.50 74.26 46.98 15.78 38.45 70.50 35.73 42.05 18.29 74.26 Outpatient Wbc antibody identification 86021 79.00 29.20 12.79 64.52 20.30 49.39 15.35 50.94 12.79 15.05 54.02 14.22 38.53 12.79 16.10 56.89 13.55 15.05 51.61 64.52 14.90 15.35 15.05 63.20 13.77 59.25 59.25 62.41 39.43 13.24 32.31 59.25 30.03 35.34 15.35 62.41 Outpatient Antinuclear antibodies (ana) 86039 59.00 21.81 9.49 65.03 15.16 63.05 11.38 65.03 9.49 11.16 40.34 10.62 28.57 9.49 11.94 42.49 10.04 11.16 38.27 47.84 11.05 11.38 11.16 47.20 10.21 44.25 44.25 46.61 29.24 9.82 24.13 44.25 22.43 26.39 11.38 46.61 Outpatient C-reactive protein 86140 27.00 9.98 4.40 30.15 6.94 29.23 5.28 30.15 4.40 5.18 18.46 4.86 13.26 4.40 5.54 19.44 4.66 5.18 17.76 22.21 5.13 5.28 5.18 21.60 4.74 20.25 20.25 21.33 13.57 4.56 11.04 20.25 10.26 12.08 5.28 21.33 Outpatient C-reactive protein hs 86141 68.00 25.13 11.01 75.41 17.48 73.11 13.21 75.41 11.01 12.95 46.50 12.24 33.15 11.01 13.86 48.97 11.66 12.95 44.41 55.52 12.82 13.21 12.95 54.40 11.85 51.00 51.00 53.72 33.93 11.40 27.81 51.00 25.85 30.42 13.21 53.72 Outpatient Beta-2 glycoprotein antibody 86146 134.00 49.53 21.63 148.21 34.44 143.70 25.96 148.21 21.63 25.45 91.63 24.12 65.15 21.63 27.23 96.49 22.91 25.45 87.28 109.10 25.20 25.96 25.45 107.20 23.29 100.50 100.50 105.86 66.68 22.40 54.81 100.50 50.93 59.94 25.96 105.86 Outpatient Cardiolipin antibody ea ig 86147 134.00 49.53 21.63 148.21 34.44 143.70 25.96 148.21 21.63 25.45 91.63 24.12 65.15 21.63 27.23 96.49 22.91 25.45 87.28 109.10 25.20 25.96 25.45 107.20 23.29 100.50 100.50 105.86 66.68 22.40 54.81 100.50 50.93 59.94 25.96 105.86 Outpatient Anti-phospholipid antibody 86148 84.00 31.05 13.66 93.60 21.59 90.75 16.39 93.60 13.66 16.07 57.44 15.12 41.14 13.66 17.19 60.49 14.46 16.07 55.11 68.89 15.91 16.39 16.07 67.20 14.70 63.00 63.00 66.36 42.10 14.14 34.36 63.00 31.93 37.57 16.39 66.36 Outpatient Cell enumeration & id 86152 " 1,317.00 " 486.76 213.16 " 1,075.07 " 338.47 879.09 255.80 906.69 213.16 250.78 900.56 237.06 642.00 213.16 268.33 948.37 225.70 250.78 860.05 " 1,075.07 " 248.27 255.80 250.78 " 1,053.60 " 229.46 987.75 987.75 " 1,040.43 " 657.04 220.69 538.65 987.75 500.59 589.09 255.80 " 1,040.43 " Outpatient Cold agglutinin titer 86157 42.00 15.52 6.85 46.97 10.79 45.54 8.22 46.97 6.85 8.06 28.72 7.56 20.63 6.85 8.62 30.24 7.25 8.06 27.64 34.55 7.98 8.22 8.06 33.60 7.37 31.50 31.50 33.18 21.12 7.09 17.18 31.50 15.96 18.79 8.22 33.18 Outpatient Complement/function activity 86161 63.00 23.28 10.20 69.94 16.19 67.81 12.24 69.94 10.20 12.00 43.08 11.34 30.72 10.20 12.84 45.37 10.80 12.00 41.15 51.44 11.88 12.24 12.00 50.40 10.98 47.25 47.25 49.77 31.44 10.56 25.77 47.25 23.95 28.18 12.24 49.77 Outpatient Complement total (ch50) 86162 107.00 39.55 17.27 118.36 27.50 114.76 20.73 118.36 17.27 20.32 73.17 19.26 52.02 17.27 21.74 77.05 18.29 20.32 69.69 87.11 20.12 20.73 20.32 85.60 18.59 80.25 80.25 84.53 53.24 17.88 43.76 80.25 40.67 47.86 20.73 84.53 Outpatient Ccp antibody 86200 68.00 25.13 11.01 75.41 17.48 73.11 13.21 75.41 11.01 12.95 46.50 12.24 33.15 11.01 13.86 48.97 11.66 12.95 44.41 55.52 12.82 13.21 12.95 54.40 11.85 51.00 51.00 53.72 33.93 11.40 27.81 51.00 25.85 30.42 13.21 53.72 Outpatient Deoxyribonuclease antibody 86215 70.00 25.87 11.26 77.20 17.99 74.85 13.52 77.20 11.26 13.25 47.87 12.60 33.92 11.26 14.18 50.41 11.93 13.25 45.44 56.80 13.12 13.52 13.25 56.00 12.12 52.50 52.50 55.30 34.72 11.66 28.63 52.50 26.61 31.31 13.52 55.30 Outpatient Dna antibody native 86225 72.00 26.61 11.68 80.02 18.50 77.58 14.01 80.02 11.68 13.74 49.23 12.96 35.17 11.68 14.70 51.85 12.37 13.74 47.12 58.90 13.60 14.01 13.74 57.60 12.57 54.00 54.00 56.88 36.00 12.09 29.45 54.00 27.37 32.21 14.01 56.88 Outpatient Nuclear antigen antibody 86235 94.00 34.74 15.24 104.44 24.16 101.26 18.29 104.44 15.24 17.93 64.28 16.92 45.90 15.24 19.19 67.69 16.14 17.93 61.49 76.86 17.75 18.29 17.93 75.20 16.41 70.50 70.50 74.26 46.98 15.78 38.45 70.50 35.73 42.05 18.29 74.26 Outpatient Fluorescent antibody titer 86256 63.00 23.28 10.24 51.66 16.19 49.39 12.29 50.94 10.24 12.05 43.08 11.34 30.85 10.24 12.89 45.37 10.85 12.05 41.33 51.66 11.93 12.29 12.05 50.40 11.03 47.25 47.25 49.77 31.57 10.60 25.77 47.25 23.95 28.18 12.29 49.77 Outpatient Immunoassay tumor ca 19-9 86301 109.00 40.29 17.69 121.23 28.01 117.53 21.23 121.23 17.69 20.81 74.53 19.62 53.27 17.69 22.27 78.49 18.73 20.81 71.37 89.21 20.60 21.23 20.81 87.20 19.04 81.75 81.75 86.11 54.52 18.31 44.58 81.75 41.43 48.76 21.23 86.11 Outpatient Immunoassay tumor ca 125 86304 109.00 40.29 17.69 121.23 28.01 117.53 21.23 121.23 17.69 20.81 74.53 19.62 53.27 17.69 22.27 78.49 18.73 20.81 71.37 89.21 20.60 21.23 20.81 87.20 19.04 81.75 81.75 86.11 54.52 18.31 44.58 81.75 41.43 48.76 21.23 86.11 Outpatient Heterophile antibody screen 86308 27.00 9.98 4.40 30.15 6.94 29.23 5.28 30.15 4.40 5.18 18.46 4.86 13.26 4.40 5.54 19.44 4.66 5.18 17.76 22.21 5.13 5.28 5.18 21.60 4.74 20.25 20.25 21.33 13.57 4.56 11.04 20.25 10.26 12.08 5.28 21.33 Outpatient Immune complex assay 86332 128.00 47.31 20.71 141.98 32.90 137.66 24.86 141.98 20.71 24.37 87.53 23.04 62.39 20.71 26.08 92.17 21.93 24.37 83.58 104.47 24.13 24.86 24.37 102.40 22.30 96.00 96.00 101.12 63.85 21.45 52.35 96.00 48.65 57.25 24.86 101.12 Outpatient Immunofix e-phoresis serum 86334 117.00 43.24 18.99 130.15 30.07 126.19 22.79 130.15 18.99 22.34 80.00 21.06 57.19 18.99 23.90 84.25 20.11 22.34 76.62 95.77 22.12 22.79 22.34 93.60 20.44 87.75 87.75 92.43 58.53 19.66 47.85 87.75 44.47 52.33 22.79 92.43 Outpatient Immunfix e-phorsis/urine/csf 86335 154.00 56.92 24.95 170.97 39.58 165.77 29.94 170.97 24.95 29.35 105.31 27.72 75.14 24.95 31.40 110.90 26.42 29.35 100.66 125.82 29.06 29.94 29.35 123.20 26.86 115.50 115.50 121.66 76.90 25.83 62.99 115.50 58.54 68.88 29.94 121.66 Outpatient Inhibin a 86336 " 1,080.00 " 399.17 13.25 864.00 277.56 76.34 15.90 78.74 13.25 15.59 738.50 194.40 39.91 13.25 16.68 777.71 14.03 15.59 53.47 66.83 15.43 15.90 15.59 864.00 14.26 810.00 810.00 853.20 40.85 13.72 441.72 810.00 410.51 483.08 15.90 853.20 Outpatient Insulin antibodies 86337 112.00 41.40 18.20 91.78 28.78 78.83 21.84 81.30 18.20 21.41 76.59 20.16 54.81 18.20 22.91 80.65 19.27 21.41 73.43 91.78 21.20 21.84 21.41 89.60 19.59 84.00 84.00 88.48 56.09 18.84 45.81 84.00 42.57 50.10 21.84 88.48 Outpatient Intrinsic factor antibody 86340 79.00 29.20 12.82 87.79 20.30 85.12 15.38 87.79 12.82 15.08 54.02 14.22 38.60 12.82 16.14 56.89 13.57 15.08 51.72 64.65 14.93 15.38 15.08 63.20 13.80 59.25 59.25 62.41 39.51 13.27 32.31 59.25 30.03 35.34 15.38 62.41 Outpatient Cell function assay w/stim 86352 713.00 263.52 115.48 791.49 183.24 767.39 138.58 791.49 115.48 135.86 487.55 128.34 347.80 115.48 145.37 513.43 122.27 135.86 465.93 582.42 134.50 138.58 135.86 570.40 124.31 534.75 534.75 563.27 355.95 119.56 291.62 534.75 271.01 318.92 138.58 563.27 Outpatient B cells total count 86355 198.00 73.18 32.07 219.73 50.89 213.04 38.48 219.73 32.07 37.73 135.39 35.64 96.59 32.07 40.37 142.58 33.96 37.73 129.40 161.74 37.35 38.48 37.73 158.40 34.52 148.50 148.50 156.42 98.85 33.20 80.98 148.50 75.26 88.57 38.48 156.42 Outpatient Nk cells total count 86357 198.00 73.18 32.07 219.73 50.89 213.04 38.48 219.73 32.07 37.73 135.39 35.64 96.59 32.07 40.37 142.58 33.96 37.73 129.40 161.74 37.35 38.48 37.73 158.40 34.52 148.50 148.50 156.42 98.85 33.20 80.98 148.50 75.26 88.57 38.48 156.42 Outpatient T cells total count 86359 198.00 73.18 32.07 219.73 50.89 213.04 38.48 219.73 32.07 37.73 135.39 35.64 96.59 32.07 40.37 142.58 33.96 37.73 129.40 161.74 37.35 38.48 37.73 158.40 34.52 148.50 148.50 156.42 98.85 33.20 80.98 148.50 75.26 88.57 38.48 156.42 Outpatient T cell absolute count/ratio 86360 247.00 91.29 39.93 273.71 63.48 265.37 47.92 273.71 39.93 46.98 168.90 44.46 120.27 39.93 50.27 177.86 42.28 46.98 161.12 201.40 46.51 47.92 46.98 197.60 42.99 185.25 185.25 195.13 123.09 41.34 101.02 185.25 93.88 110.48 47.92 195.13 Outpatient T cell absolute count 86361 141.00 52.11 22.76 155.98 36.24 151.23 27.32 155.98 22.76 26.78 96.42 25.38 68.56 22.76 28.65 101.53 24.10 26.78 91.84 114.80 26.51 27.32 26.78 112.80 24.50 105.75 105.75 111.39 70.16 23.57 57.67 105.75 53.59 63.07 27.32 111.39 Outpatient Microsomal antibody each 86376 76.00 28.09 12.37 84.76 19.53 82.18 14.84 84.76 12.37 14.55 51.97 13.68 37.25 12.37 15.57 54.73 13.10 14.55 49.90 62.37 14.40 14.84 14.55 60.80 13.31 57.00 57.00 60.04 38.12 12.80 31.08 57.00 28.89 33.99 14.84 60.04 Outpatient Neutralization test viral 86382 89.00 32.89 14.37 98.51 22.87 95.51 17.25 98.51 14.37 16.91 60.86 16.02 43.29 14.37 18.09 64.09 15.22 16.91 57.99 72.49 16.74 17.25 16.91 71.20 15.47 66.75 66.75 70.31 44.30 14.88 36.40 66.75 33.83 39.81 17.25 70.31 Outpatient Particle agglut antbdy scrn 86403 61.00 22.55 9.81 59.35 15.68 57.55 11.77 59.35 9.81 11.54 41.71 10.98 29.54 9.81 12.35 43.93 10.39 11.54 39.58 49.47 11.42 11.77 11.54 48.80 10.56 45.75 45.75 48.19 30.23 10.16 24.95 45.75 23.19 27.29 11.77 48.19 Outpatient Rheumatoid factor quant 86431 30.00 11.09 4.82 33.05 7.71 32.04 5.78 33.05 4.82 5.67 20.51 5.40 14.52 4.82 6.07 21.60 5.10 5.67 19.45 24.31 5.61 5.78 5.67 24.00 5.19 22.50 22.50 23.70 14.86 4.99 12.27 22.50 11.40 13.42 5.78 23.70 Outpatient Tb ag response t-cell susp 86481 525.00 194.04 85.00 436.48 134.93 423.19 102.00 436.48 85.00 100.00 359.00 94.50 256.00 85.00 107.00 378.05 90.00 100.00 342.95 428.69 99.00 102.00 100.00 420.00 91.50 393.75 393.75 414.75 262.00 88.00 214.73 393.75 199.55 234.83 102.00 414.75 Outpatient Skin test candida 86485 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 63.16 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 64.64 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Tb intradermal test 86580 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 63.16 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 64.64 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Syphilis test non-trep qual 86592 22.00 8.13 3.63 24.85 5.65 24.09 4.36 24.85 3.63 4.27 15.04 3.96 10.93 3.63 4.57 15.84 3.84 4.27 14.64 18.31 4.23 4.36 4.27 17.60 3.91 16.50 16.50 17.38 11.19 3.76 9.00 16.50 8.36 9.84 4.36 17.38 Outpatient Syphilis test non-trep quant 86593 23.00 8.50 3.74 25.62 5.91 24.84 4.49 25.62 3.74 4.40 15.73 4.14 11.26 3.74 4.71 16.56 3.96 4.40 15.09 18.86 4.36 4.49 4.40 18.40 4.03 17.25 17.25 18.17 11.53 3.87 9.41 17.25 8.74 10.29 4.49 18.17 Outpatient Aspergillus antibody 86606 79.00 29.20 12.79 87.71 20.30 85.04 15.35 87.71 12.79 15.05 54.02 14.22 38.53 12.79 16.10 56.89 13.55 15.05 51.61 64.52 14.90 15.35 15.05 63.20 13.77 59.25 59.25 62.41 39.43 13.24 32.31 59.25 30.03 35.34 15.35 62.41 Outpatient Bacterium antibody 86609 68.00 25.13 10.95 75.07 17.48 72.78 13.14 75.07 10.95 12.88 46.50 12.24 32.97 10.95 13.78 48.97 11.59 12.88 44.17 55.22 12.75 13.14 12.88 54.40 11.79 51.00 51.00 53.72 33.75 11.33 27.81 51.00 25.85 30.42 13.14 53.72 Outpatient Bartonella antibody 86611 53.00 19.59 8.65 59.31 13.62 57.50 10.38 59.31 8.65 10.18 36.24 9.54 26.06 8.65 10.89 38.17 9.16 10.18 34.91 43.64 10.08 10.38 10.18 42.40 9.31 39.75 39.75 41.87 26.67 8.96 21.68 39.75 20.15 23.71 10.38 41.87 Outpatient Blastomyces antibody 86612 68.00 25.13 10.97 75.15 17.48 72.86 13.16 75.15 10.97 12.90 46.50 12.24 33.02 10.97 13.80 48.97 11.61 12.90 44.24 55.30 12.77 13.16 12.90 54.40 11.80 51.00 51.00 53.72 33.80 11.35 27.81 51.00 25.85 30.42 13.16 53.72 Outpatient Bordetella antibody 86615 69.00 25.50 11.21 76.86 17.73 74.52 13.45 76.86 11.21 13.19 47.18 12.42 33.77 11.21 14.11 49.69 11.87 13.19 45.24 56.54 13.06 13.45 13.19 55.20 12.07 51.75 51.75 54.51 34.56 11.61 28.22 51.75 26.23 30.86 13.45 54.51 Outpatient Lyme disease antibody 86617 81.00 29.94 13.17 90.23 20.82 87.48 15.80 90.23 13.17 15.49 55.39 14.58 39.65 13.17 16.57 58.33 13.94 15.49 53.12 66.40 15.34 15.80 15.49 64.80 14.17 60.75 60.75 63.99 40.58 13.63 33.13 60.75 30.79 36.23 15.80 63.99 Outpatient Lyme disease antibody 86618 89.00 32.89 14.48 99.23 22.87 96.21 17.37 99.23 14.48 17.03 60.86 16.02 43.60 14.48 18.22 64.09 15.33 17.03 58.40 73.01 16.86 17.37 17.03 71.20 15.58 66.75 66.75 70.31 44.62 14.99 36.40 66.75 33.83 39.81 17.37 70.31 Outpatient Chlamydia antibody 86631 62.00 22.92 10.05 50.90 15.93 49.35 12.06 50.90 10.05 11.82 42.40 11.16 30.26 10.05 12.65 44.65 10.64 11.82 40.54 50.67 11.70 12.06 11.82 49.60 10.82 46.50 46.50 48.98 30.97 10.40 25.36 46.50 23.57 27.73 12.06 48.98 Outpatient Coccidioides antibody 86635 60.00 22.18 9.75 66.83 15.42 64.79 11.70 66.83 9.75 11.47 41.03 10.80 29.36 9.75 12.27 43.21 10.32 11.47 39.34 49.17 11.36 11.70 11.47 48.00 10.50 45.00 45.00 47.40 30.05 10.09 24.54 45.00 22.81 26.84 11.70 47.40 Outpatient Q fever antibody 86638 64.00 23.65 10.30 70.63 16.45 68.48 12.36 70.63 10.30 12.12 43.76 11.52 31.03 10.30 12.97 46.09 10.91 12.12 41.57 51.96 12.00 12.36 12.12 51.20 11.09 48.00 48.00 50.56 31.75 10.67 26.18 48.00 24.33 28.63 12.36 50.56 Outpatient Cmv antibody igm 86645 88.00 32.52 14.32 98.12 22.62 95.14 17.19 98.12 14.32 16.85 60.17 15.84 43.14 14.32 18.03 63.37 15.17 16.85 57.79 72.23 16.68 17.19 16.85 70.40 15.42 66.00 66.00 69.52 44.15 14.83 35.99 66.00 33.45 39.36 17.19 69.52 Outpatient Diphtheria antibody 86648 404.00 149.32 12.93 323.20 103.83 85.91 15.51 88.60 12.93 15.21 276.26 72.72 38.94 12.93 16.27 290.92 13.69 15.21 52.16 65.20 15.06 15.51 15.21 323.20 13.92 303.00 303.00 319.16 39.85 13.38 165.24 303.00 153.56 180.71 15.51 319.16 Outpatient Enterovirus antibody 86658 68.00 25.13 11.08 75.88 17.48 73.57 13.29 75.88 11.08 13.03 46.50 12.24 33.36 11.08 13.94 48.97 11.73 13.03 44.69 55.86 12.90 13.29 13.03 54.40 11.92 51.00 51.00 53.72 34.14 11.47 27.81 51.00 25.85 30.42 13.29 53.72 Outpatient Epstein-barr nuclear antigen 86664 80.00 29.57 13.00 89.11 20.56 86.40 15.60 89.11 13.00 15.29 54.70 14.40 39.14 13.00 16.36 57.61 13.76 15.29 52.44 65.55 15.14 15.60 15.29 64.00 13.99 60.00 60.00 63.20 40.06 13.46 32.72 60.00 30.41 35.78 15.60 63.20 Outpatient Ehrlichia antibody 86666 53.00 19.59 8.65 59.31 13.62 57.50 10.38 59.31 8.65 10.18 36.24 9.54 26.06 8.65 10.89 38.17 9.16 10.18 34.91 43.64 10.08 10.38 10.18 42.40 9.31 39.75 39.75 41.87 26.67 8.96 21.68 39.75 20.15 23.71 10.38 41.87 Outpatient Fungus nes antibody 86671 64.00 23.65 10.41 71.39 16.45 69.22 12.50 71.39 10.41 12.25 43.76 11.52 31.36 10.41 13.11 46.09 11.03 12.25 42.01 52.51 12.13 12.50 12.25 51.20 11.21 48.00 48.00 50.56 32.10 10.78 26.18 48.00 24.33 28.63 12.50 50.56 Outpatient Herpes simplex nes antbdy 86694 76.00 28.09 12.23 83.86 19.53 81.31 14.68 83.86 12.23 14.39 51.97 13.68 36.84 12.23 15.40 54.73 12.95 14.39 49.35 61.69 14.25 14.68 14.39 60.80 13.17 57.00 57.00 60.04 37.70 12.66 31.08 57.00 28.89 33.99 14.68 60.04 Outpatient Histoplasma antibody 86698 72.00 26.61 11.72 72.80 18.50 70.59 14.07 72.80 11.72 13.79 49.23 12.96 35.30 11.72 14.76 51.85 12.41 13.79 47.29 59.12 13.65 14.07 13.79 57.60 12.62 54.00 54.00 56.88 36.13 12.14 29.45 54.00 27.37 32.21 14.07 56.88 Outpatient Hiv-2 antibody 86702 71.00 26.24 11.49 61.57 18.25 59.70 13.79 61.57 11.49 13.52 48.55 12.78 34.61 11.49 14.47 51.13 12.17 13.52 46.37 57.96 13.38 13.79 13.52 56.80 12.37 53.25 53.25 56.09 35.42 11.90 29.04 53.25 26.99 31.76 13.79 56.09 Outpatient Hiv-1/hiv-2 1 result antbdy 86703 72.00 26.61 11.65 79.85 18.50 77.42 13.98 79.85 11.65 13.71 49.23 12.96 35.10 11.65 14.67 51.85 12.34 13.71 47.02 58.77 13.57 13.98 13.71 57.60 12.54 54.00 54.00 56.88 35.92 12.06 29.45 54.00 27.37 32.21 13.98 56.88 Outpatient Hep b core antibody total 86704 63.00 23.28 10.24 70.20 16.19 68.06 12.29 70.20 10.24 12.05 43.08 11.34 30.85 10.24 12.89 45.37 10.85 12.05 41.33 51.66 11.93 12.29 12.05 50.40 11.03 47.25 47.25 49.77 31.57 10.60 25.77 47.25 23.95 28.18 12.29 49.77 Outpatient Hep b core antibody igm 86705 62.00 22.92 10.00 68.62 15.93 66.53 12.01 68.62 10.00 11.77 42.40 11.16 30.13 10.00 12.59 44.65 10.59 11.77 40.37 50.46 11.65 12.01 11.77 49.60 10.77 46.50 46.50 48.98 30.84 10.36 25.36 46.50 23.57 27.73 12.01 48.98 Outpatient Hep b surface antibody 86706 56.00 20.70 9.13 62.56 14.39 60.65 10.95 62.56 9.13 10.74 38.29 10.08 27.49 9.13 11.49 40.33 9.67 10.74 36.83 46.04 10.63 10.95 10.74 44.80 9.83 42.00 42.00 44.24 28.14 9.45 22.90 42.00 21.29 25.05 10.95 44.24 Outpatient Hepatitis be antibody 86707 61.00 22.55 9.83 67.38 15.68 65.33 11.80 67.38 9.83 11.57 41.71 10.98 29.62 9.83 12.38 43.93 10.41 11.57 39.68 49.60 11.45 11.80 11.57 48.80 10.59 45.75 45.75 48.19 30.31 10.18 24.95 45.75 23.19 27.29 11.80 48.19 Outpatient Hepatitis a antibody 86708 65.00 24.02 10.53 72.16 16.71 69.97 12.64 72.16 10.53 12.39 44.45 11.70 31.72 10.53 13.26 46.81 11.15 12.39 42.49 53.11 12.27 12.64 12.39 52.00 11.34 48.75 48.75 51.35 32.46 10.90 26.59 48.75 24.71 29.07 12.64 51.35 Outpatient Hepatitis a igm antibody 86709 59.00 21.81 9.57 65.59 15.16 63.59 11.49 65.59 9.57 11.26 40.34 10.62 28.83 9.57 12.05 42.49 10.13 11.26 38.62 48.27 11.15 11.49 11.26 47.20 10.30 44.25 44.25 46.61 29.50 9.91 24.13 44.25 22.43 26.39 11.49 46.61 Outpatient Mumps antibody 86735 69.00 25.50 11.09 76.01 17.73 73.69 13.31 76.01 11.09 13.05 47.18 12.42 33.41 11.09 13.96 49.69 11.75 13.05 44.75 55.94 12.92 13.31 13.05 55.20 11.94 51.75 51.75 54.51 34.19 11.48 28.22 51.75 26.23 30.86 13.31 54.51 Outpatient Mycoplasma antibody 86738 70.00 25.87 11.25 77.16 17.99 74.81 13.50 77.16 11.25 13.24 47.87 12.60 33.89 11.25 14.17 50.41 11.92 13.24 45.41 56.76 13.11 13.50 13.24 56.00 12.11 52.50 52.50 55.30 34.69 11.65 28.63 52.50 26.61 31.31 13.50 55.30 Outpatient Parvovirus antibody 86747 79.00 29.20 12.78 87.58 20.30 84.91 15.33 87.58 12.78 15.03 54.02 14.22 38.48 12.78 16.08 56.89 13.53 15.03 51.55 64.43 14.88 15.33 15.03 63.20 13.75 59.25 59.25 62.41 39.38 13.23 32.31 59.25 30.03 35.34 15.33 62.41 Outpatient Protozoa antibody nos 86753 65.00 24.02 10.53 72.16 16.71 69.97 12.64 72.16 10.53 12.39 44.45 11.70 31.72 10.53 13.26 46.81 11.15 12.39 42.49 53.11 12.27 12.64 12.39 52.00 11.34 48.75 48.75 51.35 32.46 10.90 26.59 48.75 24.71 29.07 12.64 51.35 Outpatient Rickettsia antibody 86757 102.00 37.70 16.45 112.73 26.21 109.30 19.74 112.73 16.45 19.35 69.75 18.36 49.54 16.45 20.70 73.45 17.42 19.35 66.36 82.95 19.16 19.74 19.35 81.60 17.71 76.50 76.50 80.58 50.70 17.03 41.72 76.50 38.77 45.62 19.74 80.58 Outpatient Rubeola antibody 86765 68.00 25.13 10.95 57.05 17.48 55.31 13.14 57.05 10.95 12.88 46.50 12.24 32.97 10.95 13.78 48.97 11.59 12.88 44.17 55.22 12.75 13.14 12.88 54.40 11.79 51.00 51.00 53.72 33.75 11.33 27.81 51.00 25.85 30.42 13.14 53.72 Outpatient Tetanus antibody 86774 78.00 28.83 12.58 86.21 20.05 83.59 15.10 86.21 12.58 14.80 53.34 14.04 37.89 12.58 15.84 56.17 13.32 14.80 50.76 63.45 14.65 15.10 14.80 62.40 13.54 58.50 58.50 61.62 38.78 13.02 31.90 58.50 29.65 34.89 15.10 61.62 Outpatient Toxoplasma antibody igm 86778 76.00 28.09 12.25 83.91 19.53 81.35 14.70 83.91 12.25 14.41 51.97 13.68 36.89 12.25 15.42 54.73 12.97 14.41 49.42 61.77 14.27 14.70 14.41 60.80 13.19 57.00 57.00 60.04 37.75 12.68 31.08 57.00 28.89 33.99 14.70 60.04 Outpatient Thyroglobulin antibody 86800 84.00 31.05 13.52 92.66 21.59 89.84 16.23 92.66 13.52 15.91 57.44 15.12 40.73 13.52 17.02 60.49 14.32 15.91 54.56 68.20 15.75 16.23 15.91 67.20 14.56 63.00 63.00 66.36 41.68 14.00 34.36 63.00 31.93 37.57 16.23 66.36 Outpatient Hla x-math non-cytotoxic 86825 575.00 212.52 93.07 469.37 147.78 453.62 111.68 467.86 93.07 109.49 393.19 103.50 280.29 93.07 117.15 414.06 98.54 109.49 375.50 469.37 108.40 111.68 109.49 460.00 100.18 431.25 431.25 454.25 286.86 96.35 235.18 431.25 218.56 257.20 111.68 454.25 Outpatient Hla x-match noncytotoxc addl 86826 192.00 70.96 31.05 156.60 49.34 151.23 37.26 155.98 31.05 36.53 131.29 34.56 93.52 31.05 39.09 138.26 32.88 36.53 125.28 156.60 36.16 37.26 36.53 153.60 33.42 144.00 144.00 151.68 95.71 32.15 78.53 144.00 72.98 85.88 37.26 151.68 Outpatient Hla class i&ii antibody qual 86828 337.00 124.56 54.56 275.18 86.61 223.52 65.47 230.54 54.56 64.19 230.44 60.66 164.33 54.56 68.68 242.67 57.77 64.19 220.14 275.18 63.55 65.47 64.19 269.60 58.73 252.75 252.75 266.23 168.18 56.49 137.83 252.75 128.09 150.74 65.47 266.23 Outpatient Hla class i/ii antibody qual 86829 337.00 124.56 54.56 275.18 86.61 167.63 65.47 172.89 54.56 64.19 230.44 60.66 164.33 54.56 68.68 242.67 57.77 64.19 220.14 275.18 63.55 65.47 64.19 269.60 58.73 252.75 252.75 266.23 168.18 56.49 137.83 252.75 128.09 150.74 65.47 266.23 Outpatient Hla class i high defin qual 86832 " 1,700.00 " 628.32 275.19 " 1,387.88 " 436.90 683.85 330.23 705.32 275.19 323.75 " 1,162.46 " 306.00 828.80 275.19 346.41 " 1,224.17 " 291.38 323.75 " 1,110.30 " " 1,387.88 " 320.51 330.23 323.75 " 1,360.00 " 296.23 " 1,275.00 " " 1,275.00 " " 1,343.00 " 848.23 284.90 695.30 " 1,275.00 " 646.17 760.41 330.23 " 1,343.00 " Outpatient Hla class ii high defin qual 86833 " 1,710.00 " 632.02 276.93 " 1,396.67 " 439.47 621.70 332.32 641.23 276.93 325.80 " 1,169.30 " 307.80 834.05 276.93 348.61 " 1,231.37 " 293.22 325.80 " 1,117.33 " " 1,396.67 " 322.54 332.32 325.80 " 1,368.00 " 298.11 " 1,282.50 " " 1,282.50 " " 1,350.90 " 853.60 286.70 699.39 " 1,282.50 " 649.97 764.88 332.32 " 1,350.90 " Outpatient Rbc antibody screen 86850 261.00 96.47 25.60 215.06 67.08 172.23 51.58 177.85 42.98 50.57 178.47 46.98 127.39 42.98 54.11 187.95 45.51 50.57 172.04 215.06 50.06 51.58 50.57 208.80 46.27 195.75 195.75 206.19 25.60 44.50 106.75 195.75 99.21 116.75 51.58 206.19 Outpatient Rbc antibody elution 86860 783.00 289.40 129.02 644.69 201.23 516.70 154.83 533.54 129.02 151.79 535.42 140.94 381.85 129.02 162.42 563.84 136.61 151.79 515.75 644.69 150.27 154.83 151.79 626.40 138.89 587.25 587.25 618.57 390.80 133.58 320.25 587.25 297.62 350.24 154.83 618.57 Outpatient Rbc antibody identification 86870 " 1,529.00 " 565.12 251.95 " 1,258.93 " 392.95 " 1,008.99 " 302.34 " 1,041.86 " 251.95 296.41 " 1,045.53 " 275.22 745.63 251.95 317.16 " 1,101.03 " 266.77 296.41 " 1,007.13 " " 1,258.93 " 293.45 302.34 296.41 " 1,223.20 " 271.22 " 1,146.75 " " 1,146.75 " " 1,207.91 " 763.10 260.84 625.36 " 1,146.75 " 581.17 683.92 302.34 " 1,207.91 " Outpatient Coombs test direct 86880 292.00 107.92 14.12 240.57 75.04 30.39 57.78 31.34 48.15 56.65 199.67 52.56 142.49 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 14.12 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Coombs test indirect titer 86886 783.00 289.40 13.57 644.69 201.23 29.23 154.83 30.15 129.02 151.79 535.42 140.94 381.85 129.02 162.42 563.84 136.61 151.79 515.75 644.69 150.27 154.83 151.79 626.40 138.89 587.25 587.25 618.57 13.57 133.58 320.25 587.25 297.62 350.24 154.83 618.57 Outpatient Blood typing serologic abo 86900 588.00 217.32 7.83 483.88 151.12 16.85 117.06 17.38 97.55 114.76 402.07 105.84 286.59 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 7.83 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Blood typing serologic rh(d) 86901 178.00 65.79 7.83 146.29 45.75 16.85 35.14 17.38 29.28 34.45 121.72 32.04 86.63 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 7.83 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Blood type antigen donor ea 86902 " 1,529.00 " 565.12 14.16 " 1,258.93 " 392.95 14.16 302.34 14.60 251.95 296.41 " 1,045.53 " 275.22 745.63 251.95 317.16 " 1,101.03 " 266.77 296.41 " 1,007.13 " " 1,258.93 " 293.45 302.34 296.41 " 1,223.20 " 271.22 " 1,146.75 " " 1,146.75 " " 1,207.91 " 16.64 260.84 625.36 " 1,146.75 " 581.17 683.92 302.34 " 1,207.91 " Outpatient Blood typing rbc antigens 86905 " 1,529.00 " 565.12 10.03 " 1,258.93 " 392.95 14.16 302.34 14.60 251.95 296.41 " 1,045.53 " 275.22 745.63 251.95 317.16 " 1,101.03 " 266.77 296.41 " 1,007.13 " " 1,258.93 " 293.45 302.34 296.41 " 1,223.20 " 271.22 " 1,146.75 " " 1,146.75 " " 1,207.91 " 10.03 260.84 625.36 " 1,146.75 " 581.17 683.92 302.34 " 1,207.91 " Outpatient Compatibility test spin 86920 783.00 289.40 129.02 644.69 201.23 516.70 154.83 533.54 129.02 151.79 535.42 140.94 381.85 129.02 162.42 563.84 136.61 151.79 515.75 644.69 150.27 154.83 151.79 626.40 138.89 587.25 587.25 618.57 390.80 133.58 320.25 587.25 297.62 350.24 154.83 618.57 Outpatient Compatibility test antiglob 86922 783.00 289.40 129.02 644.69 201.23 516.70 154.83 533.54 129.02 151.79 535.42 140.94 381.85 129.02 162.42 563.84 136.61 151.79 515.75 644.69 150.27 154.83 151.79 626.40 138.89 587.25 587.25 618.57 390.80 133.58 320.25 587.25 297.62 350.24 154.83 618.57 Outpatient Compatibility test electric 86923 783.00 289.40 129.02 644.69 201.23 516.70 154.83 533.54 129.02 151.79 535.42 140.94 381.85 129.02 162.42 563.84 136.61 151.79 515.75 644.69 150.27 154.83 151.79 626.40 138.89 587.25 587.25 618.57 390.80 133.58 320.25 587.25 297.62 350.24 154.83 618.57 Outpatient Blood product/irradiation 86945 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 86.63 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 88.66 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Rbc pretx incubatj w/chemicl 86970 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 86.63 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 88.66 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Split blood or products 86985 783.00 289.40 129.02 644.69 201.23 516.70 154.83 533.54 129.02 151.79 535.42 140.94 381.85 129.02 162.42 563.84 136.61 151.79 515.75 644.69 150.27 154.83 151.79 626.40 138.89 587.25 587.25 618.57 390.80 133.58 320.25 587.25 297.62 350.24 154.83 618.57 Outpatient Transfusion procedure 86999 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 63.16 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 64.64 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Specimen infect agnt concntj 87015 35.00 12.94 5.68 38.90 9.00 37.72 6.81 38.90 5.68 6.68 23.93 6.30 17.10 5.68 7.15 25.20 6.01 6.68 22.91 28.64 6.61 6.81 6.68 28.00 6.11 26.25 26.25 27.65 17.50 5.88 14.32 26.25 13.30 15.66 6.81 27.65 Outpatient Blood culture for bacteria 87040 54.00 19.96 8.77 60.16 13.88 58.33 10.53 60.16 8.77 10.32 36.93 9.72 26.42 8.77 11.04 38.89 9.29 10.32 35.39 44.24 10.22 10.53 10.32 43.20 9.44 40.50 40.50 42.66 27.04 9.08 22.09 40.50 20.53 24.15 10.53 42.66 Outpatient Feces culture aerobic bact 87045 50.00 18.48 8.02 55.00 12.85 53.32 9.63 55.00 8.02 9.44 34.19 9.00 24.17 8.02 10.10 36.01 8.50 9.44 32.37 40.47 9.35 9.63 9.44 40.00 8.64 37.50 37.50 39.50 24.73 8.31 20.45 37.50 19.01 22.37 9.63 39.50 Outpatient Stool cultr aerobic bact ea 87046 50.00 18.48 8.02 55.00 12.85 53.32 9.63 55.00 8.02 9.44 34.19 9.00 24.17 8.02 10.10 36.01 8.50 9.44 32.37 40.47 9.35 9.63 9.44 40.00 8.64 37.50 37.50 39.50 24.73 8.31 20.45 37.50 19.01 22.37 9.63 39.50 Outpatient Culture othr specimn aerobic 87070 45.00 16.63 7.33 50.17 11.57 48.65 8.79 50.17 7.33 8.62 30.77 8.10 22.07 7.33 9.22 32.40 7.76 8.62 29.56 36.95 8.53 8.79 8.62 36.00 7.89 33.75 33.75 35.55 22.58 7.59 18.41 33.75 17.10 20.13 8.79 35.55 Outpatient Cultr bacteria except blood 87075 50.00 18.48 8.05 55.13 12.85 53.45 9.66 55.13 8.05 9.47 34.19 9.00 24.24 8.05 10.13 36.01 8.52 9.47 32.48 40.60 9.38 9.66 9.47 40.00 8.67 37.50 37.50 39.50 24.81 8.33 20.45 37.50 19.01 22.37 9.66 39.50 Outpatient Culture anaerobe ident each 87076 42.00 15.52 6.87 37.36 10.79 36.23 8.24 37.36 6.87 8.08 28.72 7.56 20.68 6.87 8.65 30.24 7.27 8.08 27.71 34.64 8.00 8.24 8.08 33.60 7.39 31.50 31.50 33.18 21.17 7.11 17.18 31.50 15.96 18.79 8.24 33.18 Outpatient Culture aerobic identify 87077 42.00 15.52 6.87 37.36 10.79 36.23 8.24 37.36 6.87 8.08 28.72 7.56 20.68 6.87 8.65 30.24 7.27 8.08 27.71 34.64 8.00 8.24 8.08 33.60 7.39 31.50 31.50 33.18 21.17 7.11 17.18 31.50 15.96 18.79 8.24 33.18 Outpatient Urine culture/colony count 87086 42.00 15.52 6.86 47.01 10.79 45.58 8.23 47.01 6.86 8.07 28.72 7.56 20.66 6.86 8.63 30.24 7.26 8.07 27.68 34.60 7.99 8.23 8.07 33.60 7.38 31.50 31.50 33.18 21.14 7.10 17.18 31.50 15.96 18.79 8.23 33.18 Outpatient Urine bacteria culture 87088 42.00 15.52 6.88 47.18 10.79 45.75 8.25 47.18 6.88 8.09 28.72 7.56 20.71 6.88 8.66 30.24 7.28 8.09 27.74 34.68 8.01 8.25 8.09 33.60 7.40 31.50 31.50 33.18 21.20 7.12 17.18 31.50 15.96 18.79 8.25 33.18 Outpatient Skin fungi culture 87101 40.00 14.78 6.55 44.92 10.28 43.55 7.86 44.92 6.55 7.71 27.35 7.20 19.74 6.55 8.25 28.80 6.94 7.71 26.44 33.05 7.63 7.86 7.71 32.00 7.05 30.00 30.00 31.60 20.20 6.78 16.36 30.00 15.20 17.89 7.86 31.60 Outpatient Fungus isolation culture 87102 44.00 16.26 7.15 48.93 11.31 47.44 8.58 48.93 7.15 8.41 30.09 7.92 21.53 7.15 9.00 31.68 7.57 8.41 28.84 36.05 8.33 8.58 8.41 35.20 7.70 33.00 33.00 34.76 22.03 7.40 18.00 33.00 16.72 19.68 8.58 34.76 Outpatient Blood fungus culture 87103 107.00 39.55 17.39 87.71 27.50 50.92 20.87 52.52 17.39 20.46 73.17 19.26 52.38 17.39 21.89 77.05 18.41 20.46 70.17 87.71 20.26 20.87 20.46 85.60 18.72 80.25 80.25 84.53 53.61 18.00 43.76 80.25 40.67 47.86 20.87 84.53 Outpatient Fungi identification yeast 87106 54.00 19.96 8.77 60.16 13.88 58.33 10.53 60.16 8.77 10.32 36.93 9.72 26.42 8.77 11.04 38.89 9.29 10.32 35.39 44.24 10.22 10.53 10.32 43.20 9.44 40.50 40.50 42.66 27.04 9.08 22.09 40.50 20.53 24.15 10.53 42.66 Outpatient Fungi identification mold 87107 54.00 19.96 8.77 60.16 13.88 58.33 10.53 60.16 8.77 10.32 36.93 9.72 26.42 8.77 11.04 38.89 9.29 10.32 35.39 44.24 10.22 10.53 10.32 43.20 9.44 40.50 40.50 42.66 27.04 9.08 22.09 40.50 20.53 24.15 10.53 42.66 Outpatient Mycoplasma 87109 81.00 29.94 13.08 89.63 20.82 86.90 15.70 89.63 13.08 15.39 55.39 14.58 39.40 13.08 16.47 58.33 13.85 15.39 52.78 65.98 15.24 15.70 15.39 64.80 14.08 60.75 60.75 63.99 40.32 13.54 33.13 60.75 30.79 36.23 15.70 63.99 Outpatient Mycobacteria culture 87116 57.00 21.07 9.18 62.94 14.65 61.02 11.02 62.94 9.18 10.80 38.98 10.26 27.65 9.18 11.56 41.05 9.72 10.80 37.04 46.30 10.69 11.02 10.80 45.60 9.88 42.75 42.75 45.03 28.30 9.50 23.31 42.75 21.67 25.50 11.02 45.03 Outpatient Mycobacteric identification 87118 77.00 28.46 12.42 63.75 19.79 61.81 14.90 63.75 12.42 14.61 52.65 13.86 37.40 12.42 15.63 55.45 13.15 14.61 50.10 62.63 14.46 14.90 14.61 61.60 13.37 57.75 57.75 60.83 38.28 12.86 31.49 57.75 29.27 34.44 14.90 60.83 Outpatient Dna/rna amplified probe 87150 184.00 68.01 29.83 204.40 47.29 198.18 35.79 204.40 29.83 35.09 125.82 33.12 89.83 29.83 37.55 132.50 31.58 35.09 120.34 150.43 34.74 35.79 35.09 147.20 32.11 138.00 138.00 145.36 91.94 30.88 75.26 138.00 69.94 82.30 35.79 145.36 Outpatient Tissue homogenization cultr 87176 31.00 11.46 5.00 34.29 7.97 33.24 6.00 34.29 5.00 5.88 21.20 5.58 15.05 5.00 6.29 22.32 5.29 5.88 20.17 25.21 5.82 6.00 5.88 24.80 5.38 23.25 23.25 24.49 15.41 5.17 12.68 23.25 11.78 13.87 6.00 24.49 Outpatient Microbe susceptible diffuse 87181 25.00 9.24 4.04 27.67 6.43 26.83 4.85 27.67 4.04 4.75 17.10 4.50 12.16 4.04 5.08 18.00 4.28 4.75 16.29 20.36 4.70 4.85 4.75 20.00 4.35 18.75 18.75 19.75 12.45 4.18 10.23 18.75 9.50 11.18 4.85 19.75 Outpatient Microbe susceptible disk 87184 39.00 14.41 6.36 40.18 10.02 38.96 7.63 40.18 6.36 7.48 26.67 7.02 19.15 6.36 8.00 28.08 6.73 7.48 25.65 32.07 7.41 7.63 7.48 31.20 6.84 29.25 29.25 30.81 19.60 6.58 15.95 29.25 14.82 17.44 7.63 30.81 Outpatient Microbe susceptible enzyme 87185 25.00 9.24 4.04 27.67 6.43 26.83 4.85 27.67 4.04 4.75 17.10 4.50 12.16 4.04 5.08 18.00 4.28 4.75 16.29 20.36 4.70 4.85 4.75 20.00 4.35 18.75 18.75 19.75 12.45 4.18 10.23 18.75 9.50 11.18 4.85 19.75 Outpatient Smear gram stain 87205 22.00 8.13 3.63 24.85 5.65 24.09 4.36 24.85 3.63 4.27 15.04 3.96 10.93 3.63 4.57 15.84 3.84 4.27 14.64 18.31 4.23 4.36 4.27 17.60 3.91 16.50 16.50 17.38 11.19 3.76 9.00 16.50 8.36 9.84 4.36 17.38 Outpatient Smear fluorescent/acid stai 87206 28.00 10.35 4.58 27.07 7.20 26.25 5.50 27.07 4.58 5.39 19.15 5.04 13.80 4.58 5.77 20.16 4.85 5.39 18.49 23.11 5.34 5.50 5.39 22.40 4.93 21.00 21.00 22.12 14.12 4.74 11.45 21.00 10.64 12.52 5.50 22.12 Outpatient Smear complex stain 87209 94.00 34.74 15.28 104.70 24.16 101.51 18.34 104.70 15.28 17.98 64.28 16.92 46.03 15.28 19.24 67.69 16.18 17.98 61.66 77.08 17.80 18.34 17.98 75.20 16.45 70.50 70.50 74.26 47.11 15.82 38.45 70.50 35.73 42.05 18.34 74.26 Outpatient Smear wet mount saline/ink 87210 31.00 11.46 4.95 24.95 7.97 24.09 5.94 24.85 4.95 5.82 21.20 5.58 14.90 4.95 6.23 22.32 5.24 5.82 19.96 24.95 5.76 5.94 5.82 24.80 5.33 23.25 23.25 24.49 15.25 5.12 12.68 23.25 11.78 13.87 5.94 24.49 Outpatient Tissue exam for fungi 87220 22.00 8.13 3.63 20.11 5.65 19.50 4.36 20.11 3.63 4.27 15.04 3.96 10.93 3.63 4.57 15.84 3.84 4.27 14.64 18.31 4.23 4.36 4.27 17.60 3.91 16.50 16.50 17.38 11.19 3.76 9.00 16.50 8.36 9.84 4.36 17.38 Outpatient Aspergillus ag ia 87305 148.00 54.70 10.18 118.40 38.04 62.18 12.22 64.14 10.18 11.98 101.20 26.64 30.67 10.18 12.82 106.57 10.78 11.98 41.09 51.36 11.86 12.22 11.98 118.40 10.96 111.00 111.00 116.92 31.39 10.54 60.53 111.00 56.25 66.20 12.22 116.92 Outpatient Clostridium ag ia 87324 63.00 23.28 10.18 64.14 16.19 62.18 12.22 64.14 10.18 11.98 43.08 11.34 30.67 10.18 12.82 45.37 10.78 11.98 41.09 51.36 11.86 12.22 11.98 50.40 10.96 47.25 47.25 49.77 31.39 10.54 25.77 47.25 23.95 28.18 12.22 49.77 Outpatient Hpylori stool ag ia 87338 75.00 27.72 12.22 64.14 19.28 62.18 14.67 64.14 12.22 14.38 51.29 13.50 36.81 12.22 15.39 54.01 12.94 14.38 49.32 61.65 14.24 14.67 14.38 60.00 13.16 56.25 56.25 59.25 37.68 12.65 30.68 56.25 28.51 33.55 14.67 59.25 Outpatient Hepatitis b surface ag ia 87340 54.00 19.96 8.78 60.21 13.88 58.37 10.54 60.21 8.78 10.33 36.93 9.72 26.44 8.78 11.05 38.89 9.30 10.33 35.43 44.28 10.23 10.54 10.33 43.20 9.45 40.50 40.50 42.66 27.06 9.09 22.09 40.50 20.53 24.15 10.54 42.66 Outpatient Hep b surface ag neutrlzj ia 87341 54.00 19.96 8.78 60.21 13.88 58.37 10.54 60.21 8.78 10.33 36.93 9.72 26.44 8.78 11.05 38.89 9.30 10.33 35.43 44.28 10.23 10.54 10.33 43.20 9.45 40.50 40.50 42.66 27.06 9.09 22.09 40.50 20.53 24.15 10.54 42.66 Outpatient Hepatitis be ag ia 87350 61.00 22.55 9.80 67.17 15.68 65.12 11.76 67.17 9.80 11.53 41.71 10.98 29.52 9.80 12.34 43.93 10.38 11.53 39.54 49.43 11.41 11.76 11.53 48.80 10.55 45.75 45.75 48.19 30.21 10.15 24.95 45.75 23.19 27.29 11.76 48.19 Outpatient Histoplasma capsul ag ia 87385 530.00 195.89 11.26 424.00 136.21 62.18 13.52 64.14 11.26 13.25 362.41 95.40 33.92 11.26 14.18 381.65 11.93 13.25 45.44 56.80 13.12 13.52 13.25 424.00 12.12 397.50 397.50 418.70 34.72 11.66 216.77 397.50 201.45 237.07 13.52 418.70 Outpatient Hiv-1 ag w/hiv-1&-2 ab ag ia 87389 126.00 46.57 20.47 140.31 32.38 136.04 24.56 140.31 20.47 24.08 86.16 22.68 61.64 20.47 25.77 90.73 21.67 24.08 82.58 103.23 23.84 24.56 24.08 100.80 22.03 94.50 94.50 99.54 63.09 21.19 51.53 94.50 47.89 56.36 24.56 99.54 Outpatient Sarscov coronavirus ag ia 87426 237.00 87.60 - 189.60 60.91 156.40 - 161.49 - - 162.06 42.66 158.60 - - 170.66 - - - - - - - 189.60 - 177.75 177.75 187.23 182.49 - 96.93 177.75 90.08 106.01 - 187.23 Outpatient Strep a ag ia 87430 88.00 32.52 14.29 72.06 22.62 62.18 17.15 64.14 14.29 16.81 60.17 15.84 43.03 14.29 17.99 63.37 15.13 16.81 57.65 72.06 16.64 17.15 16.81 70.40 15.38 66.00 66.00 69.52 44.04 14.79 35.99 66.00 33.45 39.36 17.15 69.52 Outpatient Bartonella dna amp probe 87471 " 1,119.00 " 413.58 29.83 895.20 287.58 198.18 35.79 204.40 29.83 35.09 765.17 201.42 89.83 29.83 37.55 805.79 31.58 35.09 120.34 150.43 34.74 35.79 35.09 895.20 32.11 839.25 839.25 884.01 91.94 30.88 457.67 839.25 425.33 500.53 35.79 884.01 Outpatient Lyme dis dna amp probe 87476 " 1,297.00 " 479.37 29.83 " 1,037.60 " 333.33 198.18 35.79 204.40 29.83 35.09 886.89 233.46 89.83 29.83 37.55 933.97 31.58 35.09 120.34 150.43 34.74 35.79 35.09 " 1,037.60 " 32.11 972.75 972.75 " 1,024.63 " 91.94 30.88 530.47 972.75 492.99 580.15 35.79 " 1,024.63 " Outpatient C diff amplified probe 87493 196.00 72.44 31.68 204.40 50.37 198.18 38.02 204.40 31.68 37.27 134.02 35.28 95.41 31.68 39.88 141.14 33.54 37.27 127.82 159.77 36.90 38.02 37.27 156.80 34.10 147.00 147.00 154.84 97.65 32.80 80.16 147.00 74.50 87.67 38.02 154.84 Outpatient Cytomeg dna amp probe 87496 184.00 68.01 29.83 204.40 47.29 198.18 35.79 204.40 29.83 35.09 125.82 33.12 89.83 29.83 37.55 132.50 31.58 35.09 120.34 150.43 34.74 35.79 35.09 147.20 32.11 138.00 138.00 145.36 91.94 30.88 75.26 138.00 69.94 82.30 35.79 145.36 Outpatient Cytomeg dna quant 87497 225.00 83.16 36.41 249.54 57.83 241.94 43.70 249.54 36.41 42.84 153.86 40.50 109.67 36.41 45.84 162.02 38.56 42.84 146.92 183.65 42.41 43.70 42.84 180.00 39.20 168.75 168.75 177.75 112.24 37.70 92.03 168.75 85.52 100.64 43.70 177.75 Outpatient Nfct agent detection gi 87505 674.00 249.11 109.05 549.97 173.22 444.77 130.86 459.26 109.05 128.29 460.88 121.32 328.42 109.05 137.27 485.35 115.46 128.29 439.97 549.97 127.01 130.86 128.29 539.20 117.39 505.50 505.50 532.46 336.12 112.90 275.67 505.50 256.19 301.48 130.86 532.46 Outpatient Iadna-dna/rna probe tq 6-11 87506 " 1,381.00 " 510.42 223.54 " 1,127.41 " 354.92 911.32 268.25 941.01 223.54 262.99 944.33 248.58 673.25 223.54 281.40 994.46 236.69 262.99 901.92 " 1,127.41 " 260.36 268.25 262.99 " 1,104.80 " 240.64 " 1,035.75 " " 1,035.75 " " 1,090.99 " 689.03 231.43 564.83 " 1,035.75 " 524.92 617.72 268.25 " 1,090.99 " Outpatient Hepatitis b dna quant 87517 225.00 83.16 36.41 249.54 57.83 241.94 43.70 249.54 36.41 42.84 153.86 40.50 109.67 36.41 45.84 162.02 38.56 42.84 146.92 183.65 42.41 43.70 42.84 180.00 39.20 168.75 168.75 177.75 112.24 37.70 92.03 168.75 85.52 100.64 43.70 177.75 Outpatient Hepatitis c revrs trnscrpj 87522 225.00 83.16 36.41 249.54 57.83 241.94 43.70 249.54 36.41 42.84 153.86 40.50 109.67 36.41 45.84 162.02 38.56 42.84 146.92 183.65 42.41 43.70 42.84 180.00 39.20 168.75 168.75 177.75 112.24 37.70 92.03 168.75 85.52 100.64 43.70 177.75 Outpatient Hiv-1 quant&revrse trnscrpj 87536 447.00 165.21 72.34 495.70 114.88 480.61 86.80 495.70 72.34 85.10 305.66 80.46 217.86 72.34 91.06 321.88 76.59 85.10 291.85 364.82 84.25 86.80 85.10 357.60 77.87 335.25 335.25 353.13 222.96 74.89 182.82 335.25 169.90 199.94 86.80 353.13 Outpatient M.tuberculo dna amp probe 87556 219.00 80.94 35.43 204.40 56.28 198.18 42.51 204.40 35.43 41.68 149.75 39.42 106.70 35.43 44.60 157.70 37.51 41.68 142.94 178.68 41.26 42.51 41.68 175.20 38.14 164.25 164.25 173.01 109.20 36.68 89.57 164.25 83.24 97.96 42.51 173.01 Outpatient M.pneumon dna amp probe 87581 184.00 68.01 29.83 204.40 47.29 198.18 35.79 204.40 29.83 35.09 125.82 33.12 89.83 29.83 37.55 132.50 31.58 35.09 120.34 150.43 34.74 35.79 35.09 147.20 32.11 138.00 138.00 145.36 91.94 30.88 75.26 138.00 69.94 82.30 35.79 145.36 Outpatient Hpv high-risk types 87624 184.00 68.01 29.83 150.43 47.29 121.42 35.79 125.38 29.83 35.09 125.82 33.12 89.83 29.83 37.55 132.50 31.58 35.09 120.34 150.43 34.74 35.79 35.09 147.20 32.11 138.00 138.00 145.36 91.94 30.88 75.26 138.00 69.94 82.30 35.79 145.36 Outpatient Resp virus 3-5 targets 87631 749.00 276.83 121.24 747.34 192.49 724.58 145.48 747.34 121.24 142.63 512.17 134.82 365.13 121.24 152.61 539.35 128.37 142.63 489.15 611.44 141.20 145.48 142.63 599.20 130.51 561.75 561.75 591.71 373.69 125.51 306.34 561.75 284.69 335.03 145.48 591.71 Outpatient Resp virus 12-25 targets 87633 " 2,188.00 " 808.68 354.26 " 2,427.92 " 562.32 " 2,354.00 " 425.12 " 2,427.92 " 354.26 416.78 " 1,496.15 " 393.84 " 1,066.96 " 354.26 445.95 " 1,575.58 " 375.10 416.78 " 1,429.35 " " 1,786.69 " 412.61 425.12 416.78 " 1,750.40 " 381.35 " 1,641.00 " " 1,641.00 " " 1,728.52 " " 1,091.96 " 366.77 894.89 " 1,641.00 " 831.66 978.69 425.12 " 1,728.52 " Outpatient Mr-staph dna amp probe 87641 184.00 68.01 29.83 204.40 47.29 198.18 35.79 204.40 29.83 35.09 125.82 33.12 89.83 29.83 37.55 132.50 31.58 35.09 120.34 150.43 34.74 35.79 35.09 147.20 32.11 138.00 138.00 145.36 91.94 30.88 75.26 138.00 69.94 82.30 35.79 145.36 Outpatient Strep b dna amp probe 87653 184.00 68.01 29.83 204.40 47.29 198.18 35.79 204.40 29.83 35.09 125.82 33.12 89.83 29.83 37.55 132.50 31.58 35.09 120.34 150.43 34.74 35.79 35.09 147.20 32.11 138.00 138.00 145.36 91.94 30.88 75.26 138.00 69.94 82.30 35.79 145.36 Outpatient Trichomonas vaginalis amplif 87661 184.00 68.01 29.83 204.40 47.29 198.18 35.79 204.40 29.83 35.09 125.82 33.12 89.83 29.83 37.55 132.50 31.58 35.09 120.34 150.43 34.74 35.79 35.09 147.20 32.11 138.00 138.00 145.36 91.94 30.88 75.26 138.00 69.94 82.30 35.79 145.36 Outpatient Strep a assay w/optic 87880 87.00 32.16 14.05 70.86 22.36 62.18 16.86 64.14 14.05 16.53 59.49 15.66 42.32 14.05 17.69 62.65 14.88 16.53 56.69 70.86 16.36 16.86 16.53 69.60 15.12 65.25 65.25 68.73 43.31 14.55 35.58 65.25 33.07 38.92 16.86 68.73 Outpatient Agent nos assay w/optic 87899 84.00 31.05 13.66 68.89 21.59 62.18 16.39 64.14 13.66 16.07 57.44 15.12 41.14 13.66 17.19 60.49 14.46 16.07 55.11 68.89 15.91 16.39 16.07 67.20 14.70 63.00 63.00 66.36 42.10 14.14 34.36 63.00 31.93 37.57 16.39 66.36 Outpatient Genotype dna hiv reverse t 87901 " 1,352.00 " 499.70 218.83 " 1,499.71 " 347.46 " 1,454.05 " 262.60 " 1,499.71 " 218.83 257.45 924.50 243.36 659.07 218.83 275.47 973.58 231.71 257.45 882.92 " 1,103.66 " 254.88 262.60 257.45 " 1,081.60 " 235.57 " 1,014.00 " " 1,014.00 " " 1,068.08 " 674.52 226.56 552.97 " 1,014.00 " 513.90 604.75 262.60 " 1,068.08 " Outpatient Genotype dna/rna hep c 87902 " 1,352.00 " 499.70 218.83 " 1,499.71 " 347.46 " 1,454.05 " 262.60 " 1,499.71 " 218.83 257.45 924.50 243.36 659.07 218.83 275.47 973.58 231.71 257.45 882.92 " 1,103.66 " 254.88 262.60 257.45 " 1,081.60 " 235.57 " 1,014.00 " " 1,014.00 " " 1,068.08 " 674.52 226.56 552.97 " 1,014.00 " 513.90 604.75 262.60 " 1,068.08 " Outpatient Genotype dna/rna hiv 87906 676.00 249.85 109.42 749.90 173.73 727.07 131.30 749.90 109.42 128.73 462.25 121.68 329.55 109.42 137.74 486.79 115.86 128.73 441.48 551.85 127.44 131.30 128.73 540.80 117.79 507.00 507.00 534.04 337.27 113.28 276.48 507.00 256.95 302.37 131.30 534.04 Outpatient Cytopath cell enhance tech 88112 261.00 96.47 42.98 215.06 67.08 172.23 51.58 177.85 42.98 50.57 178.47 46.98 127.39 42.98 54.11 187.95 45.51 50.57 172.04 215.06 50.06 51.58 50.57 208.80 46.27 195.75 195.75 206.19 130.37 44.50 106.75 195.75 99.21 116.75 51.58 206.19 Outpatient Cytp urne 3-5 probes ea spec 88120 783.00 289.40 129.02 644.69 201.23 516.70 154.83 533.54 129.02 151.79 535.42 140.94 381.85 129.02 162.42 563.84 136.61 151.79 515.75 644.69 150.27 154.83 151.79 626.40 138.89 587.25 587.25 618.57 390.80 133.58 320.25 587.25 297.62 350.24 154.83 618.57 Outpatient Cytopath c/v thin layer 88142 106.00 39.18 17.22 118.02 27.24 114.43 20.67 118.02 17.22 20.26 72.48 19.08 51.87 17.22 21.68 76.33 18.23 20.26 69.48 86.85 20.06 20.67 20.26 84.80 18.54 79.50 79.50 83.74 53.08 17.83 43.35 79.50 40.29 47.41 20.67 83.74 Outpatient Cytp dx eval fna 1st ea site 88172 783.00 289.40 129.02 644.69 201.23 516.70 154.83 533.54 129.02 151.79 535.42 140.94 381.85 129.02 162.42 563.84 136.61 151.79 515.75 644.69 150.27 154.83 151.79 626.40 138.89 587.25 587.25 618.57 390.80 133.58 320.25 587.25 297.62 350.24 154.83 618.57 Outpatient Cytopath eval fna report 88173 261.00 96.47 42.98 215.06 67.08 172.23 51.58 177.85 42.98 50.57 178.47 46.98 127.39 42.98 54.11 187.95 45.51 50.57 172.04 215.06 50.06 51.58 50.57 208.80 46.27 195.75 195.75 206.19 130.37 44.50 106.75 195.75 99.21 116.75 51.58 206.19 Outpatient Cytopath c/v auto fluid redo 88175 140.00 51.74 22.62 154.06 35.98 149.37 27.14 154.06 22.62 26.61 95.73 25.20 68.12 22.62 28.47 100.81 23.95 26.61 91.26 114.07 26.34 27.14 26.61 112.00 24.35 105.00 105.00 110.60 69.72 23.42 57.26 105.00 53.21 62.62 27.14 110.60 Outpatient Flowcytometry/ tc 1 marker 88184 " 1,529.00 " 565.12 251.95 " 1,258.93 " 392.95 " 1,008.99 " 302.34 " 1,041.86 " 251.95 296.41 " 1,045.53 " 275.22 745.63 251.95 317.16 " 1,101.03 " 266.77 296.41 " 1,007.13 " " 1,258.93 " 293.45 302.34 296.41 " 1,223.20 " 271.22 " 1,146.75 " " 1,146.75 " " 1,207.91 " 763.10 260.84 625.36 " 1,146.75 " 581.17 683.92 302.34 " 1,207.91 " Outpatient Tissue culture lymphocyte 88230 612.00 226.20 99.02 678.67 157.28 658.01 118.82 678.67 99.02 116.49 418.49 110.16 298.21 99.02 124.64 440.70 104.84 116.49 399.50 499.38 115.33 118.82 116.49 489.60 106.59 459.00 459.00 483.48 305.20 102.51 250.31 459.00 232.62 273.75 118.82 483.48 Outpatient Tissue culture bone marrow 88237 755.00 279.05 122.19 735.81 194.04 713.40 146.63 735.81 122.19 143.75 516.27 135.90 368.00 122.19 153.81 543.68 129.38 143.75 492.99 616.24 142.31 146.63 143.75 604.00 131.53 566.25 566.25 596.45 376.63 126.50 308.80 566.25 286.98 337.71 146.63 596.45 Outpatient Chromosome analysis 15-20 88262 659.00 243.57 106.67 726.07 169.36 703.97 128.00 726.07 106.67 125.49 450.62 118.62 321.25 106.67 134.27 474.55 112.94 125.49 430.37 537.96 124.24 128.00 125.49 527.20 114.82 494.25 494.25 520.61 328.78 110.43 269.53 494.25 250.49 294.77 128.00 520.61 Outpatient Chromosome analysis 20-25 88264 759.00 280.53 122.92 726.07 195.06 703.97 147.50 726.07 122.92 144.61 519.00 136.62 370.20 122.92 154.73 546.56 130.15 144.61 495.94 619.93 143.16 147.50 144.61 607.20 132.32 569.25 569.25 599.61 378.88 127.26 310.43 569.25 288.50 339.50 147.50 599.61 Outpatient Cytogenetics 100-300 88275 269.00 99.42 43.51 231.86 69.13 224.80 52.21 231.86 43.51 51.19 183.94 48.42 131.05 43.51 54.77 193.71 46.07 51.19 175.56 219.45 50.68 52.21 51.19 215.20 46.84 201.75 201.75 212.51 134.12 45.05 110.02 201.75 102.25 120.32 52.21 212.51 Outpatient Surgical path gross 88300 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 63.16 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 64.64 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Tissue exam by pathologist 88302 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 63.16 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 64.64 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Tissue exam by pathologist 88304 261.00 96.47 42.98 215.06 67.08 172.23 51.58 177.85 42.98 50.57 178.47 46.98 127.39 42.98 54.11 187.95 45.51 50.57 172.04 215.06 50.06 51.58 50.57 208.80 46.27 195.75 195.75 206.19 130.37 44.50 106.75 195.75 99.21 116.75 51.58 206.19 Outpatient Tissue exam by pathologist 88305 261.00 96.47 42.98 215.06 67.08 172.23 51.58 177.85 42.98 50.57 178.47 46.98 127.39 42.98 54.11 187.95 45.51 50.57 172.04 215.06 50.06 51.58 50.57 208.80 46.27 195.75 195.75 206.19 130.37 44.50 106.75 195.75 99.21 116.75 51.58 206.19 Outpatient Tissue exam by pathologist 88307 " 1,529.00 " 565.12 251.95 " 1,258.93 " 392.95 " 1,008.99 " 302.34 " 1,041.86 " 251.95 296.41 " 1,045.53 " 275.22 745.63 251.95 317.16 " 1,101.03 " 266.77 296.41 " 1,007.13 " " 1,258.93 " 293.45 302.34 296.41 " 1,223.20 " 271.22 " 1,146.75 " " 1,146.75 " " 1,207.91 " 763.10 260.84 625.36 " 1,146.75 " 581.17 683.92 302.34 " 1,207.91 " Outpatient Tissue exam by pathologist 88309 " 3,445.00 " " 1,273.27 " 566.92 " 2,836.08 " 885.37 " 2,273.36 " 680.30 " 2,347.42 " 566.92 666.96 " 2,355.69 " 620.10 " 1,679.74 " 566.92 713.65 " 2,480.74 " 600.26 666.96 " 2,268.82 " " 2,836.08 " 660.29 680.30 666.96 " 2,756.00 " 610.27 " 2,583.75 " " 2,583.75 " " 2,721.55 " " 1,719.11 " 586.92 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 680.30 " 2,721.55 " Outpatient Special stains group 1 88312 261.00 96.47 42.98 215.06 67.08 172.23 51.58 177.85 42.98 50.57 178.47 46.98 127.39 42.98 54.11 187.95 45.51 50.57 172.04 215.06 50.06 51.58 50.57 208.80 46.27 195.75 195.75 206.19 130.37 44.50 106.75 195.75 99.21 116.75 51.58 206.19 Outpatient Special stains group 2 88313 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 86.63 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 88.66 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Enzyme histochemistry 88319 " 3,445.00 " " 1,273.27 " 566.92 " 2,836.08 " 885.37 " 2,273.36 " 680.30 " 2,347.42 " 566.92 666.96 " 2,355.69 " 620.10 " 1,679.74 " 566.92 713.65 " 2,480.74 " 600.26 666.96 " 2,268.82 " " 2,836.08 " 660.29 680.30 666.96 " 2,756.00 " 610.27 " 2,583.75 " " 2,583.75 " " 2,721.55 " " 1,719.11 " 586.92 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 680.30 " 2,721.55 " Outpatient Path consult intraop 1 bloc 88331 783.00 289.40 129.02 644.69 201.23 516.70 154.83 533.54 129.02 151.79 535.42 140.94 381.85 129.02 162.42 563.84 136.61 151.79 515.75 644.69 150.27 154.83 151.79 626.40 138.89 587.25 587.25 618.57 390.80 133.58 320.25 587.25 297.62 350.24 154.83 618.57 Outpatient Intraop cyto path consult 1 88333 " 3,445.00 " " 1,273.27 " 566.92 " 2,836.08 " 885.37 " 2,273.36 " 680.30 " 2,347.42 " 566.92 666.96 " 2,355.69 " 620.10 " 1,679.74 " 566.92 713.65 " 2,480.74 " 600.26 666.96 " 2,268.82 " " 2,836.08 " 660.29 680.30 666.96 " 2,756.00 " 610.27 " 2,583.75 " " 2,583.75 " " 2,721.55 " " 1,719.11 " 586.92 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 680.30 " 2,721.55 " Outpatient Immunohisto antibody slide 88344 " 1,529.00 " 565.12 251.95 " 1,258.93 " 392.95 " 1,008.99 " 302.34 " 1,041.86 " 251.95 296.41 " 1,045.53 " 275.22 745.63 251.95 317.16 " 1,101.03 " 266.77 296.41 " 1,007.13 " " 1,258.93 " 293.45 302.34 296.41 " 1,223.20 " 271.22 " 1,146.75 " " 1,146.75 " " 1,207.91 " 763.10 260.84 625.36 " 1,146.75 " 581.17 683.92 302.34 " 1,207.91 " Outpatient Immunofluor antb 1st stain 88346 " 1,529.00 " 565.12 251.95 " 1,258.93 " 392.95 " 1,008.99 " 302.34 " 1,041.86 " 251.95 296.41 " 1,045.53 " 275.22 745.63 251.95 317.16 " 1,101.03 " 266.77 296.41 " 1,007.13 " " 1,258.93 " 293.45 302.34 296.41 " 1,223.20 " 271.22 " 1,146.75 " " 1,146.75 " " 1,207.91 " 763.10 260.84 625.36 " 1,146.75 " 581.17 683.92 302.34 " 1,207.91 " Outpatient Electron microscopy 88348 " 3,445.00 " " 1,273.27 " 566.92 " 2,836.08 " 885.37 " 2,273.36 " 680.30 " 2,347.42 " 566.92 666.96 " 2,355.69 " 620.10 " 1,679.74 " 566.92 713.65 " 2,480.74 " 600.26 666.96 " 2,268.82 " " 2,836.08 " 660.29 680.30 666.96 " 2,756.00 " 610.27 " 2,583.75 " " 2,583.75 " " 2,721.55 " " 1,719.11 " 586.92 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 680.30 " 2,721.55 " Outpatient Tumor immunohistochem/manual 88360 783.00 289.40 129.02 644.69 201.23 516.70 154.83 533.54 129.02 151.79 535.42 140.94 381.85 129.02 162.42 563.84 136.61 151.79 515.75 644.69 150.27 154.83 151.79 626.40 138.89 587.25 587.25 618.57 390.80 133.58 320.25 587.25 297.62 350.24 154.83 618.57 Outpatient Insitu hybridization manual 88368 " 1,529.00 " 565.12 251.95 " 1,258.93 " 392.95 " 1,008.99 " 302.34 " 1,041.86 " 251.95 296.41 " 1,045.53 " 275.22 745.63 251.95 317.16 " 1,101.03 " 266.77 296.41 " 1,007.13 " " 1,258.93 " 293.45 302.34 296.41 " 1,223.20 " 271.22 " 1,146.75 " " 1,146.75 " " 1,207.91 " 763.10 260.84 625.36 " 1,146.75 " 581.17 683.92 302.34 " 1,207.91 " Outpatient Surgical pathology procedure 88399 261.00 96.47 42.98 215.06 67.08 172.23 51.58 177.85 42.98 50.57 178.47 46.98 127.39 42.98 54.11 187.95 45.51 50.57 172.04 215.06 50.06 51.58 50.57 208.80 46.27 195.75 195.75 206.19 130.37 44.50 106.75 195.75 99.21 116.75 51.58 206.19 Outpatient Bilirubin total transcut 88720 26.00 9.61 4.27 29.21 6.68 28.32 5.12 29.21 4.27 5.02 17.78 4.68 12.85 4.27 5.37 18.72 4.52 5.02 17.22 21.52 4.97 5.12 5.02 20.80 4.59 19.50 19.50 20.54 13.15 4.42 10.63 19.50 9.88 11.63 5.12 20.54 Outpatient Body fluid cell count 89051 29.00 10.72 4.76 32.07 7.45 31.09 5.71 32.07 4.76 5.60 19.83 5.22 14.34 4.76 5.99 20.88 5.04 5.60 19.21 24.01 5.54 5.71 5.60 23.20 5.12 21.75 21.75 22.91 14.67 4.93 11.86 21.75 11.02 12.97 5.71 22.91 Outpatient Leukocyte assessment fecal 89055 22.00 8.13 3.63 24.85 5.65 24.09 4.36 24.85 3.63 4.27 15.04 3.96 10.93 3.63 4.57 15.84 3.84 4.27 14.64 18.31 4.23 4.36 4.27 17.60 3.91 16.50 16.50 17.38 11.19 3.76 9.00 16.50 8.36 9.84 4.36 17.38 Outpatient Exam synovial fluid crystals 89060 38.00 14.04 6.23 41.68 9.77 40.41 7.48 41.68 6.23 7.33 25.98 6.84 18.76 6.23 7.84 27.36 6.60 7.33 25.14 31.42 7.26 7.48 7.33 30.40 6.71 28.50 28.50 30.02 19.20 6.45 15.54 28.50 14.44 17.00 7.48 30.02 Outpatient Collect sweat for test 89230 261.00 96.47 42.98 215.06 67.08 172.23 51.58 177.85 42.98 50.57 178.47 46.98 127.39 42.98 54.11 187.95 45.51 50.57 172.04 215.06 50.06 51.58 50.57 208.80 46.27 195.75 195.75 206.19 130.37 44.50 106.75 195.75 99.21 116.75 51.58 206.19 Outpatient Cultr oocyte/embryo <4 days 89250 " 1,553.00 " 573.99 129.02 " 1,242.40 " 399.12 " 1,024.82 " 154.83 " 1,058.21 " 129.02 151.79 " 1,061.94 " 279.54 381.85 129.02 162.42 " 1,118.32 " 136.61 151.79 515.75 644.69 150.27 154.83 151.79 " 1,242.40 " 138.89 " 1,164.75 " " 1,164.75 " " 1,226.87 " 390.80 133.58 635.18 " 1,164.75 " 590.30 694.66 154.83 " 1,226.87 " Outpatient Embryo hatching 89253 110.00 40.66 19.80 644.69 28.27 72.59 154.83 74.95 129.02 151.79 75.22 19.80 381.85 129.02 162.42 79.21 136.61 151.79 515.75 644.69 150.27 154.83 151.79 88.00 138.89 82.50 82.50 86.90 390.80 133.58 44.99 82.50 41.81 49.20 154.83 86.90 Outpatient Oocyte identification 89254 906.00 334.86 129.02 724.80 232.84 597.87 154.83 617.35 129.02 151.79 619.52 163.08 381.85 129.02 162.42 652.41 136.61 151.79 515.75 644.69 150.27 154.83 151.79 724.80 138.89 679.50 679.50 715.74 390.80 133.58 370.55 679.50 344.37 405.25 154.83 715.74 Outpatient Prepare embryo for transfer 89255 498.00 184.06 42.98 398.40 127.99 328.63 51.58 339.34 42.98 50.57 340.53 89.64 127.39 42.98 54.11 358.61 45.51 50.57 172.04 215.06 50.06 51.58 50.57 398.40 46.27 373.50 373.50 393.42 130.37 44.50 203.68 373.50 189.29 222.76 51.58 393.42 Outpatient Cryopreservation embryo(s) 89258 666.00 246.15 119.88 " 2,836.08 " 171.16 439.49 680.30 453.81 566.92 666.96 455.41 119.88 " 1,679.74 " 566.92 713.65 479.59 600.26 666.96 " 2,268.82 " " 2,836.08 " 660.29 680.30 666.96 532.80 610.27 499.50 499.50 526.14 " 1,719.11 " 586.92 272.39 499.50 253.15 297.90 680.30 526.14 Outpatient Cryopreservation sperm 89259 216.00 79.83 38.88 644.69 55.51 142.54 154.83 147.18 129.02 151.79 147.70 38.88 381.85 129.02 162.42 155.54 136.61 151.79 515.75 644.69 150.27 154.83 151.79 172.80 138.89 162.00 162.00 170.64 390.80 133.58 88.34 162.00 82.10 96.62 154.83 170.64 Outpatient Sperm isolation simple 89260 274.00 101.27 42.98 219.20 70.42 180.81 51.58 186.70 42.98 50.57 187.36 49.32 127.39 42.98 54.11 197.31 45.51 50.57 172.04 215.06 50.06 51.58 50.57 219.20 46.27 205.50 205.50 216.46 130.37 44.50 112.07 205.50 104.15 122.56 51.58 216.46 Outpatient Extended culture of oocytes 89272 " 2,357.00 " 871.15 424.26 " 2,836.08 " 605.75 " 1,555.38 " 680.30 " 1,606.06 " 566.92 666.96 " 1,611.72 " 424.26 " 1,679.74 " 566.92 713.65 " 1,697.28 " 600.26 666.96 " 2,268.82 " " 2,836.08 " 660.29 680.30 666.96 " 1,885.60 " 610.27 " 1,767.75 " " 1,767.75 " " 1,862.03 " " 1,719.11 " 586.92 964.01 " 1,767.75 " 895.90 " 1,054.29 " 680.30 " 1,862.03 " Outpatient Assist oocyte fertilization 89280 882.00 325.99 158.76 " 2,836.08 " 226.67 582.03 680.30 600.99 566.92 666.96 603.11 158.76 " 1,679.74 " 566.92 713.65 635.13 600.26 666.96 " 2,268.82 " " 2,836.08 " 660.29 680.30 666.96 705.60 610.27 661.50 661.50 696.78 " 1,719.11 " 586.92 360.74 661.50 335.25 394.52 680.30 696.78 Outpatient Assist oocyte fertilization 89281 992.00 366.64 129.02 793.60 254.94 654.62 154.83 675.95 129.02 151.79 678.33 178.56 381.85 129.02 162.42 714.34 136.61 151.79 515.75 644.69 150.27 154.83 151.79 793.60 138.89 744.00 744.00 783.68 390.80 133.58 405.73 744.00 377.06 443.72 154.83 783.68 Outpatient Semen analysis w/count 89310 102.00 37.70 7.32 81.60 26.21 48.60 8.78 50.13 7.32 8.61 69.75 18.36 22.04 7.32 9.21 73.45 7.75 8.61 29.53 36.91 8.52 8.78 8.61 81.60 7.88 76.50 76.50 80.58 22.56 7.58 41.72 76.50 38.77 45.62 8.78 80.58 Outpatient Semen anal strict criteria 89322 218.00 80.57 13.18 174.40 56.03 87.52 15.81 90.27 13.18 15.50 149.07 39.24 39.68 13.18 16.59 156.98 13.95 15.50 53.16 66.45 15.35 15.81 15.50 174.40 14.18 163.50 163.50 172.22 40.61 13.64 89.16 163.50 82.86 97.51 15.81 172.22 Outpatient Thawing cryopresrved embryo 89352 110.00 40.66 19.80 644.69 28.27 72.59 154.83 74.95 129.02 151.79 75.22 19.80 381.85 129.02 162.42 79.21 136.61 151.79 515.75 644.69 150.27 154.83 151.79 88.00 138.89 82.50 82.50 86.90 390.80 133.58 44.99 82.50 41.81 49.20 154.83 86.90 Outpatient Immunization admin 90471 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Immune admin oral/nasal 90473 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Psych diagnostic evaluation 90791 702.00 259.46 115.74 577.60 180.41 463.25 138.89 478.34 115.74 136.17 480.03 126.36 469.78 115.74 145.70 505.51 122.55 136.17 462.07 577.60 134.81 138.89 136.17 561.60 124.60 526.50 526.50 554.58 540.54 119.83 287.12 526.50 266.83 314.00 138.89 554.58 Outpatient Psych diag eval w/med srvcs 90792 702.00 259.46 115.74 577.60 180.41 463.25 138.89 478.34 115.74 136.17 480.03 126.36 469.78 115.74 145.70 505.51 122.55 136.17 462.07 577.60 134.81 138.89 136.17 561.60 124.60 526.50 526.50 554.58 540.54 119.83 287.12 526.50 266.83 314.00 138.89 554.58 Outpatient Psytx w pt 30 minutes 90832 702.00 259.46 115.74 577.60 180.41 463.25 138.89 478.34 115.74 136.17 520.00 126.36 469.78 115.74 145.70 505.51 122.55 136.17 462.07 577.60 134.81 138.89 136.17 561.60 124.60 526.50 526.50 554.58 540.54 119.83 287.12 526.50 266.83 314.00 138.89 554.58 Outpatient Psytx w pt 45 minutes 90834 702.00 259.46 115.74 577.60 180.41 463.25 138.89 478.34 115.74 136.17 520.00 126.36 469.78 115.74 145.70 505.51 122.55 136.17 462.07 577.60 134.81 138.89 136.17 561.60 124.60 526.50 526.50 554.58 540.54 119.83 287.12 526.50 266.83 314.00 138.89 554.58 Outpatient Psytx w pt 60 minutes 90837 702.00 259.46 115.74 577.60 180.41 463.25 138.89 478.34 115.74 136.17 480.03 126.36 469.78 115.74 145.70 505.51 122.55 136.17 462.07 577.60 134.81 138.89 136.17 561.60 124.60 526.50 526.50 554.58 540.54 119.83 287.12 526.50 266.83 314.00 138.89 554.58 Outpatient Family psytx w/o pt 50 min 90846 702.00 259.46 115.74 577.60 180.41 463.25 138.89 478.34 115.74 136.17 520.00 126.36 469.78 115.74 145.70 505.51 122.55 136.17 462.07 577.60 134.81 138.89 136.17 561.60 124.60 526.50 526.50 554.58 540.54 119.83 287.12 526.50 266.83 314.00 138.89 554.58 Outpatient Group psychotherapy 90853 393.00 145.25 64.73 323.61 101.00 259.34 77.67 267.79 64.73 76.15 268.73 70.74 263.00 64.73 81.48 283.00 68.54 76.15 258.88 323.61 75.39 77.67 76.15 314.40 69.68 294.75 294.75 310.47 302.61 67.01 160.74 294.75 149.38 175.79 77.67 310.47 Outpatient Hemodialysis one evaluation 90935 " 3,435.00 " " 1,269.58 " 566.59 " 2,828.27 " 882.80 " 2,266.76 " 679.91 " 2,340.61 " 566.59 666.58 " 2,348.85 " 618.30 " 2,298.70 " 566.59 713.24 " 2,473.54 " 599.92 666.58 " 2,262.57 " " 2,828.27 " 659.91 679.91 666.58 " 2,748.00 " 609.92 " 2,576.25 " " 2,576.25 " " 2,713.65 " " 2,644.95 " 586.59 " 1,404.92 " " 2,576.25 " " 1,305.64 " " 1,536.48 " 679.91 " 2,713.65 " Outpatient Dialysis one evaluation 90945 " 1,910.00 " 705.94 314.70 " 1,572.21 " 490.87 " 1,260.41 " 377.63 " 1,301.47 " 314.70 370.23 " 1,306.06 " 343.80 " 1,278.17 " 314.70 396.15 " 1,375.39 " 333.21 370.23 " 1,257.74 " " 1,572.21 " 366.53 377.63 370.23 " 1,528.00 " 338.76 " 1,432.50 " " 1,432.50 " " 1,508.90 " " 1,470.70 " 325.80 781.19 " 1,432.50 " 725.99 854.34 377.63 " 1,508.90 " Outpatient Esophagus motility study 91010 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Gastroesophageal reflux test 91034 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient G-esoph reflx tst w/electrod 91035 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Esoph imped function test 91037 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Esoph imped funct test > 1hr 91038 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Breath hydrogen/methane test 91065 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Gi trc img intral esoph-ile 91110 " 4,250.00 " " 1,570.80 " 699.98 " 3,499.31 " " 1,092.25 " " 2,804.58 " 839.98 " 2,895.95 " 699.98 823.51 " 2,906.15 " 765.00 " 2,844.10 " 699.98 881.16 " 3,060.43 " 741.16 823.51 " 2,799.40 " " 3,499.31 " 815.27 839.98 823.51 " 3,400.00 " 753.51 " 3,187.50 " " 3,187.50 " " 3,357.50 " " 3,272.50 " 724.69 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 839.98 " 3,357.50 " Outpatient Rectal sensation test 91120 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Anal pressure record 91122 " 1,397.00 " 516.33 230.20 " 1,150.34 " 359.03 921.88 276.24 951.92 230.20 270.82 955.27 251.46 934.87 230.20 289.78 " 1,005.98 " 243.74 270.82 920.26 " 1,150.34 " 268.11 276.24 270.82 " 1,117.60 " 247.80 " 1,047.75 " " 1,047.75 " " 1,103.63 " " 1,075.69 " 238.32 571.37 " 1,047.75 " 531.00 624.88 276.24 " 1,103.63 " Outpatient Liver elastography 91200 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 365.62 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Gastroenterology procedure 91299 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Eye exam new patient 92002 115.00 42.50 20.70 513.24 29.56 75.89 123.35 78.36 102.79 120.93 78.64 20.70 76.96 102.79 129.40 82.81 108.84 120.93 410.58 513.24 119.72 123.35 120.93 92.00 110.65 86.25 86.25 90.85 88.55 106.42 47.04 86.25 43.71 51.44 123.35 90.85 Outpatient Eye exam new patient 92004 115.00 42.50 20.70 513.24 29.56 75.89 123.35 78.36 102.79 120.93 78.64 20.70 76.96 102.79 129.40 82.81 108.84 120.93 410.58 513.24 119.72 123.35 120.93 92.00 110.65 86.25 86.25 90.85 88.55 106.42 47.04 86.25 43.71 51.44 123.35 90.85 Outpatient Eye exam establish patient 92012 115.00 42.50 20.70 513.24 29.56 75.89 123.35 78.36 102.79 120.93 78.64 20.70 76.96 102.79 129.40 82.81 108.84 120.93 410.58 513.24 119.72 123.35 120.93 92.00 110.65 86.25 86.25 90.85 88.55 106.42 47.04 86.25 43.71 51.44 123.35 90.85 Outpatient Eye exam&tx estab pt 1/>vst 92014 115.00 42.50 20.70 513.24 29.56 75.89 123.35 78.36 102.79 120.93 78.64 20.70 76.96 102.79 129.40 82.81 108.84 120.93 410.58 513.24 119.72 123.35 120.93 92.00 110.65 86.25 86.25 90.85 88.55 106.42 47.04 86.25 43.71 51.44 123.35 90.85 Outpatient Determine refractive state 92015 16.00 5.91 - 19.69 4.11 10.56 - 10.90 - - 10.94 2.88 10.71 - - 11.52 - - 15.75 19.69 - - 12.80 - 12.00 12.00 12.64 12.32 - 6.54 12.00 6.08 7.16 - 12.64 Outpatient New eye exam & treatment 92018 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Eye exam & treatment 92019 " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Special eye evaluation 92020 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Corneal topography 92025 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Special eye evaluation 92060 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Visual field examination(s) 92081 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Visual field examination(s) 92082 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Visual field examination(s) 92083 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Cmptr ophth dx img ant segmt 92132 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Cmptr ophth img optic nerve 92133 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Cptr ophth dx img post segmt 92134 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Ophthalmic biometry 92136 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Opscpy extnd rta draw uni/bi 92201 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Img rta detcj/mntr ds staff 92227 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 119.12 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 137.06 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Img rta detc/mntr ds phy/qhp 92228 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 119.12 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 137.06 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Fluorescein angrph uni/bi 92235 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Eye exam with photos 92250 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Full field erg w/i&r 92273 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Multifocal erg w/i&r 92274 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Eye photography 92285 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Internal eye photography 92286 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Contact lens fitting 92310 33.00 12.20 - 40.60 8.48 21.78 - 22.49 - - 22.57 5.94 22.08 - - 23.76 - - 32.48 40.60 - - 26.40 - 24.75 24.75 26.07 25.41 - 13.50 24.75 12.54 14.76 - 26.07 Outpatient Eye service or procedure 92499 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 87.00 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 100.10 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Ear and throat examination 92502 " 2,375.00 " 877.80 391.25 " 1,955.23 " 610.38 " 1,567.26 " 469.50 " 1,618.33 " 391.25 460.29 " 1,624.03 " 427.50 " 1,589.35 " 391.25 492.51 " 1,710.24 " 414.26 460.29 " 1,564.15 " " 1,955.23 " 455.69 469.50 460.29 " 1,900.00 " 421.17 " 1,781.25 " " 1,781.25 " " 1,876.25 " " 1,828.75 " 405.06 971.38 " 1,781.25 " 902.74 " 1,062.34 " 469.50 " 1,876.25 " Outpatient Speech/hearing therapy 92507 399.00 147.47 64.69 339.01 102.54 263.30 77.62 271.88 64.69 76.10 272.84 71.82 267.01 64.69 81.43 287.32 68.49 76.10 271.20 339.01 75.34 77.62 76.10 319.20 69.63 299.25 299.25 315.21 307.23 66.97 163.19 299.25 151.66 178.47 77.62 315.21 Outpatient Nasopharyngoscopy 92511 863.00 318.96 142.40 710.55 221.79 569.49 170.88 588.05 142.40 167.53 590.12 155.34 577.52 142.40 179.26 621.45 150.78 167.53 568.43 710.55 165.85 170.88 167.53 690.40 153.29 647.25 647.25 681.77 664.51 147.43 352.97 647.25 328.03 386.02 170.88 681.77 Outpatient Laryngeal function studies 92520 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Evaluate speech production 92522 585.00 216.22 94.18 468.00 150.35 386.04 113.02 398.62 94.18 110.80 400.02 105.30 391.48 94.18 118.56 421.26 99.72 110.80 315.75 394.69 109.69 113.02 110.80 468.00 101.38 438.75 438.75 462.15 450.45 97.50 239.27 438.75 222.36 261.67 113.02 462.15 Outpatient Speech sound lang comprehen 92523 " 1,201.00 " 443.89 191.50 960.80 308.66 792.54 229.80 818.36 191.50 225.29 821.24 216.18 803.71 191.50 241.06 864.84 202.76 225.29 661.55 826.94 223.04 229.80 225.29 960.80 206.14 900.75 900.75 948.79 924.77 198.26 491.21 900.75 456.50 537.21 229.80 948.79 Outpatient Behavral qualit analys voice 92524 573.00 211.78 92.80 458.40 147.26 378.12 111.36 390.44 92.80 109.18 391.82 103.14 383.45 92.80 116.82 412.62 98.26 109.18 308.83 386.04 108.09 111.36 109.18 458.40 99.90 429.75 429.75 452.67 441.21 96.08 234.36 429.75 217.80 256.30 111.36 452.67 Outpatient Oral function therapy 92526 441.00 162.99 71.66 372.75 113.34 291.02 85.99 300.50 71.66 84.30 301.56 79.38 295.12 71.66 90.20 317.56 75.87 84.30 298.20 372.75 83.46 85.99 84.30 352.80 77.13 330.75 330.75 348.39 339.57 74.18 180.37 330.75 167.62 197.26 85.99 348.39 Outpatient Caloric vstblr test w/rec 92537 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Basic vestibular evaluation 92540 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Tympanometry & reflex thresh 92550 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Pure tone hearing test air 92551 86.00 31.79 - 105.81 22.10 56.75 - 58.60 - - 58.81 15.48 57.55 - - 61.93 - - 84.65 105.81 - - 68.80 - 64.50 64.50 67.94 66.22 - 35.17 64.50 32.69 38.47 - 67.94 Outpatient Pure tone audiometry air 92552 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Audiometry air & bone 92553 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Speech threshold audiometry 92555 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 119.12 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 137.06 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Speech audiometry complete 92556 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Comprehensive hearing test 92557 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Evoked auditory test qual 92558 121.00 44.72 - 148.87 31.10 79.85 - 82.45 - - 82.74 21.78 80.97 - - 87.13 - - 119.10 148.87 - - 96.80 - 90.75 90.75 95.59 93.17 - 49.49 90.75 45.99 54.12 - 95.59 Outpatient Tympanometry 92567 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 119.12 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 137.06 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Acoustic refl threshold tst 92568 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 119.12 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 137.06 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Visual audiometry (vra) 92579 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Conditioning play audiometry 92582 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Select picture audiometry 92583 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Electrocochleography 92584 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Evoked auditory test limited 92587 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Evoked auditory tst complete 92588 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Hearing aid exam one ear 92590 203.00 75.03 - 249.76 52.17 133.96 - 138.32 - - 138.81 36.54 135.85 - - 146.18 - - 199.81 249.76 - - 162.40 - 152.25 152.25 160.37 156.31 - 83.03 152.25 77.16 90.80 - 160.37 Outpatient Hearing aid exam both ears 92591 229.00 84.64 - 281.75 58.85 151.12 - 156.04 - - 156.59 41.22 153.25 - - 164.90 - - 225.40 281.75 - - 183.20 - 171.75 171.75 180.91 176.33 - 93.66 171.75 87.04 102.43 - 180.91 Outpatient Hearing aid check one ear 92592 29.00 10.72 - 35.68 7.45 19.14 - 19.76 - - 19.83 5.22 19.41 - - 20.88 - - 28.54 35.68 - - 23.20 - 21.75 21.75 22.91 22.33 - 11.86 21.75 11.02 12.97 - 22.91 Outpatient Hearing aid check both ears 92593 58.00 21.44 - 71.36 14.91 38.27 - 39.52 - - 39.66 10.44 38.81 - - 41.77 - - 57.09 71.36 - - 46.40 - 43.50 43.50 45.82 44.66 - 23.72 43.50 22.05 25.94 - 45.82 Outpatient Electro hearng aid tst both 92595 129.00 47.68 - 158.71 33.15 85.13 - 87.90 - - 88.21 23.22 86.33 - - 92.89 - - 126.97 158.71 - - 103.20 - 96.75 96.75 101.91 99.33 - 52.76 96.75 49.03 57.70 - 101.91 Outpatient Oral speech device eval 92597 371.00 137.12 60.99 314.02 95.35 244.82 73.19 252.80 60.99 71.75 253.69 66.78 248.27 60.99 76.77 267.16 64.58 71.75 251.21 314.02 71.03 73.19 71.75 296.80 65.65 278.25 278.25 293.09 285.67 63.14 151.74 278.25 141.02 165.95 73.19 293.09 Outpatient Reprogram cochlear implt <7 92602 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Cochlear implt f/up exam 7/> 92603 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Reprogram cochlear implt 7/> 92604 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Ex for speech device rx 1hr 92607 650.00 240.24 104.30 548.89 167.05 428.94 125.15 442.91 104.30 122.70 444.47 117.00 434.98 104.30 131.29 468.07 110.43 122.70 439.11 548.89 121.47 125.15 122.70 520.00 112.27 487.50 487.50 513.50 500.50 107.98 265.85 487.50 247.07 290.75 125.15 513.50 Outpatient Evaluate swallowing function 92610 363.00 134.16 59.13 296.61 93.29 239.54 70.95 247.35 59.13 69.56 248.22 65.34 242.92 59.13 74.43 261.40 62.60 69.56 237.29 296.61 68.86 70.95 69.56 290.40 63.65 272.25 272.25 286.77 279.51 61.21 148.47 272.25 137.98 162.37 70.95 286.77 Outpatient Motion fluoroscopy/swallow 92611 477.00 176.30 77.12 389.38 122.59 314.77 92.54 325.03 77.12 90.73 326.17 85.86 319.21 77.12 97.08 343.49 81.66 90.73 311.50 389.38 89.82 92.54 90.73 381.60 83.02 357.75 357.75 376.83 367.29 79.84 195.09 357.75 181.31 213.36 92.54 376.83 Outpatient Endoscopy swallow (fees) vid 92612 344.00 127.14 56.30 280.79 88.41 227.01 67.55 234.40 56.30 66.23 235.23 61.92 230.20 56.30 70.87 247.71 59.61 66.23 224.63 280.79 65.57 67.55 66.23 275.20 60.60 258.00 258.00 271.76 264.88 58.28 140.70 258.00 130.75 153.87 67.55 271.76 Outpatient Eval aud funcj 1st hour 92626 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Aep scr auditory potential 92650 646.00 238.76 - 794.80 166.02 426.30 - 440.18 - - 441.73 116.28 432.30 - - 465.18 - - 635.84 794.80 - - 516.80 - 484.50 484.50 510.34 497.42 - 264.21 484.50 245.54 288.96 - 510.34 Outpatient Aep thrshld est mlt freq i&r 92652 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Ent procedure/service 92700 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 87.00 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 100.10 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Prq card stent w/angio 1 vsl 92928 " 52,725.00 " " 19,487.16 " " 8,689.37 " " 43,408.58 " " 13,550.33 " " 34,793.23 " " 10,427.25 " " 35,926.82 " " 8,689.37 " " 10,222.79 " " 36,053.36 " " 9,490.50 " " 35,283.57 " " 8,689.37 " " 10,938.39 " " 37,967.27 " " 9,200.51 " " 10,222.79 " " 34,726.27 " " 43,408.58 " " 10,120.56 " " 10,427.25 " " 10,222.79 " " 42,180.00 " " 9,353.85 " " 39,543.75 " " 39,543.75 " " 41,652.75 " " 40,598.25 " " 8,996.06 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,427.25 " " 41,652.75 " Outpatient Heart/lung resuscitation cpr 92950 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Cardioversion electric ext 92960 " 2,950.00 " " 1,090.32 " 485.97 " 2,428.74 " 758.15 " 1,946.71 " 583.16 " 2,010.13 " 485.97 571.73 " 2,017.21 " 531.00 " 1,974.14 " 485.97 611.75 " 2,124.30 " 514.56 571.73 " 1,942.96 " " 2,428.74 " 566.01 583.16 571.73 " 2,360.00 " 523.13 " 2,212.50 " " 2,212.50 " " 2,330.50 " " 2,271.50 " 503.12 " 1,206.55 " " 2,212.50 " " 1,121.30 " " 1,319.54 " 583.16 " 2,330.50 " Outpatient Electrocardiogram tracing 93005 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Cardiovascular stress test 93017 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Ecg monit/reprt up to 48 hrs 93225 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Ecg monit/reprt up to 48 hrs 93226 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Prgrmg dev eval impltbl sys 93260 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Interrogate subq defib 93261 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Remote 30 day ecg rev/report 93270 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Prgrmg dev eval pm/ldls pm 93279 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Pm device progr eval dual 93280 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Pm device progr eval multi 93281 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Prgrmg eval implantable dfb 93282 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Prgrmg eval implantable dfb 93283 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Prgrmg eval implantable dfb 93284 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Prgrmg dev eval scrms ip 93285 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Interrog evl pm/ldls pm ip 93288 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Interrog device eval heart 93289 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Interrog dev eval scrms ip 93291 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 87.00 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 100.10 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Pm phone r-strip device eval 93293 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Rem interrog evl pm/ids 93296 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Echo transthoracic 93303 " 2,535.00 " 936.94 418.00 " 2,087.21 " 651.50 " 1,672.85 " 501.60 " 1,727.35 " 418.00 491.76 " 1,733.43 " 456.30 " 1,696.42 " 418.00 526.18 " 1,825.45 " 442.58 491.76 " 1,669.74 " " 2,087.21 " 486.84 501.60 491.76 " 2,028.00 " 449.96 " 1,901.25 " " 1,901.25 " " 2,002.65 " " 1,951.95 " 432.75 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 501.60 " 2,002.65 " Outpatient Echo transthoracic 93304 " 2,535.00 " 936.94 418.00 " 2,087.21 " 651.50 " 1,672.85 " 501.60 " 1,727.35 " 418.00 491.76 " 1,733.43 " 456.30 " 1,696.42 " 418.00 526.18 " 1,825.45 " 442.58 491.76 " 1,669.74 " " 2,087.21 " 486.84 501.60 491.76 " 2,028.00 " 449.96 " 1,901.25 " " 1,901.25 " " 2,002.65 " " 1,951.95 " 432.75 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 501.60 " 2,002.65 " Outpatient Tte w/doppler complete 93306 " 2,535.00 " 936.94 418.00 " 2,087.21 " 651.50 " 1,672.85 " 501.60 " 1,727.35 " 418.00 491.76 " 1,733.43 " 456.30 " 1,696.42 " 418.00 526.18 " 1,825.45 " 442.58 491.76 " 1,669.74 " " 2,087.21 " 486.84 501.60 491.76 " 2,028.00 " 449.96 " 1,901.25 " " 1,901.25 " " 2,002.65 " " 1,951.95 " 432.75 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 501.60 " 2,002.65 " Outpatient Tte f-up or lmtd 93308 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 808.39 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 930.16 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Echo transesophageal 93315 " 2,535.00 " 936.94 418.00 " 2,087.21 " 651.50 " 1,672.85 " 501.60 " 1,727.35 " 418.00 491.76 " 1,733.43 " 456.30 " 1,696.42 " 418.00 526.18 " 1,825.45 " 442.58 491.76 " 1,669.74 " " 2,087.21 " 486.84 501.60 491.76 " 2,028.00 " 449.96 " 1,901.25 " " 1,901.25 " " 2,002.65 " " 1,951.95 " 432.75 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 501.60 " 2,002.65 " Outpatient Stress tte only 93350 " 2,535.00 " 936.94 418.00 " 2,087.21 " 651.50 " 1,672.85 " 501.60 " 1,727.35 " 418.00 491.76 " 1,733.43 " 456.30 " 1,696.42 " 418.00 526.18 " 1,825.45 " 442.58 491.76 " 1,669.74 " " 2,087.21 " 486.84 501.60 491.76 " 2,028.00 " 449.96 " 1,901.25 " " 1,901.25 " " 2,002.65 " " 1,951.95 " 432.75 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 501.60 " 2,002.65 " Outpatient Right heart cath 93451 " 15,220.00 " " 5,625.31 " " 2,508.53 " " 12,530.41 " " 3,911.54 " " 10,043.68 " " 3,010.23 " " 10,370.91 " " 2,508.53 " " 2,951.21 " " 10,407.44 " " 2,739.60 " " 10,185.22 " " 2,508.53 " " 3,157.79 " " 10,959.92 " " 2,656.09 " " 2,951.21 " " 10,024.16 " " 12,530.41 " " 2,921.70 " " 3,010.23 " " 2,951.21 " " 12,176.00 " " 2,700.36 " " 11,415.00 " " 11,415.00 " " 12,023.80 " " 11,719.40 " " 2,597.06 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 3,010.23 " " 12,023.80 " Outpatient Coronary artery angio s&i 93454 " 15,220.00 " " 5,625.31 " " 2,508.53 " " 12,530.41 " " 3,911.54 " " 10,043.68 " " 3,010.23 " " 10,370.91 " " 2,508.53 " " 2,951.21 " " 10,407.44 " " 2,739.60 " " 10,185.22 " " 2,508.53 " " 3,157.79 " " 10,959.92 " " 2,656.09 " " 2,951.21 " " 10,024.16 " " 12,530.41 " " 2,921.70 " " 3,010.23 " " 2,951.21 " " 12,176.00 " " 2,700.36 " " 11,415.00 " " 11,415.00 " " 12,023.80 " " 11,719.40 " " 2,597.06 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 3,010.23 " " 12,023.80 " Outpatient Coronary art/grft angio s&i 93455 " 15,220.00 " " 5,625.31 " " 2,508.53 " " 12,530.41 " " 3,911.54 " " 10,043.68 " " 3,010.23 " " 10,370.91 " " 2,508.53 " " 2,951.21 " " 10,407.44 " " 2,739.60 " " 10,185.22 " " 2,508.53 " " 3,157.79 " " 10,959.92 " " 2,656.09 " " 2,951.21 " " 10,024.16 " " 12,530.41 " " 2,921.70 " " 3,010.23 " " 2,951.21 " " 12,176.00 " " 2,700.36 " " 11,415.00 " " 11,415.00 " " 12,023.80 " " 11,719.40 " " 2,597.06 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 3,010.23 " " 12,023.80 " Outpatient R hrt coronary artery angio 93456 " 15,220.00 " " 5,625.31 " " 2,508.53 " " 12,530.41 " " 3,911.54 " " 10,043.68 " " 3,010.23 " " 10,370.91 " " 2,508.53 " " 2,951.21 " " 10,407.44 " " 2,739.60 " " 10,185.22 " " 2,508.53 " " 3,157.79 " " 10,959.92 " " 2,656.09 " " 2,951.21 " " 10,024.16 " " 12,530.41 " " 2,921.70 " " 3,010.23 " " 2,951.21 " " 12,176.00 " " 2,700.36 " " 11,415.00 " " 11,415.00 " " 12,023.80 " " 11,719.40 " " 2,597.06 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 3,010.23 " " 12,023.80 " Outpatient L hrt artery/ventricle angio 93458 " 15,220.00 " " 5,625.31 " " 2,508.53 " " 12,530.41 " " 3,911.54 " " 10,043.68 " " 3,010.23 " " 10,370.91 " " 2,508.53 " " 2,951.21 " " 10,407.44 " " 2,739.60 " " 10,185.22 " " 2,508.53 " " 3,157.79 " " 10,959.92 " " 2,656.09 " " 2,951.21 " " 10,024.16 " " 12,530.41 " " 2,921.70 " " 3,010.23 " " 2,951.21 " " 12,176.00 " " 2,700.36 " " 11,415.00 " " 11,415.00 " " 12,023.80 " " 11,719.40 " " 2,597.06 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 3,010.23 " " 12,023.80 " Outpatient R&l hrt art/ventricle angio 93460 " 15,220.00 " " 5,625.31 " " 2,508.53 " " 12,530.41 " " 3,911.54 " " 10,043.68 " " 3,010.23 " " 10,370.91 " " 2,508.53 " " 2,951.21 " " 10,407.44 " " 2,739.60 " " 10,185.22 " " 2,508.53 " " 3,157.79 " " 10,959.92 " " 2,656.09 " " 2,951.21 " " 10,024.16 " " 12,530.41 " " 2,921.70 " " 3,010.23 " " 2,951.21 " " 12,176.00 " " 2,700.36 " " 11,415.00 " " 11,415.00 " " 12,023.80 " " 11,719.40 " " 2,597.06 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 3,010.23 " " 12,023.80 " Outpatient Biopsy of heart lining 93505 " 15,024.00 " " 5,552.87 " " 2,476.44 " " 12,368.94 " " 3,861.17 " " 9,914.34 " " 2,971.73 " " 10,237.35 " " 2,476.44 " " 2,913.46 " " 10,273.41 " " 2,704.32 " " 10,054.06 " " 2,476.44 " " 3,117.40 " " 10,818.78 " " 2,622.11 " " 2,913.46 " " 9,894.99 " " 12,368.94 " " 2,884.33 " " 2,971.73 " " 2,913.46 " " 12,019.20 " " 2,665.82 " " 11,268.00 " " 11,268.00 " " 11,868.96 " " 11,568.48 " " 2,563.84 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,971.73 " " 11,868.96 " Outpatient Transcath closure of asd 93580 " 84,336.00 " " 31,170.59 " " 13,893.45 " " 69,433.38 " " 21,674.35 " " 55,653.33 " " 16,672.13 " " 57,466.55 " " 13,893.45 " " 16,345.23 " " 57,668.96 " " 15,180.48 " " 56,437.65 " " 13,893.45 " " 17,489.40 " " 60,730.35 " " 14,710.71 " " 16,345.23 " " 55,545.76 " " 69,433.38 " " 16,181.78 " " 16,672.13 " " 16,345.23 " " 67,468.80 " " 14,955.89 " " 63,252.00 " " 63,252.00 " " 66,625.44 " " 64,938.72 " " 14,383.80 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,672.13 " " 66,625.44 " Outpatient Electrophysiology evaluation 93620 " 31,912.00 " " 11,794.68 " " 5,258.30 " " 26,273.01 " " 8,201.38 " " 21,058.73 " " 6,309.96 " " 21,744.84 " " 5,258.30 " " 6,186.24 " " 21,821.43 " " 5,744.16 " " 21,355.51 " " 5,258.30 " " 6,619.28 " " 22,979.83 " " 5,567.62 " " 6,186.24 " " 21,018.05 " " 26,273.01 " " 6,124.38 " " 6,309.96 " " 6,186.24 " " 25,529.60 " " 5,660.41 " " 23,934.00 " " 23,934.00 " " 25,210.48 " " 24,572.24 " " 5,443.89 " " 13,052.01 " " 23,934.00 " " 12,129.75 " " 14,274.24 " " 6,309.96 " " 25,210.48 " Outpatient Compre ep eval tx svt 93653 " 112,688.00 " " 41,649.48 " " 18,563.41 " " 92,775.54 " " 28,960.82 " " 74,362.81 " " 22,276.10 " " 76,785.60 " " 18,563.41 " " 21,839.31 " " 77,056.05 " " 20,283.84 " " 75,410.81 " " 18,563.41 " " 23,368.06 " " 81,146.63 " " 19,655.38 " " 21,839.31 " " 74,219.17 " " 92,775.54 " " 21,620.92 " " 22,276.10 " " 21,839.31 " " 90,150.40 " " 19,982.97 " " 84,516.00 " " 84,516.00 " " 89,023.52 " " 86,769.76 " " 19,218.59 " " 46,089.39 " " 84,516.00 " " 42,832.71 " " 50,405.34 " " 22,276.10 " " 89,023.52 " Outpatient Compre ep eval tx vt 93654 " 112,688.00 " " 41,649.48 " " 18,563.41 " " 92,775.54 " " 28,960.82 " " 74,362.81 " " 22,276.10 " " 76,785.60 " " 18,563.41 " " 21,839.31 " " 77,056.05 " " 20,283.84 " " 75,410.81 " " 18,563.41 " " 23,368.06 " " 81,146.63 " " 19,655.38 " " 21,839.31 " " 74,219.17 " " 92,775.54 " " 21,620.92 " " 22,276.10 " " 21,839.31 " " 90,150.40 " " 19,982.97 " " 84,516.00 " " 84,516.00 " " 89,023.52 " " 86,769.76 " " 19,218.59 " " 46,089.39 " " 84,516.00 " " 42,832.71 " " 50,405.34 " " 22,276.10 " " 89,023.52 " Outpatient Compre ep eval abltj atr fib 93656 " 112,688.00 " " 41,649.48 " " 18,563.41 " " 92,775.54 " " 28,960.82 " " 74,362.81 " " 22,276.10 " " 76,785.60 " " 18,563.41 " " 21,839.31 " " 77,056.05 " " 20,283.84 " " 75,410.81 " " 18,563.41 " " 23,368.06 " " 81,146.63 " " 19,655.38 " " 21,839.31 " " 74,219.17 " " 92,775.54 " " 21,620.92 " " 22,276.10 " " 21,839.31 " " 90,150.40 " " 19,982.97 " " 84,516.00 " " 84,516.00 " " 89,023.52 " " 86,769.76 " " 19,218.59 " " 46,089.39 " " 84,516.00 " " 42,832.71 " " 50,405.34 " " 22,276.10 " " 89,023.52 " Outpatient Tilt table evaluation 93660 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Interrogation vad in person 93750 527.00 194.78 86.84 433.56 135.44 347.77 104.21 359.10 86.84 102.17 360.36 94.86 352.67 86.84 109.32 379.49 91.95 102.17 346.84 433.56 101.15 104.21 102.17 421.60 93.49 395.25 395.25 416.33 405.79 89.91 215.54 395.25 200.31 235.73 104.21 416.33 Outpatient Cardiac rehab 93797 609.00 225.09 100.42 501.63 156.51 401.88 120.50 414.97 100.42 118.14 416.43 109.62 407.54 100.42 126.41 438.54 106.33 118.14 401.30 501.63 116.96 120.50 118.14 487.20 108.10 456.75 456.75 481.11 468.93 103.96 249.08 456.75 231.48 272.41 120.50 481.11 Outpatient Cardiac rehab/monitor 93798 609.00 225.09 100.42 501.63 156.51 401.88 120.50 414.97 100.42 118.14 416.43 109.62 407.54 100.42 126.41 438.54 106.33 118.14 401.30 501.63 116.96 120.50 118.14 487.20 108.10 456.75 456.75 481.11 468.93 103.96 249.08 456.75 231.48 272.41 120.50 481.11 Outpatient Extracranial bilat study 93880 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 930.16 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Extracranial uni/ltd study 93882 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Intracranial complete study 93886 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 930.16 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Intracranial limited study 93888 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Tcd emboli detect w/o inj 93892 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 382.78 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Tcd emboli detect w/inj 93893 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 382.78 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Upr/l xtremity art 2 levels 93922 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 286.59 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Upr/lxtr art stdy 3+ lvls 93923 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 357.25 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Lower extremity study 93925 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 930.16 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Lower extremity study 93926 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Upper extremity study 93930 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 930.16 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Upper extremity study 93931 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Extremity study 93970 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 930.16 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Extremity study 93971 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Vascular study 93975 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 930.16 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Vascular study 93976 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Vascular study 93978 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 930.16 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Vascular study 93979 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Dup-scan hemo compl bi std 93985 " 1,208.00 " 446.48 199.05 994.70 310.46 797.16 238.86 823.13 199.05 234.18 826.03 217.44 589.13 199.05 250.57 869.88 210.76 234.18 795.74 994.70 231.84 238.86 234.18 966.40 214.27 906.00 906.00 954.32 930.16 206.08 494.07 906.00 459.16 540.34 238.86 954.32 Outpatient Dup-scan hemo compl uni std 93986 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Doppler flow testing 93990 572.00 211.41 94.18 471.00 147.00 377.46 113.02 389.76 94.18 110.80 391.13 102.96 278.96 94.18 118.56 411.90 99.72 110.80 376.79 471.00 109.69 113.02 110.80 457.60 101.38 429.00 429.00 451.88 440.44 97.50 233.95 429.00 217.42 255.86 113.02 451.88 Outpatient Vent mgmt inpat init day 94002 " 2,548.00 " 941.74 421.44 " 2,097.45 " 654.84 " 1,681.43 " 505.73 " 1,736.21 " 421.44 495.81 " 1,742.32 " 458.64 " 1,705.12 " 421.44 530.52 " 1,834.81 " 446.23 495.81 " 1,677.93 " " 2,097.45 " 490.85 505.73 495.81 " 2,038.40 " 453.67 " 1,911.00 " " 1,911.00 " " 2,012.92 " " 1,961.96 " 436.31 " 1,042.13 " " 1,911.00 " 968.49 " 1,139.72 " 505.73 " 2,012.92 " Outpatient Vent mgmt inpat subq day 94003 " 2,548.00 " 941.74 421.44 " 2,097.45 " 654.84 " 1,681.43 " 505.73 " 1,736.21 " 421.44 495.81 " 1,742.32 " 458.64 " 1,705.12 " 421.44 530.52 " 1,834.81 " 446.23 495.81 " 1,677.93 " " 2,097.45 " 490.85 505.73 495.81 " 2,038.40 " 453.67 " 1,911.00 " " 1,911.00 " " 2,012.92 " " 1,961.96 " 436.31 " 1,042.13 " " 1,911.00 " 968.49 " 1,139.72 " 505.73 " 2,012.92 " Outpatient Breathing capacity test 94010 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Evaluation of wheezing 94060 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Evaluation of wheezing 94070 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Vital capacity test 94150 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Exercise tst brncspsm w/ecg 94617 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Pulmonary stress testing 94618 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Airway inhalation treatment 94640 986.00 364.43 162.61 812.08 253.40 650.66 195.13 671.86 162.61 191.30 674.23 177.48 659.83 162.61 204.69 710.02 172.17 191.30 649.65 812.08 189.39 195.13 191.30 788.80 175.04 739.50 739.50 778.94 759.22 168.34 403.27 739.50 374.78 441.04 195.13 778.94 Outpatient Aerosol inhalation treatment 94642 986.00 364.43 162.61 812.08 253.40 650.66 195.13 671.86 162.61 191.30 674.23 177.48 659.83 162.61 204.69 710.02 172.17 191.30 649.65 812.08 189.39 195.13 191.30 788.80 175.04 739.50 739.50 778.94 759.22 168.34 403.27 739.50 374.78 441.04 195.13 778.94 Outpatient Cbt 1st hour 94644 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Pos airway pressure cpap 94660 986.00 364.43 162.61 812.08 253.40 650.66 195.13 671.86 162.61 191.30 674.23 177.48 659.83 162.61 204.69 710.02 172.17 191.30 649.65 812.08 189.39 195.13 191.30 788.80 175.04 739.50 739.50 778.94 759.22 168.34 403.27 739.50 374.78 441.04 195.13 778.94 Outpatient Evaluate pt use of inhaler 94664 986.00 364.43 162.61 812.08 253.40 650.66 195.13 671.86 162.61 191.30 674.23 177.48 659.83 162.61 204.69 710.02 172.17 191.30 649.65 812.08 189.39 195.13 191.30 788.80 175.04 739.50 739.50 778.94 759.22 168.34 403.27 739.50 374.78 441.04 195.13 778.94 Outpatient Chest wall manipulation 94667 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Mechanical chest wall oscill 94669 986.00 364.43 162.61 812.08 253.40 650.66 195.13 671.86 162.61 191.30 674.23 177.48 659.83 162.61 204.69 710.02 172.17 191.30 649.65 812.08 189.39 195.13 191.30 788.80 175.04 739.50 739.50 778.94 759.22 168.34 403.27 739.50 374.78 441.04 195.13 778.94 Outpatient Exhaled air analysis o2 94680 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Pulm funct tst plethysmograp 94726 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Pulm function test by gas 94727 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Airwy resist by oscillometry 94728 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Measure blood oxygen level 94762 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Pulmonary service/procedure 94799 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Percut allergy skin tests 95004 95.00 35.11 17.10 " 3,975.74 " 24.42 62.69 955.07 64.73 795.89 936.34 64.96 17.10 63.57 795.89 " 1,001.88 " 68.41 842.71 936.34 " 3,180.54 " " 3,975.74 " 926.98 955.07 936.34 76.00 856.75 71.25 71.25 75.05 73.15 823.98 38.86 71.25 36.11 42.49 955.07 75.05 Outpatient Perq & icut allg test venoms 95017 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 87.00 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 100.10 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Perq&ic allg test drugs/biol 95018 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 119.12 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 137.06 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Icut allergy test drug/bug 95024 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Allergy patch tests 95044 95.00 35.11 17.10 " 3,975.74 " 24.42 62.69 955.07 64.73 795.89 936.34 64.96 17.10 63.57 795.89 " 1,001.88 " 68.41 842.71 936.34 " 3,180.54 " " 3,975.74 " 926.98 955.07 936.34 76.00 856.75 71.25 71.25 75.05 73.15 823.98 38.86 71.25 36.11 42.49 955.07 75.05 Outpatient Ingest challenge ini 120 min 95076 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Immunotherapy one injection 95115 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Immunotherapy injections 95117 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Antigen therapy services 95145 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Antigen therapy services 95146 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Antigen therapy services 95147 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Antigen therapy services 95165 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Rapid desensitization 95180 " 1,419.00 " 524.46 234.79 " 1,167.95 " 364.68 936.40 281.74 966.91 234.79 276.22 970.31 255.42 949.59 234.79 295.56 " 1,021.82 " 248.60 276.22 934.35 " 1,167.95 " 273.46 281.74 276.22 " 1,135.20 " 252.74 " 1,064.25 " " 1,064.25 " " 1,121.01 " " 1,092.63 " 243.07 580.37 " 1,064.25 " 539.36 634.72 281.74 " 1,121.01 " Outpatient Cont gluc mntr pt prov eqp 95249 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Cont gluc mntr phys/qhp eqp 95250 623.00 230.26 102.79 513.24 160.11 411.12 123.35 424.51 102.79 120.93 426.01 112.14 416.91 102.79 129.40 448.62 108.84 120.93 410.58 513.24 119.72 123.35 120.93 498.40 110.65 467.25 467.25 492.17 479.71 106.42 254.81 467.25 236.80 278.67 123.35 492.17 Outpatient Eeg cont rec w/vid eeg tech 95700 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Eeg wo vid ea 12-26hr unmntr 95708 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Veeg 2-12 hr intmt mntr 95712 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Veeg ea 12-26 hr unmntr 95714 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Veeg ea 12-26hr intmt mntr 95715 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Polysom <6 yrs 4/> paramtrs 95782 " 4,829.00 " " 1,784.80 " 795.89 " 3,975.74 " " 1,241.05 " " 3,186.66 " 955.07 " 3,290.48 " 795.89 936.34 " 3,302.07 " 869.22 " 3,231.57 " 795.89 " 1,001.88 " " 3,477.36 " 842.71 936.34 " 3,180.54 " " 3,975.74 " 926.98 955.07 936.34 " 3,863.20 " 856.75 " 3,621.75 " " 3,621.75 " " 3,814.91 " " 3,718.33 " 823.98 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 955.07 " 3,814.91 " Outpatient Polysom <6 yrs cpap/bilvl 95783 " 4,829.00 " " 1,784.80 " 795.89 " 3,975.74 " " 1,241.05 " " 3,186.66 " 955.07 " 3,290.48 " 795.89 936.34 " 3,302.07 " 869.22 " 3,231.57 " 795.89 " 1,001.88 " " 3,477.36 " 842.71 936.34 " 3,180.54 " " 3,975.74 " 926.98 955.07 936.34 " 3,863.20 " 856.75 " 3,621.75 " " 3,621.75 " " 3,814.91 " " 3,718.33 " 823.98 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 955.07 " 3,814.91 " Outpatient Multiple sleep latency test 95805 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Sleep study unatt&resp efft 95806 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Polysom 6/> yrs 4/> param 95810 " 4,829.00 " " 1,784.80 " 795.89 " 3,975.74 " " 1,241.05 " " 3,186.66 " 955.07 " 3,290.48 " 795.89 936.34 " 3,302.07 " 869.22 " 3,231.57 " 795.89 " 1,001.88 " " 3,477.36 " 842.71 936.34 " 3,180.54 " " 3,975.74 " 926.98 955.07 936.34 " 3,863.20 " 856.75 " 3,621.75 " " 3,621.75 " " 3,814.91 " " 3,718.33 " 823.98 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 955.07 " 3,814.91 " Outpatient Polysom 6/>yrs cpap 4/> parm 95811 " 4,829.00 " " 1,784.80 " 795.89 " 3,975.74 " " 1,241.05 " " 3,186.66 " 955.07 " 3,290.48 " 795.89 936.34 " 3,302.07 " 869.22 " 3,231.57 " 795.89 " 1,001.88 " " 3,477.36 " 842.71 936.34 " 3,180.54 " " 3,975.74 " 926.98 955.07 936.34 " 3,863.20 " 856.75 " 3,621.75 " " 3,621.75 " " 3,814.91 " " 3,718.33 " 823.98 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 955.07 " 3,814.91 " Outpatient Eeg 41-60 minutes 95812 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Eeg extnd mntr 61-119 min 95813 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Eeg awake and drowsy 95816 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Eeg awake and asleep 95819 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Muscle test 2 limbs 95861 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Muscle test larynx 95865 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Muscle test cran nerv unilat 95867 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Muscle test cran nerve bilat 95868 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Muscle test thor paraspinal 95869 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Muscle test nonparaspinal 95870 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Nvr cndj tst 1-2 studies 95907 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Nrv cndj tst 3-4 studies 95908 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Nrv cndj tst 5-6 studies 95909 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Nrv cndj test 7-8 studies 95910 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Nrv cndj test 9-10 studies 95911 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Nrv cndj test 11-12 studies 95912 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Nrv cndj test 13/> studies 95913 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Autonomic nrv parasym inervj 95921 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Autonomic nrv syst funj test 95923 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Neuromuscular junction test 95937 733.00 270.92 120.78 603.16 188.38 483.71 144.93 499.47 120.78 142.09 501.23 131.94 490.52 120.78 152.04 527.83 127.88 142.09 482.52 603.16 140.67 144.93 142.09 586.40 130.01 549.75 549.75 579.07 564.41 125.04 299.80 549.75 278.61 327.87 144.93 579.07 Outpatient Somatosensory testing 95938 " 2,561.00 " 946.55 422.28 " 2,108.31 " 658.18 " 1,690.00 " 506.74 " 1,745.07 " 422.28 496.80 " 1,751.21 " 460.98 " 1,713.82 " 422.28 531.58 " 1,844.18 " 447.12 496.80 " 1,686.62 " " 2,108.31 " 491.83 506.74 496.80 " 2,048.80 " 454.57 " 1,920.75 " " 1,920.75 " " 2,023.19 " " 1,971.97 " 437.18 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 506.74 " 2,023.19 " Outpatient Alys npgt w/o prgrmg 95970 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Alys smpl sp/pn npgt w/prgrm 95971 527.00 194.78 86.84 433.56 135.44 347.77 104.21 359.10 86.84 102.17 360.36 94.86 352.67 86.84 109.32 379.49 91.95 102.17 346.84 433.56 101.15 104.21 102.17 421.60 93.49 395.25 395.25 416.33 405.79 89.91 215.54 395.25 200.31 235.73 104.21 416.33 Outpatient Alys cplx sp/pn npgt w/prgrm 95972 527.00 194.78 86.84 433.56 135.44 347.77 104.21 359.10 86.84 102.17 360.36 94.86 352.67 86.84 109.32 379.49 91.95 102.17 346.84 433.56 101.15 104.21 102.17 421.60 93.49 395.25 395.25 416.33 405.79 89.91 215.54 395.25 200.31 235.73 104.21 416.33 Outpatient Alys smpl cn npgt prgrmg 95976 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Alys cplx cn npgt prgrmg 95977 527.00 194.78 86.84 433.56 135.44 347.77 104.21 359.10 86.84 102.17 360.36 94.86 352.67 86.84 109.32 379.49 91.95 102.17 346.84 433.56 101.15 104.21 102.17 421.60 93.49 395.25 395.25 416.33 405.79 89.91 215.54 395.25 200.31 235.73 104.21 416.33 Outpatient Alys brn npgt prgrmg 15 min 95983 527.00 194.78 86.84 433.56 135.44 347.77 104.21 359.10 86.84 102.17 360.36 94.86 352.67 86.84 109.32 379.49 91.95 102.17 346.84 433.56 101.15 104.21 102.17 421.60 93.49 395.25 395.25 416.33 405.79 89.91 215.54 395.25 200.31 235.73 104.21 416.33 Outpatient Spin/brain pump refil & main 95991 " 1,371.00 " 506.72 226.02 " 1,128.84 " 352.35 904.72 271.22 934.20 226.02 265.90 937.49 246.78 917.47 226.02 284.51 987.26 239.31 265.90 903.06 " 1,128.84 " 263.24 271.22 265.90 " 1,096.80 " 243.30 " 1,028.25 " " 1,028.25 " " 1,083.09 " " 1,055.67 " 233.99 560.74 " 1,028.25 " 521.12 613.25 271.22 " 1,083.09 " Outpatient Canalith repositioning proc 95992 192.00 70.96 30.84 156.81 49.34 126.70 37.01 130.83 30.84 36.28 131.29 34.56 128.49 30.84 38.82 138.26 32.65 36.28 125.45 156.81 35.92 37.01 36.28 153.60 33.20 144.00 144.00 151.68 147.84 31.93 78.53 144.00 72.98 85.88 37.01 151.68 Outpatient Developmental screen w/score 96110 294.00 108.66 - 361.72 75.56 194.01 - 200.33 - - 201.04 52.92 196.74 - - 211.71 - - 289.37 361.72 - - 235.20 - 220.50 220.50 232.26 226.38 - 120.25 220.50 111.75 131.51 - 232.26 Outpatient Devel tst phys/qhp 1st hr 96112 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Nubhvl xm phys/qhp 1st hr 96116 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Brief emotional/behav assmt 96127 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 119.12 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 137.06 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Psycl tst eval phys/qhp 1st 96130 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Nrpsyc tst eval phys/qhp 1st 96132 " 1,388.00 " 513.00 228.95 " 1,143.01 " 356.72 915.94 274.74 945.78 228.95 269.35 949.11 249.84 928.85 228.95 288.20 999.50 242.42 269.35 914.39 " 1,143.01 " 266.66 274.74 269.35 " 1,110.40 " 246.46 " 1,041.00 " " 1,041.00 " " 1,096.52 " " 1,068.76 " 237.03 567.69 " 1,041.00 " 527.58 620.85 274.74 " 1,096.52 " Outpatient Psycl/nrpsyc tst phy/qhp 1st 96136 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Psycl/nrpsyc tech 1st 96138 " 1,419.00 " 524.46 234.79 " 1,167.95 " 364.68 936.40 281.74 966.91 234.79 276.22 970.31 255.42 949.59 234.79 295.56 " 1,021.82 " 248.60 276.22 934.35 " 1,167.95 " 273.46 281.74 276.22 " 1,135.20 " 252.74 " 1,064.25 " " 1,064.25 " " 1,121.01 " " 1,092.63 " 243.07 580.37 " 1,064.25 " 539.36 634.72 281.74 " 1,121.01 " Outpatient Hlth bhv assmt/reassessment 96156 393.00 145.25 64.73 323.61 101.00 259.34 77.67 267.79 64.73 76.15 268.73 70.74 263.00 64.73 81.48 283.00 68.54 76.15 258.88 323.61 75.39 77.67 76.15 314.40 69.68 294.75 294.75 310.47 302.61 67.01 160.74 294.75 149.38 175.79 77.67 310.47 Outpatient Hlth bhv ivntj indiv 1st 30 96158 393.00 145.25 64.73 323.61 101.00 259.34 77.67 267.79 64.73 76.15 268.73 70.74 263.00 64.73 81.48 283.00 68.54 76.15 258.88 323.61 75.39 77.67 76.15 314.40 69.68 294.75 294.75 310.47 302.61 67.01 160.74 294.75 149.38 175.79 77.67 310.47 Outpatient Caregiver health risk assmt 96161 138.00 51.00 22.74 113.36 35.47 91.07 27.29 94.03 22.74 26.75 94.36 24.84 92.35 22.74 28.62 99.37 24.08 26.75 90.68 113.36 26.48 27.29 26.75 110.40 24.48 103.50 103.50 109.02 106.26 23.54 56.44 103.50 52.45 61.73 27.29 109.02 Outpatient Hlth bhv ivntj fam 1st 30 96167 138.00 51.00 22.74 113.36 35.47 91.07 27.29 94.03 22.74 26.75 94.36 24.84 92.35 22.74 28.62 99.37 24.08 26.75 90.68 113.36 26.48 27.29 26.75 110.40 24.48 103.50 103.50 109.02 106.26 23.54 56.44 103.50 52.45 61.73 27.29 109.02 Outpatient Hlth bhv ivntj fam wo pt 1st 96170 695.00 256.87 - 855.09 178.62 458.63 - 473.57 - - 475.24 125.10 465.09 - - 500.47 - - 684.07 855.09 - - 556.00 - 521.25 521.25 549.05 535.15 - 284.26 521.25 264.17 310.87 - 549.05 Outpatient Hlth bhv ivntj fam w/o pt ea 96171 254.00 93.88 - 312.51 65.28 167.61 - 173.08 - - 173.69 45.72 169.98 - - 182.91 - - 250.00 312.51 - - 203.20 - 190.50 190.50 200.66 195.58 - 103.89 190.50 96.55 113.61 - 200.66 Outpatient Hydration iv infusion init 96360 " 1,068.00 " 394.73 176.97 879.57 274.48 704.77 212.36 727.74 176.97 208.20 730.30 192.24 714.71 176.97 222.77 769.07 187.38 208.20 703.65 879.57 206.12 212.36 208.20 854.40 190.50 801.00 801.00 843.72 822.36 183.22 436.81 801.00 405.95 477.72 212.36 843.72 Outpatient Hydrate iv infusion add-on 96361 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Ther/proph/diag iv inf init 96365 " 1,068.00 " 394.73 176.97 879.57 274.48 704.77 212.36 727.74 176.97 208.20 730.30 192.24 714.71 176.97 222.77 769.07 187.38 208.20 703.65 879.57 206.12 212.36 208.20 854.40 190.50 801.00 801.00 843.72 822.36 183.22 436.81 801.00 405.95 477.72 212.36 843.72 Outpatient Ther/proph/diag iv inf addon 96366 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Tx/proph/dg addl seq iv inf 96367 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Ther/proph/diag inj sc/im 96372 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Ther/proph/diag inj iv push 96374 " 1,068.00 " 394.73 176.97 879.57 274.48 704.77 212.36 727.74 176.97 208.20 730.30 192.24 714.71 176.97 222.77 769.07 187.38 208.20 703.65 879.57 206.12 212.36 208.20 854.40 190.50 801.00 801.00 843.72 822.36 183.22 436.81 801.00 405.95 477.72 212.36 843.72 Outpatient Tx/pro/dx inj new drug addon 96375 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Applicaton on-body injector 96377 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Chemo anti-neopl sq/im 96401 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Chemo hormon antineopl sq/im 96402 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Chemo intralesional up to 7 96405 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Chemo iv push sngl drug 96409 " 1,068.00 " 394.73 176.97 879.57 274.48 704.77 212.36 727.74 176.97 208.20 730.30 192.24 714.71 176.97 222.77 769.07 187.38 208.20 703.65 879.57 206.12 212.36 208.20 854.40 190.50 801.00 801.00 843.72 822.36 183.22 436.81 801.00 405.95 477.72 212.36 843.72 Outpatient Chemo iv push addl drug 96411 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Chemo iv infusion 1 hr 96413 " 1,631.00 " 602.82 275.83 " 1,343.15 " 419.17 " 1,076.30 " 331.00 " 1,111.36 " 275.83 324.51 " 1,115.28 " 293.58 " 1,091.47 " 275.83 347.23 " 1,174.48 " 292.06 324.51 " 1,074.50 " " 1,343.15 " 321.26 331.00 324.51 " 1,304.80 " 296.93 " 1,223.25 " " 1,223.25 " " 1,288.49 " " 1,255.87 " 285.57 667.08 " 1,223.25 " 619.94 729.55 331.00 " 1,288.49 " Outpatient Chemo iv infusion addl hr 96415 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Chemo prolong infuse w/pump 96416 " 1,631.00 " 602.82 275.83 " 1,343.15 " 419.17 " 1,076.30 " 331.00 " 1,111.36 " 275.83 324.51 " 1,115.28 " 293.58 " 1,091.47 " 275.83 347.23 " 1,174.48 " 292.06 324.51 " 1,074.50 " " 1,343.15 " 321.26 331.00 324.51 " 1,304.80 " 296.93 " 1,223.25 " " 1,223.25 " " 1,288.49 " " 1,255.87 " 285.57 667.08 " 1,223.25 " 619.94 729.55 331.00 " 1,288.49 " Outpatient Chemo iv infus each addl seq 96417 325.00 120.12 53.64 267.85 83.53 214.47 64.36 221.46 53.64 63.10 222.24 58.50 217.49 53.64 67.52 234.03 56.79 63.10 214.28 267.85 62.47 64.36 63.10 260.00 57.74 243.75 243.75 256.75 250.25 55.53 132.93 243.75 123.53 145.37 64.36 256.75 Outpatient Chemotx admn prtl cavity 96446 " 1,631.00 " 602.82 275.83 " 1,343.15 " 419.17 " 1,076.30 " 331.00 " 1,111.36 " 275.83 324.51 " 1,115.28 " 293.58 " 1,091.47 " 275.83 347.23 " 1,174.48 " 292.06 324.51 " 1,074.50 " " 1,343.15 " 321.26 331.00 324.51 " 1,304.80 " 296.93 " 1,223.25 " " 1,223.25 " " 1,288.49 " " 1,255.87 " 285.57 667.08 " 1,223.25 " 619.94 729.55 331.00 " 1,288.49 " Outpatient Chemotherapy into cns 96450 " 1,631.00 " 602.82 275.83 " 1,343.15 " 419.17 " 1,076.30 " 331.00 " 1,111.36 " 275.83 324.51 " 1,115.28 " 293.58 " 1,091.47 " 275.83 347.23 " 1,174.48 " 292.06 324.51 " 1,074.50 " " 1,343.15 " 321.26 331.00 324.51 " 1,304.80 " 296.93 " 1,223.25 " " 1,223.25 " " 1,288.49 " " 1,255.87 " 285.57 667.08 " 1,223.25 " 619.94 729.55 331.00 " 1,288.49 " Outpatient Irrig drug delivery device 96523 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Chemotherapy injection 96542 " 1,068.00 " 394.73 176.97 879.57 274.48 704.77 212.36 727.74 176.97 208.20 730.30 192.24 714.71 176.97 222.77 769.07 187.38 208.20 703.65 879.57 206.12 212.36 208.20 854.40 190.50 801.00 801.00 843.72 822.36 183.22 436.81 801.00 405.95 477.72 212.36 843.72 Outpatient Ultraviolet light therapy 96900 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 119.12 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 137.06 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Photochemotherapy with uv-a 96912 292.00 107.92 48.15 240.57 75.04 192.69 57.78 198.97 48.15 56.65 199.67 52.56 195.41 48.15 60.62 210.27 50.99 56.65 192.46 240.57 56.08 57.78 56.65 233.60 51.83 219.00 219.00 230.68 224.84 49.85 119.43 219.00 110.99 130.61 57.78 230.68 Outpatient Laser tx skin < 250 sq cm 96920 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Laser tx skin 250-500 sq cm 96921 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Mechanical traction therapy 97012 77.00 28.46 12.04 64.82 19.79 50.81 14.44 52.47 12.04 14.16 52.65 13.86 51.53 12.04 15.15 55.45 12.74 14.16 51.85 64.82 14.02 14.44 14.16 61.60 12.96 57.75 57.75 60.83 59.29 12.46 31.49 57.75 29.27 34.44 14.44 60.83 Outpatient Electric stimulation therapy 97014 71.00 26.24 - 87.35 18.25 46.85 - 48.38 - - 48.55 12.78 47.51 - - 51.13 - - 69.88 87.35 - - 56.80 - 53.25 53.25 56.09 54.67 - 29.04 53.25 26.99 31.76 - 56.09 Outpatient Vasopneumatic device therapy 97016 62.00 22.92 9.98 52.51 15.93 40.91 11.97 42.25 9.98 11.74 42.40 11.16 41.49 9.98 12.56 44.65 10.57 11.74 42.01 52.51 11.62 11.97 11.74 49.60 10.74 46.50 46.50 48.98 47.74 10.33 25.36 46.50 23.57 27.73 11.97 48.98 Outpatient Paraffin bath therapy 97018 30.00 11.09 4.79 25.25 7.71 19.80 5.74 20.44 4.79 5.63 20.51 5.40 20.08 4.79 6.02 21.60 5.07 5.63 20.20 25.25 5.57 5.74 5.63 24.00 5.15 22.50 22.50 23.70 23.10 4.95 12.27 22.50 11.40 13.42 5.74 23.70 Outpatient Electrical stimulation 97032 77.00 28.46 12.31 63.36 19.79 50.81 14.77 52.47 12.31 14.48 52.65 13.86 51.53 12.31 15.49 55.45 13.03 14.48 50.69 63.36 14.34 14.77 14.48 61.60 13.25 57.75 57.75 60.83 59.29 12.74 31.49 57.75 29.27 34.44 14.77 60.83 Outpatient Ultrasound therapy 97035 74.00 27.35 11.96 61.52 19.02 48.83 14.35 50.42 11.96 14.07 50.60 13.32 49.52 11.96 15.05 53.29 12.66 14.07 49.21 61.52 13.93 14.35 14.07 59.20 12.87 55.50 55.50 58.46 56.98 12.38 30.27 55.50 28.13 33.10 14.35 58.46 Outpatient Therapeutic exercises 97110 155.00 57.29 24.81 130.58 39.84 102.28 29.77 105.62 24.81 29.19 105.99 27.90 103.73 24.81 31.23 111.62 26.27 29.19 104.46 130.58 28.90 29.77 29.19 124.00 26.71 116.25 116.25 122.45 119.35 25.69 63.40 116.25 58.92 69.33 29.77 122.45 Outpatient Neuromuscular reeducation 97112 179.00 66.16 28.76 149.91 46.00 118.12 34.52 121.97 28.76 33.84 122.40 32.22 119.79 28.76 36.21 128.90 30.46 33.84 119.93 149.91 33.50 34.52 33.84 143.20 30.96 134.25 134.25 141.41 137.83 29.78 73.21 134.25 68.04 80.07 34.52 141.41 Outpatient Aquatic therapy/exercises 97113 194.00 71.70 30.94 164.23 49.86 128.02 37.13 132.19 30.94 36.40 132.66 34.92 129.82 30.94 38.95 139.70 32.76 36.40 131.38 164.23 36.04 37.13 36.40 155.20 33.31 145.50 145.50 153.26 149.38 32.03 79.35 145.50 73.74 86.78 37.13 153.26 Outpatient Gait training therapy 97116 155.00 57.29 24.81 129.12 39.84 102.28 29.77 105.62 24.81 29.19 105.99 27.90 103.73 24.81 31.23 111.62 26.27 29.19 103.30 129.12 28.90 29.77 29.19 124.00 26.71 116.25 116.25 122.45 119.35 25.69 63.40 116.25 58.92 69.33 29.77 122.45 Outpatient Ther ivntj ea addl 15 min 97130 115.00 42.50 18.50 94.14 29.56 75.89 22.21 78.36 18.50 21.77 78.64 20.70 76.96 18.50 23.29 82.81 19.59 21.77 75.31 94.14 21.55 22.21 21.77 92.00 19.92 86.25 86.25 90.85 88.55 19.16 47.04 86.25 43.71 51.44 22.21 90.85 Outpatient Manual therapy 1/> regions 97140 142.00 52.48 22.84 120.25 36.49 93.71 27.41 96.76 22.84 26.87 97.10 25.56 95.03 22.84 28.75 102.25 24.18 26.87 96.20 120.25 26.60 27.41 26.87 113.60 24.59 106.50 106.50 112.18 109.34 23.65 58.08 106.50 53.97 63.52 27.41 112.18 Outpatient Adapt behavior tx phys/qhp 97155 393.00 145.25 64.73 323.61 101.00 259.34 77.67 267.79 64.73 76.15 268.73 70.74 263.00 64.73 81.48 283.00 68.54 76.15 258.88 323.61 75.39 77.67 76.15 314.40 69.68 294.75 294.75 310.47 302.61 67.01 160.74 294.75 149.38 175.79 77.67 310.47 Outpatient Fam adapt bhv tx gdn phy/qhp 97156 138.00 51.00 22.74 113.36 35.47 91.07 27.29 94.03 22.74 26.75 94.36 24.84 92.35 22.74 28.62 99.37 24.08 26.75 90.68 113.36 26.48 27.29 26.75 110.40 24.48 103.50 103.50 109.02 106.26 23.54 56.44 103.50 52.45 61.73 27.29 109.02 Outpatient Pt eval low complex 20 min 97161 519.00 191.82 84.41 415.20 133.38 342.49 101.30 353.65 84.41 99.31 354.89 93.42 347.31 84.41 106.26 373.73 89.38 99.31 291.30 364.13 98.32 101.30 99.31 415.20 90.87 389.25 389.25 410.01 399.63 87.39 212.27 389.25 197.27 232.15 101.30 410.01 Outpatient Pt eval mod complex 30 min 97162 519.00 191.82 84.41 415.20 133.38 342.49 101.30 353.65 84.41 99.31 354.89 93.42 347.31 84.41 106.26 373.73 89.38 99.31 291.30 364.13 98.32 101.30 99.31 415.20 90.87 389.25 389.25 410.01 399.63 87.39 212.27 389.25 197.27 232.15 101.30 410.01 Outpatient Pt eval high complex 45 min 97163 519.00 191.82 84.41 415.20 133.38 342.49 101.30 353.65 84.41 99.31 354.89 93.42 347.31 84.41 106.26 373.73 89.38 99.31 291.30 364.13 98.32 101.30 99.31 415.20 90.87 389.25 389.25 410.01 399.63 87.39 212.27 389.25 197.27 232.15 101.30 410.01 Outpatient Pt re-eval est plan care 97164 354.00 130.84 58.01 283.20 90.98 233.60 69.62 241.22 58.01 68.25 242.07 63.72 236.90 58.01 73.03 254.92 61.43 68.25 199.60 249.50 67.57 69.62 68.25 283.20 62.45 265.50 265.50 279.66 272.58 60.06 144.79 265.50 134.56 158.34 69.62 279.66 Outpatient Ot eval low complex 30 min 97165 504.00 186.28 84.97 403.20 129.53 332.59 101.96 343.43 84.97 99.96 344.64 90.72 337.28 84.97 106.96 362.93 89.96 99.96 308.72 385.91 98.96 101.96 99.96 403.20 91.46 378.00 378.00 398.16 388.08 87.96 206.14 378.00 191.57 225.44 101.96 398.16 Outpatient Ot eval mod complex 45 min 97166 504.00 186.28 84.97 403.20 129.53 332.59 101.96 343.43 84.97 99.96 344.64 90.72 337.28 84.97 106.96 362.93 89.96 99.96 307.56 384.45 98.96 101.96 99.96 403.20 91.46 378.00 378.00 398.16 388.08 87.96 206.14 378.00 191.57 225.44 101.96 398.16 Outpatient Ot eval high complex 60 min 97167 504.00 186.28 84.97 403.20 129.53 332.59 101.96 343.43 84.97 99.96 344.64 90.72 337.28 84.97 106.96 362.93 89.96 99.96 307.56 384.45 98.96 101.96 99.96 403.20 91.46 378.00 378.00 398.16 388.08 87.96 206.14 378.00 191.57 225.44 101.96 398.16 Outpatient Ot re-eval est plan care 97168 339.00 125.29 58.28 271.20 87.12 223.71 69.94 230.99 58.28 68.57 231.81 61.02 226.86 58.28 73.37 244.11 61.71 68.57 212.35 265.44 67.88 69.94 68.57 271.20 62.74 254.25 254.25 267.81 261.03 60.34 138.65 254.25 128.85 151.63 69.94 267.81 Outpatient Therapeutic activities 97530 199.00 73.55 31.14 166.72 51.14 131.32 37.37 135.60 31.14 36.64 136.08 35.82 133.17 31.14 39.20 143.30 32.98 36.64 133.37 166.72 36.27 37.37 36.64 159.20 33.53 149.25 149.25 157.21 153.23 32.24 81.39 149.25 75.64 89.01 37.37 157.21 Outpatient Self care mngment training 97535 172.00 63.57 27.57 145.07 44.20 113.50 33.09 117.20 27.57 32.44 117.61 30.96 115.10 27.57 34.71 123.86 29.20 32.44 116.05 145.07 32.12 33.09 32.44 137.60 29.68 129.00 129.00 135.88 132.44 28.55 70.35 129.00 65.38 76.94 33.09 135.88 Outpatient Wheelchair mngment training 97542 167.00 61.72 26.79 141.00 42.92 110.20 32.15 113.79 26.79 31.52 114.19 30.06 111.76 26.79 33.73 120.26 28.37 31.52 112.80 141.00 31.20 32.15 31.52 133.60 28.84 125.25 125.25 131.93 128.59 27.74 68.30 125.25 63.48 74.70 32.15 131.93 Outpatient Rmvl devital tis 20 cm/< 97597 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Neg press wound tx <=50 cm 97605 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Neg press wound tx >50 cm 97606 " 1,816.00 " 671.19 299.00 " 1,494.82 " 466.71 " 1,198.38 " 358.81 " 1,237.42 " 299.00 351.77 " 1,241.78 " 326.88 " 1,215.27 " 299.00 376.39 " 1,307.70 " 316.59 351.77 " 1,195.84 " " 1,494.82 " 348.25 358.81 351.77 " 1,452.80 " 321.87 " 1,362.00 " " 1,362.00 " " 1,434.64 " " 1,398.32 " 309.56 742.74 " 1,362.00 " 690.26 812.30 358.81 " 1,434.64 " Outpatient Low frequency non-thermal us 97610 943.00 348.53 155.35 776.06 242.35 622.29 186.42 642.56 155.35 182.76 644.82 169.74 631.06 155.35 195.55 679.05 164.48 182.76 620.84 776.06 180.93 186.42 182.76 754.40 167.23 707.25 707.25 744.97 726.11 160.83 385.69 707.25 358.43 421.80 186.42 744.97 Outpatient Physical performance test 97750 175.00 64.68 28.12 147.98 44.98 115.48 33.74 119.25 28.12 33.08 119.67 31.50 117.11 28.12 35.40 126.02 29.77 33.08 118.39 147.98 32.75 33.74 33.08 140.00 30.27 131.25 131.25 138.25 134.75 29.11 71.58 131.25 66.52 78.28 33.74 138.25 Outpatient Orthotic mgmt&traing 1st enc 97760 253.00 93.51 40.64 207.91 65.02 166.95 48.77 172.39 40.64 47.81 173.00 45.54 169.31 40.64 51.16 182.19 43.03 47.81 166.33 207.91 47.33 48.77 47.81 202.40 43.75 189.75 189.75 199.87 194.81 42.07 103.48 189.75 96.17 113.17 48.77 199.87 Outpatient Prosthetic traing 1st enc 97761 215.00 79.46 34.84 177.43 55.26 141.88 41.81 146.50 34.84 40.99 147.02 38.70 143.88 34.84 43.86 154.82 36.89 40.99 141.95 177.43 40.58 41.81 40.99 172.00 37.51 161.25 161.25 169.85 165.55 36.07 87.94 161.25 81.72 96.17 41.81 169.85 Outpatient Orthc/prostc mgmt sbsq enc 97763 277.00 102.38 45.02 222.19 71.19 182.79 54.03 188.75 45.02 52.97 189.41 49.86 185.37 45.02 56.68 199.47 47.67 52.97 177.75 222.19 52.44 54.03 52.97 221.60 48.47 207.75 207.75 218.83 213.29 46.61 113.29 207.75 105.29 123.90 54.03 218.83 Outpatient Medical nutrition indiv in 97802 169.00 62.46 27.16 138.12 43.43 111.52 32.59 115.16 27.16 31.95 115.56 30.42 113.09 27.16 34.19 121.70 28.76 31.95 110.50 138.12 31.63 32.59 31.95 135.20 29.23 126.75 126.75 133.51 130.13 28.12 69.12 126.75 64.24 75.59 32.59 133.51 Outpatient Med nutrition indiv subseq 97803 144.00 53.22 23.15 117.72 37.01 95.03 27.78 98.12 23.15 27.24 98.47 25.92 96.36 23.15 29.15 103.69 24.52 27.24 94.17 117.72 26.97 27.78 27.24 115.20 24.92 108.00 108.00 113.76 110.88 23.97 58.90 108.00 54.73 64.41 27.78 113.76 Outpatient Medical nutrition group 97804 80.00 29.57 12.86 65.42 20.56 52.79 15.43 54.51 12.86 15.13 54.70 14.40 53.54 12.86 16.19 57.61 13.62 15.13 52.33 65.42 14.98 15.43 15.13 64.00 13.84 60.00 60.00 63.20 61.60 13.31 32.72 60.00 30.41 35.78 15.43 63.20 Outpatient Acupunct w/o stimul 15 min 97810 67.00 24.76 12.06 106.65 17.22 44.21 25.64 45.65 21.37 25.14 45.81 12.06 44.84 21.37 26.90 48.25 22.63 25.14 85.32 106.65 24.89 25.64 25.14 53.60 23.00 50.25 50.25 52.93 51.59 22.12 27.40 50.25 25.47 29.97 25.64 52.93 Outpatient Osteopath manj 1-2 regions 98925 139.00 51.37 23.08 114.77 35.72 91.73 27.69 94.71 23.08 27.15 95.05 25.02 93.02 23.08 29.05 100.09 24.44 27.15 91.81 114.77 26.88 27.69 27.15 111.20 24.84 104.25 104.25 109.81 107.03 23.89 56.85 104.25 52.83 62.17 27.69 109.81 Outpatient Osteopath manj 3-4 regions 98926 139.00 51.37 23.08 114.77 35.72 91.73 27.69 94.71 23.08 27.15 95.05 25.02 93.02 23.08 29.05 100.09 24.44 27.15 91.81 114.77 26.88 27.69 27.15 111.20 24.84 104.25 104.25 109.81 107.03 23.89 56.85 104.25 52.83 62.17 27.69 109.81 Outpatient Osteopath manj 5-6 regions 98927 139.00 51.37 23.08 114.77 35.72 91.73 27.69 94.71 23.08 27.15 95.05 25.02 93.02 23.08 29.05 100.09 24.44 27.15 91.81 114.77 26.88 27.69 27.15 111.20 24.84 104.25 104.25 109.81 107.03 23.89 56.85 104.25 52.83 62.17 27.69 109.81 Outpatient Hc pro phone call 11-20 min 98967 131.00 48.42 18.55 106.79 33.67 86.45 22.26 89.26 18.55 21.82 89.58 23.58 87.67 18.55 23.35 94.33 19.64 21.82 85.43 106.79 21.60 22.26 21.82 104.80 19.97 98.25 98.25 103.49 100.87 19.20 53.58 98.25 49.79 58.60 22.26 103.49 Outpatient Hc pro phone call 21-30 min 98968 195.00 72.07 26.97 159.56 50.12 128.68 32.36 132.87 26.97 31.73 133.34 35.10 130.49 26.97 33.95 140.42 28.56 31.73 127.65 159.56 31.41 32.36 31.73 156.00 29.03 146.25 146.25 154.05 150.15 27.92 79.76 146.25 74.12 87.22 32.36 154.05 Outpatient Visual acuity screen 99173 49.00 18.11 - 60.29 12.59 32.34 - 33.39 - - 33.51 8.82 32.79 - - 35.28 - - 48.23 60.29 - - 39.20 - 36.75 36.75 38.71 37.73 - 20.04 36.75 18.62 21.92 - 38.71 Outpatient Ocular instrumnt screen bil 99177 17.00 6.28 - 20.92 4.37 11.22 - 11.58 - - 11.62 3.06 11.38 - - 12.24 - - 16.73 20.92 - - 13.60 - 12.75 12.75 13.43 13.09 - 6.95 12.75 6.46 7.60 - 13.43 Outpatient App topical fluoride varnish 99188 63.00 23.28 - 77.51 16.19 41.57 - 42.93 - - 43.08 11.34 42.16 - - 45.37 - - 62.01 77.51 - - 50.40 - 47.25 47.25 49.77 48.51 - 25.77 47.25 23.95 28.18 - 49.77 Outpatient Phlebotomy 99195 588.00 217.32 97.55 483.88 151.12 388.02 117.06 400.66 97.55 114.76 402.07 105.84 393.49 97.55 122.79 423.42 103.28 114.76 387.10 483.88 113.61 117.06 114.76 470.40 105.01 441.00 441.00 464.52 452.76 100.99 240.49 441.00 223.50 263.01 117.06 464.52 Outpatient Emergency dept visit 99281 381.00 140.82 62.75 313.81 97.92 251.42 75.30 259.61 62.75 73.82 260.53 68.58 254.97 62.75 78.99 274.36 66.44 73.82 251.04 313.81 73.08 75.30 73.82 304.80 67.55 285.75 285.75 300.99 293.37 64.96 155.83 285.75 144.82 170.42 75.30 300.99 Outpatient Emergency dept visit 99282 691.00 255.39 113.63 568.77 177.59 455.99 136.35 470.85 113.63 133.68 472.51 124.38 462.42 113.63 143.04 497.59 120.31 133.68 455.01 568.77 132.34 136.35 133.68 552.80 122.32 518.25 518.25 545.89 532.07 117.64 282.62 518.25 262.65 309.08 136.35 545.89 Outpatient Emergency dept visit 99283 " 1,216.00 " 449.43 200.20 " 1,001.05 " 312.51 802.44 240.24 828.58 200.20 235.53 831.50 218.88 813.75 200.20 252.02 875.64 211.98 235.53 800.83 " 1,001.05 " 233.17 240.24 235.53 972.80 215.51 912.00 912.00 960.64 936.32 207.27 497.34 912.00 462.20 543.92 240.24 960.64 Outpatient Emergency dept visit 99284 " 1,910.00 " 705.94 314.70 " 1,572.21 " 490.87 " 1,260.41 " 377.63 " 1,301.47 " 314.70 370.23 " 1,306.06 " 343.80 " 1,278.17 " 314.70 396.15 " 1,375.39 " 333.21 370.23 " 1,257.74 " " 1,572.21 " 366.53 377.63 370.23 " 1,528.00 " 338.76 " 1,432.50 " " 1,432.50 " " 1,508.90 " " 1,470.70 " 325.80 781.19 " 1,432.50 " 725.99 854.34 377.63 " 1,508.90 " Outpatient Emergency dept visit 99285 " 2,741.00 " " 1,013.07 " 451.70 " 2,256.76 " 704.44 " 1,808.79 " 542.04 " 1,867.72 " 451.70 531.41 " 1,874.30 " 493.38 " 1,834.28 " 451.70 568.61 " 1,973.79 " 478.27 531.41 " 1,805.38 " " 2,256.76 " 526.10 542.04 531.41 " 2,192.80 " 486.24 " 2,055.75 " " 2,055.75 " " 2,165.39 " " 2,110.57 " 467.64 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 542.04 " 2,165.39 " Outpatient Critical care first hour 99291 " 3,637.00 " " 1,344.24 " 644.38 " 2,993.98 " 934.71 " 2,400.06 " 773.25 " 2,478.25 " 644.38 758.09 " 2,486.98 " 654.66 " 2,433.88 " 644.38 811.16 " 2,619.00 " 682.28 758.09 " 2,395.14 " " 2,993.98 " 750.51 773.25 758.09 " 2,909.60 " 693.65 " 2,727.75 " " 2,727.75 " " 2,873.23 " " 2,800.49 " 667.12 " 1,487.53 " " 2,727.75 " " 1,382.42 " " 1,626.83 " 773.25 " 2,873.23 " Outpatient Init pm e/m new pat infant 99381 114.00 42.13 - 140.26 29.30 75.23 - 77.68 - - 77.95 20.52 76.29 - - 82.09 - - 112.21 140.26 - - 91.20 - 85.50 85.50 90.06 87.78 - 46.63 85.50 43.33 50.99 - 90.06 Outpatient Init pm e/m new pat 1-4 yrs 99382 132.00 48.79 - 162.40 33.92 87.11 - 89.94 - - 90.26 23.76 88.33 - - 95.05 - - 129.92 162.40 - - 105.60 - 99.00 99.00 104.28 101.64 - 53.99 99.00 50.17 59.04 - 104.28 Outpatient Prev visit new age 5-11 99383 132.00 48.79 - 162.40 33.92 87.11 - 89.94 - - 90.26 23.76 88.33 - - 95.05 - - 129.92 162.40 - - 105.60 - 99.00 99.00 104.28 101.64 - 53.99 99.00 50.17 59.04 - 104.28 Outpatient Prev visit new age 12-17 99384 146.00 53.96 - 179.63 37.52 96.35 - 99.48 - - 99.83 26.28 97.70 - - 105.13 - - 143.70 179.63 - - 116.80 - 109.50 109.50 115.34 112.42 - 59.71 109.50 55.49 65.31 - 115.34 Outpatient Prev visit new age 18-39 99385 146.00 53.96 - 179.63 37.52 96.35 - 99.48 - - 99.83 26.28 97.70 - - 105.13 - - 143.70 179.63 - - 116.80 - 109.50 109.50 115.34 112.42 - 59.71 109.50 55.49 65.31 - 115.34 Outpatient Prev visit new age 40-64 99386 195.00 72.07 - 239.92 50.12 128.68 - 132.87 - - 133.34 35.10 130.49 - - 140.42 - - 191.93 239.92 - - 156.00 - 146.25 146.25 154.05 150.15 - 79.76 146.25 74.12 87.22 - 154.05 Outpatient Init pm e/m new pat 65+ yrs 99387 214.00 79.09 - 263.29 55.00 141.22 - 145.82 - - 146.33 38.52 143.21 - - 154.10 - - 210.63 263.29 - - 171.20 - 160.50 160.50 169.06 164.78 - 87.53 160.50 81.34 95.72 - 169.06 Outpatient Per pm reeval est pat infant 99391 97.00 35.85 - 119.34 24.93 64.01 - 66.10 - - 66.33 17.46 64.91 - - 69.85 - - 95.47 119.34 - - 77.60 - 72.75 72.75 76.63 74.69 - 39.67 72.75 36.87 43.39 - 76.63 Outpatient Prev visit est age 1-4 99392 114.00 42.13 - 140.26 29.30 75.23 - 77.68 - - 77.95 20.52 76.29 - - 82.09 - - 112.21 140.26 - - 91.20 - 85.50 85.50 90.06 87.78 - 46.63 85.50 43.33 50.99 - 90.06 Outpatient Prev visit est age 5-11 99393 122.00 45.09 - 150.10 31.35 80.51 - 83.13 - - 83.42 21.96 81.64 - - 87.85 - - 120.08 150.10 - - 97.60 - 91.50 91.50 96.38 93.94 - 49.90 91.50 46.37 54.57 - 96.38 Outpatient Prev visit est age 12-17 99394 141.00 52.11 - 173.48 36.24 93.05 - 96.08 - - 96.42 25.38 94.36 - - 101.53 - - 138.78 173.48 - - 112.80 - 105.75 105.75 111.39 108.57 - 57.67 105.75 53.59 63.07 - 111.39 Outpatient Prev visit est age 18-39 99395 141.00 52.11 - 173.48 36.24 93.05 - 96.08 - - 96.42 25.38 94.36 - - 101.53 - - 138.78 173.48 - - 112.80 - 105.75 105.75 111.39 108.57 - 57.67 105.75 53.59 63.07 - 111.39 Outpatient Prev visit est age 40-64 99396 156.00 57.66 - 191.93 40.09 102.94 - 106.30 - - 106.67 28.08 104.40 - - 112.34 - - 153.55 191.93 - - 124.80 - 117.00 117.00 123.24 120.12 - 63.80 117.00 59.30 69.78 - 123.24 Outpatient Per pm reeval est pat 65+ yr 99397 177.00 65.42 - 217.77 45.49 116.80 - 120.61 - - 121.03 31.86 118.45 - - 127.46 - - 174.22 217.77 - - 141.60 - 132.75 132.75 139.83 136.29 - 72.39 132.75 67.28 79.17 - 139.83 Outpatient Behav chng smoking 3-10 min 99406 138.00 51.00 22.74 113.36 35.47 91.07 27.29 94.03 22.74 26.75 94.36 24.84 92.35 22.74 28.62 99.37 24.08 26.75 90.68 113.36 26.48 27.29 26.75 110.40 24.48 103.50 103.50 109.02 106.26 23.54 56.44 103.50 52.45 61.73 27.29 109.02 Outpatient Behav chng smoking > 10 min 99407 138.00 51.00 22.74 113.36 35.47 91.07 27.29 94.03 22.74 26.75 94.36 24.84 92.35 22.74 28.62 99.37 24.08 26.75 90.68 113.36 26.48 27.29 26.75 110.40 24.48 103.50 103.50 109.02 106.26 23.54 56.44 103.50 52.45 61.73 27.29 109.02 Outpatient Self-meas bp pt educaj/train 99473 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 87.00 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 100.10 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Trans care mgmt 14 day disch 99495 508.00 187.76 91.44 513.24 130.56 335.23 123.35 346.15 102.79 120.93 347.37 91.44 339.95 102.79 129.40 365.81 108.84 120.93 410.58 513.24 119.72 123.35 120.93 406.40 110.65 381.00 381.00 401.32 391.16 106.42 207.77 381.00 193.09 227.23 123.35 401.32 Outpatient Trans care mgmt 7 day disch 99496 508.00 187.76 91.44 513.24 130.56 335.23 123.35 346.15 102.79 120.93 347.37 91.44 339.95 102.79 129.40 365.81 108.84 120.93 410.58 513.24 119.72 123.35 120.93 406.40 110.65 381.00 381.00 401.32 391.16 106.42 207.77 381.00 193.09 227.23 123.35 401.32 Outpatient Advncd care plan 30 min 99497 393.00 145.25 64.73 323.61 101.00 259.34 77.67 267.79 64.73 76.15 268.73 70.74 263.00 64.73 81.48 283.00 68.54 76.15 258.88 323.61 75.39 77.67 76.15 314.40 69.68 294.75 294.75 310.47 302.61 67.01 160.74 294.75 149.38 175.79 77.67 310.47 Outpatient Adm sarscov2 30mcg/0.3ml 1st 0001A 210.00 77.62 33.88 168.00 53.97 138.58 40.66 143.09 33.88 39.86 143.60 37.80 140.53 33.88 42.65 151.22 35.87 39.86 53.61 67.01 39.46 40.66 39.86 168.00 36.47 157.50 157.50 165.90 161.70 35.08 85.89 157.50 79.82 93.93 40.66 165.90 Outpatient Adm sarscov2 30mcg/0.3ml 2nd 0002A 210.00 77.62 33.88 168.00 53.97 138.58 40.66 143.09 33.88 39.86 143.60 37.80 140.53 33.88 42.65 151.22 35.87 39.86 88.18 110.22 39.46 40.66 39.86 168.00 36.47 157.50 157.50 165.90 161.70 35.08 85.89 157.50 79.82 93.93 40.66 165.90 Outpatient Adm sarscov2 100mcg/0.5ml1st 0011A 210.00 77.62 33.88 168.00 53.97 138.58 40.66 143.09 33.88 39.86 143.60 37.80 140.53 33.88 42.65 151.22 35.87 39.86 53.61 67.01 39.46 40.66 39.86 168.00 36.47 157.50 157.50 165.90 161.70 35.08 85.89 157.50 79.82 93.93 40.66 165.90 Outpatient Adm sarscov2 100mcg/0.5ml2nd 0012A 210.00 77.62 33.88 168.00 53.97 138.58 40.66 143.09 33.88 39.86 143.60 37.80 140.53 33.88 42.65 151.22 35.87 39.86 88.18 110.22 39.46 40.66 39.86 168.00 36.47 157.50 157.50 165.90 161.70 35.08 85.89 157.50 79.82 93.93 40.66 165.90 Outpatient Jak2 gene trgt seq alys 0027U 643.00 237.65 103.62 522.62 165.25 424.32 124.35 438.14 103.62 121.91 439.68 115.74 430.30 103.62 130.44 463.02 109.72 121.91 418.09 522.62 120.69 124.35 121.91 514.40 111.55 482.25 482.25 507.97 319.40 107.28 262.99 482.25 244.40 287.61 124.35 507.97 Outpatient Neuro csf prion prtn qual 0035U " 2,840.00 " " 1,049.66 " 459.84 " 2,319.17 " 729.88 " 1,874.12 " 551.81 " 1,935.18 " 459.84 540.99 " 1,941.99 " 511.20 " 1,900.53 " 459.84 578.86 " 2,045.08 " 486.89 540.99 " 1,855.33 " " 2,319.17 " 535.58 551.81 540.99 " 2,272.00 " 495.01 " 2,130.00 " " 2,130.00 " " 2,243.60 " " 1,417.39 " 476.07 " 1,161.56 " " 2,130.00 " " 1,079.48 " " 1,270.33 " 551.81 " 2,243.60 " Outpatient Flt3 gene itd variants quan 0046U " 12,501.00 " " 4,620.37 " 346.32 " 10,000.80 " " 3,212.76 " " 8,249.41 " 415.58 " 8,518.18 " 346.32 407.43 " 8,548.18 " " 2,250.18 " " 8,365.67 " 346.32 435.95 " 9,001.97 " 366.69 407.43 " 1,397.28 " " 1,746.61 " 403.36 415.58 407.43 " 10,000.80 " 372.80 " 9,375.75 " " 9,375.75 " " 9,875.79 " " 1,067.47 " 358.54 " 5,112.91 " " 9,375.75 " " 4,751.63 " " 5,591.70 " 415.58 " 9,875.79 " Outpatient Njx platelet plasma 0232T " 1,419.00 " 524.46 234.79 " 1,167.95 " 364.68 936.40 281.74 966.91 234.79 276.22 970.31 255.42 949.59 234.79 295.56 " 1,021.82 " 248.60 276.22 934.35 " 1,167.95 " 273.46 281.74 276.22 " 1,135.20 " 252.74 " 1,064.25 " " 1,064.25 " " 1,121.01 " " 1,092.63 " 243.07 580.37 " 1,064.25 " 539.36 634.72 281.74 " 1,121.01 " Outpatient Colgn cross-link crn med sep 0402T " 10,512.00 " " 3,885.24 " " 1,731.10 " " 8,654.75 " " 2,701.58 " " 6,936.87 " " 2,077.32 " " 7,162.88 " " 1,731.10 " " 2,036.59 " " 7,188.11 " " 1,892.16 " " 7,034.63 " " 1,731.10 " " 2,179.15 " " 7,569.69 " " 1,832.93 " " 2,036.59 " " 6,923.68 " " 8,654.75 " " 2,016.22 " " 2,077.32 " " 2,036.59 " " 8,409.60 " " 1,863.48 " " 7,884.00 " " 7,884.00 " " 8,304.48 " " 8,094.24 " " 1,792.20 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,077.32 " " 8,304.48 " Outpatient Body mass index docd 3008F 0.01 - - 0.01 - 0.01 - 0.01 - - 0.01 - 0.01 - - 0.01 - - 0.01 0.01 - - 0.01 - 0.01 0.01 0.01 0.01 - - 0.01 - - - 0.01 Outpatient Syst bp lt 130 mm hg 3074F 0.01 - - 0.01 - 0.01 - 0.01 - - 0.01 - 0.01 - - 0.01 - - 0.01 0.01 - - 0.01 - 0.01 0.01 0.01 0.01 - - 0.01 - - - 0.01 Outpatient Diast bp <80 mm hg 3078F 0.01 - - 0.01 - 0.01 - 0.01 - - 0.01 - 0.01 - - 0.01 - - 0.01 0.01 - - 0.01 - 0.01 0.01 0.01 0.01 - - 0.01 - - - 0.01 Outpatient Diast bp 80-89 mm hg 3079F 0.01 - - 0.01 - 0.01 - 0.01 - - 0.01 - 0.01 - - 0.01 - - 0.01 0.01 - - 0.01 - 0.01 0.01 0.01 0.01 - - 0.01 - - - 0.01 Outpatient Noner transport wheelch van A0130 83.00 30.68 - 102.12 21.33 54.77 - 56.56 - - 56.76 14.94 55.54 - - 59.77 - - 81.69 102.12 - - 66.40 - 62.25 62.25 65.57 63.91 - 33.95 62.25 31.55 37.13 - 65.57 Outpatient Hopd covid-19 spec collect C9803 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 87.00 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 64.64 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient Dental sealant per tooth D1351 70.00 25.87 - 86.12 17.99 46.19 - 47.70 - - 47.87 12.60 46.84 - - 50.41 - - 68.90 86.12 - - 56.00 - 52.50 52.50 55.30 53.90 - 28.63 52.50 26.61 31.31 - 55.30 Outpatient Resin one surface-anterior D2330 187.00 69.12 - 230.07 48.06 123.40 - 127.42 - - 127.87 33.66 125.14 - - 134.66 - - 184.06 230.07 - - 149.60 - 140.25 140.25 147.73 143.99 - 76.48 140.25 71.08 83.65 - 147.73 Outpatient Resin two surfaces-anterior D2331 236.00 87.23 - 290.36 60.65 155.74 - 160.81 - - 161.38 42.48 157.93 - - 169.94 - - 232.29 290.36 - - 188.80 - 177.00 177.00 186.44 181.72 - 96.52 177.00 89.70 105.56 - 186.44 Outpatient Post 1 srfc resinbased cmpst D2391 201.00 74.29 - 247.30 51.66 132.64 - 136.96 - - 137.44 36.18 134.51 - - 144.74 - - 197.84 247.30 - - 160.80 - 150.75 150.75 158.79 154.77 - 82.21 150.75 76.40 89.91 - 158.79 Outpatient Post 2 srfc resinbased cmpst D2392 272.00 100.53 - 334.65 69.90 179.49 - 185.34 - - 185.99 48.96 182.02 - - 195.87 - - 267.72 334.65 - - 217.60 - 204.00 204.00 214.88 209.44 - 111.25 204.00 103.39 121.67 - 214.88 Outpatient Prefab stnlss steel crown pe D2931 404.00 149.32 - 497.06 103.83 266.60 - 275.29 - - 276.26 72.72 270.36 - - 290.92 - - 397.64 497.06 - - 323.20 - 303.00 303.00 319.16 311.08 - 165.24 303.00 153.56 180.71 - 319.16 Outpatient Therapeutic pulpotomy D3220 226.00 83.53 - 278.06 58.08 149.14 - 154.00 - - 154.54 40.68 151.24 - - 162.74 - - 222.44 278.06 - - 180.80 - 169.50 169.50 178.54 174.02 - 92.43 169.50 85.90 101.09 - 178.54 Outpatient Full mouth debridement D4355 " 7,316.00 " " 2,703.99 " " 1,199.94 " " 6,023.26 " " 1,880.21 " " 4,827.83 " " 1,439.92 " " 4,985.12 " " 1,199.94 " " 1,411.69 " " 5,002.68 " " 1,316.88 " " 4,895.87 " " 1,199.94 " " 1,510.51 " " 5,268.25 " " 1,270.52 " " 1,411.69 " " 4,818.53 " " 6,023.26 " " 1,397.57 " " 1,439.92 " " 1,411.69 " " 5,852.80 " " 1,291.70 " " 5,487.00 " " 5,487.00 " " 5,779.64 " " 5,633.32 " " 1,242.29 " " 2,992.24 " " 5,487.00 " " 2,780.81 " " 3,272.45 " " 1,439.92 " " 5,779.64 " Outpatient Extraction erupted tooth/exr D7140 " 7,316.00 " " 2,703.99 " " 1,199.94 " " 6,023.26 " " 1,880.21 " " 4,827.83 " " 1,439.92 " " 4,985.12 " " 1,199.94 " " 1,411.69 " " 5,002.68 " " 1,316.88 " " 4,895.87 " " 1,199.94 " " 1,510.51 " " 5,268.25 " " 1,270.52 " " 1,411.69 " " 4,818.53 " " 6,023.26 " " 1,397.57 " " 1,439.92 " " 1,411.69 " " 5,852.80 " " 1,291.70 " " 5,487.00 " " 5,487.00 " " 5,779.64 " " 5,633.32 " " 1,242.29 " " 2,992.24 " " 5,487.00 " " 2,780.81 " " 3,272.45 " " 1,439.92 " " 5,779.64 " Outpatient Rem imp tooth w mucoper flp D7210 " 7,316.00 " " 2,703.99 " " 1,199.94 " " 6,023.26 " " 1,880.21 " " 4,827.83 " " 1,439.92 " " 4,985.12 " " 1,199.94 " " 1,411.69 " " 5,002.68 " " 1,316.88 " " 4,895.87 " " 1,199.94 " " 1,510.51 " " 5,268.25 " " 1,270.52 " " 1,411.69 " " 4,818.53 " " 6,023.26 " " 1,397.57 " " 1,439.92 " " 1,411.69 " " 5,852.80 " " 1,291.70 " " 5,487.00 " " 5,487.00 " " 5,779.64 " " 5,633.32 " " 1,242.29 " " 2,992.24 " " 5,487.00 " " 2,780.81 " " 3,272.45 " " 1,439.92 " " 5,779.64 " Outpatient Admin influenza virus vac G0008 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Admin hepatitis b vaccine G0010 210.00 77.62 34.62 172.90 53.97 138.58 41.54 143.09 34.62 40.73 143.60 37.80 140.53 34.62 43.58 151.22 36.66 40.73 138.32 172.90 40.32 41.54 40.73 168.00 37.27 157.50 157.50 165.90 161.70 35.84 85.89 157.50 79.82 93.93 41.54 165.90 Outpatient Ca screen;pelvic/breast exam G0101 393.00 145.25 64.73 323.61 101.00 259.34 77.67 267.79 64.73 76.15 268.73 70.74 263.00 64.73 81.48 283.00 68.54 76.15 258.88 323.61 75.39 77.67 76.15 314.40 69.68 294.75 294.75 310.47 302.61 67.01 160.74 294.75 149.38 175.79 77.67 310.47 Outpatient Psa screening G0103 101.00 37.33 16.41 107.13 25.96 103.87 19.70 107.13 16.41 19.31 69.06 18.18 67.59 16.41 20.66 72.73 17.38 19.31 66.22 82.78 19.12 19.70 19.31 80.80 17.67 75.75 75.75 79.79 50.59 16.99 41.31 75.75 38.39 45.18 19.70 79.79 Outpatient Colorectal scrn; hi risk ind G0105 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Diab manage trn per indiv G0108 287.00 106.08 46.28 233.98 73.76 189.39 55.54 195.56 46.28 54.45 196.25 51.66 192.06 46.28 58.26 206.67 49.01 54.45 187.18 233.98 53.91 55.54 54.45 229.60 49.82 215.25 215.25 226.73 220.99 47.92 117.38 215.25 109.09 128.38 55.54 226.73 Outpatient Diab manage trn ind/group G0109 80.00 29.57 13.14 65.42 20.56 52.79 15.77 54.51 13.14 15.46 54.70 14.40 53.54 13.14 16.54 57.61 13.91 15.46 52.33 65.42 15.31 15.77 15.46 64.00 14.15 60.00 60.00 63.20 61.60 13.60 32.72 60.00 30.41 35.78 15.77 63.20 Outpatient Colon ca scrn not hi rsk ind G0121 " 4,167.00 " " 1,540.12 " 686.51 " 3,430.41 " " 1,070.92 " " 2,749.80 " 823.81 " 2,839.39 " 686.51 807.66 " 2,849.39 " 750.06 " 2,788.56 " 686.51 864.20 " 3,000.66 " 726.89 807.66 " 2,744.28 " " 3,430.41 " 799.58 823.81 807.66 " 3,333.60 " 739.01 " 3,125.25 " " 3,125.25 " " 3,291.93 " " 3,208.59 " 710.74 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 823.81 " 3,291.93 " Outpatient Screen cerv/vag thin layer G0123 106.00 39.18 17.22 118.02 27.24 114.43 20.67 118.02 17.22 20.26 72.48 19.08 70.94 17.22 21.68 76.33 18.23 20.26 69.48 86.85 20.06 20.67 20.26 84.80 18.54 79.50 79.50 83.74 53.08 17.83 43.35 79.50 40.29 47.41 20.67 83.74 Outpatient "Scr c/v cyto,thinlayer,rescr" G0145 139.00 51.37 22.52 154.06 35.72 149.37 27.02 154.06 22.52 26.49 95.05 25.02 93.02 22.52 28.34 100.09 23.84 26.49 90.85 113.56 26.23 27.02 26.49 111.20 24.24 104.25 104.25 109.81 69.40 23.31 56.85 104.25 52.83 62.17 27.02 109.81 Outpatient "Oth resp proc, indiv" G0238 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 87.00 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 100.10 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient "Oth resp proc, group" G0239 178.00 65.79 29.28 146.29 45.75 117.46 35.14 121.29 29.28 34.45 121.72 32.04 119.12 29.28 36.86 128.18 31.01 34.45 117.03 146.29 34.11 35.14 34.45 142.40 31.52 133.50 133.50 140.62 137.06 30.32 72.80 133.50 67.66 79.62 35.14 140.62 Outpatient Unsched dialysis esrd pt hos G0257 " 3,435.00 " " 1,269.58 " 566.59 " 2,828.27 " 882.80 " 2,266.76 " 679.91 " 2,340.61 " 566.59 666.58 " 2,348.85 " 618.30 " 2,298.70 " 566.59 713.24 " 2,473.54 " 599.92 666.58 " 2,262.57 " " 2,828.27 " 659.91 679.91 666.58 " 2,748.00 " 609.92 " 2,576.25 " " 2,576.25 " " 2,713.65 " " 2,644.95 " 586.59 " 1,404.92 " " 2,576.25 " " 1,305.64 " " 1,536.48 " 679.91 " 2,713.65 " Outpatient Inj for sacroiliac jt anesth G0260 " 2,628.00 " 971.31 473.04 " 2,742.90 " 675.40 " 1,734.22 " 659.19 " 1,790.72 " 549.32 646.26 " 1,797.03 " 473.04 " 1,758.66 " 549.32 691.50 " 1,892.42 " 581.63 646.26 " 2,194.28 " " 2,742.90 " 639.80 659.19 646.26 " 2,102.40 " 591.33 " 1,971.00 " " 1,971.00 " " 2,076.12 " " 2,023.56 " 568.71 " 1,074.85 " " 1,971.00 " 998.90 " 1,175.50 " 659.19 " 2,076.12 " Outpatient Fecal blood scrn immunoassay G0328 95.00 35.11 15.34 92.66 24.42 89.84 18.41 92.66 15.34 18.05 64.96 17.10 63.57 15.34 19.31 68.41 16.25 18.05 61.90 77.38 17.87 18.41 18.05 76.00 16.52 71.25 71.25 75.05 47.29 15.88 38.86 71.25 36.11 42.49 18.41 75.05 Outpatient Initial preventive exam G0402 508.00 187.76 91.44 513.24 130.56 335.23 123.35 346.15 102.79 120.93 347.37 91.44 339.95 102.79 129.40 365.81 108.84 120.93 410.58 513.24 119.72 123.35 120.93 406.40 110.65 381.00 381.00 401.32 391.16 106.42 207.77 381.00 193.09 227.23 123.35 401.32 Outpatient Ekg tracing for initial prev G0404 130.00 48.05 21.37 106.65 33.41 85.79 25.64 88.58 21.37 25.14 88.89 23.40 87.00 21.37 26.90 93.61 22.63 25.14 85.32 106.65 24.89 25.64 25.14 104.00 23.00 97.50 97.50 102.70 100.10 22.12 53.17 97.50 49.41 58.15 25.64 102.70 Outpatient "Prostate biopsy, any mthd" G0416 " 1,529.00 " 565.12 251.95 " 1,258.93 " 392.95 " 1,008.99 " 302.34 " 1,041.86 " 251.95 296.41 " 1,045.53 " 275.22 " 1,023.21 " 251.95 317.16 " 1,101.03 " 266.77 296.41 " 1,007.13 " " 1,258.93 " 293.45 302.34 296.41 " 1,223.20 " 271.22 " 1,146.75 " " 1,146.75 " " 1,207.91 " 763.10 260.84 625.36 " 1,146.75 " 581.17 683.92 302.34 " 1,207.91 " Outpatient "Ppps, initial visit" G0438 862.00 318.60 139.76 703.82 221.53 568.83 167.71 587.37 139.76 164.42 589.44 155.16 576.85 139.76 175.93 620.73 147.98 164.42 563.06 703.82 162.78 167.71 164.42 689.60 150.44 646.50 646.50 680.98 663.74 144.69 352.56 646.50 327.65 385.57 167.71 680.98 Outpatient "Ppps, subseq visit" G0439 679.00 250.96 109.07 554.47 174.50 448.07 130.89 462.67 109.07 128.32 464.30 122.22 454.39 109.07 137.30 488.95 115.49 128.32 443.57 554.47 127.04 130.89 128.32 543.20 117.41 509.25 509.25 536.41 522.83 112.92 277.71 509.25 258.09 303.72 130.89 536.41 Outpatient Behavior counsel obesity 15m G0447 393.00 145.25 64.73 323.61 101.00 259.34 77.67 267.79 64.73 76.15 268.73 70.74 263.00 64.73 81.48 283.00 68.54 76.15 258.88 323.61 75.39 77.67 76.15 314.40 69.68 294.75 294.75 310.47 302.61 67.01 160.74 294.75 149.38 175.79 77.67 310.47 Outpatient Hospital outpt clinic visit G0463 115.00 42.50 - 129.40 29.56 62.06 123.35 64.09 102.79 120.93 - 20.70 - 102.79 129.40 82.81 108.84 120.93 - - 119.72 123.35 120.93 92.00 110.65 86.25 86.25 90.85 - 106.42 47.04 86.25 43.71 51.44 123.35 90.85 Outpatient Inter devc remote 30d G2066 195.00 72.07 32.22 160.59 50.12 128.68 38.66 132.87 32.22 37.90 133.34 35.10 130.49 32.22 40.55 140.42 34.11 37.90 128.47 160.59 37.52 38.66 37.90 156.00 34.68 146.25 146.25 154.05 150.15 33.35 79.76 146.25 74.12 87.22 38.66 154.05 Outpatient Intraut copper contraceptive J7300 " 1,450.00 " 535.92 - " 1,783.99 " 372.65 956.86 - 988.03 - - 991.51 261.00 970.34 - - " 1,044.15 " - - " 1,427.19 " " 1,783.99 " - - " 1,160.00 " - " 1,087.50 " " 1,087.50 " " 1,145.50 " " 1,116.50 " - 593.05 " 1,087.50 " 551.15 648.59 - " 1,145.50 " Outpatient Casirivi and imdevi inj M0243 " 2,363.00 " 873.36 381.59 " 1,890.40 " 607.29 " 1,559.34 " 457.91 " 1,610.15 " 381.59 448.93 " 1,615.82 " 425.34 " 1,581.32 " 381.59 480.36 " 1,701.60 " 404.04 448.93 " 1,074.50 " " 1,343.15 " 444.44 457.91 448.93 " 1,890.40 " 410.77 " 1,772.25 " " 1,772.25 " " 1,866.77 " " 1,819.51 " 395.06 966.47 " 1,772.25 " 898.18 " 1,056.97 " 457.91 " 1,866.77 " Outpatient Blood split unit P9011 775.00 286.44 127.64 637.90 199.18 511.42 153.17 528.09 127.64 150.17 529.95 139.50 518.63 127.64 160.68 558.08 135.15 150.17 510.31 637.90 148.67 153.17 150.17 620.00 137.41 581.25 581.25 612.25 596.75 132.15 316.98 581.25 294.58 346.66 153.17 612.25 Outpatient Cryoprecipitate each unit P9012 419.00 154.86 69.06 345.15 107.68 276.50 82.88 285.51 69.06 81.25 286.51 75.42 280.39 69.06 86.94 301.72 73.13 81.25 276.11 345.15 80.44 82.88 81.25 335.20 74.34 314.25 314.25 331.01 322.63 71.50 171.37 314.25 159.26 187.42 82.88 331.01 Outpatient Rbc leukocytes reduced P9016 990.00 365.90 162.96 814.82 254.43 653.30 195.55 674.59 162.96 191.72 676.96 178.20 662.51 162.96 205.14 712.90 172.55 191.72 651.84 814.82 189.80 195.55 191.72 792.00 175.42 742.50 742.50 782.10 762.30 168.71 404.91 742.50 376.30 442.83 195.55 782.10 Outpatient Platelets leukoreduced irrad P9033 " 1,119.00 " 413.58 184.37 921.46 287.58 738.43 221.24 762.49 184.37 216.90 765.17 201.42 748.83 184.37 232.08 805.79 195.21 216.90 737.16 921.46 214.73 221.24 216.90 895.20 198.46 839.25 839.25 884.01 861.63 190.87 457.67 839.25 425.33 500.53 221.24 884.01 Outpatient Platelet pheres leukoreduced P9035 " 2,556.00 " 944.70 420.90 " 2,104.07 " 656.89 " 1,686.70 " 505.08 " 1,741.66 " 420.90 495.18 " 1,747.79 " 460.08 " 1,710.48 " 420.90 529.84 " 1,840.58 " 445.66 495.18 " 1,683.23 " " 2,104.07 " 490.23 505.08 495.18 " 2,044.80 " 453.09 " 1,917.00 " " 1,917.00 " " 2,019.24 " " 1,968.12 " 435.76 " 1,045.40 " " 1,917.00 " 971.54 " 1,143.30 " 505.08 " 2,019.24 " Outpatient Plate pheres leukoredu irrad P9037 " 3,241.00 " " 1,197.87 " 533.91 " 2,668.30 " 832.94 " 2,138.74 " 640.69 " 2,208.42 " 533.91 628.13 " 2,216.20 " 583.38 " 2,168.88 " 533.91 672.10 " 2,333.84 " 565.32 628.13 " 2,134.60 " " 2,668.30 " 621.85 640.69 628.13 " 2,592.80 " 574.74 " 2,430.75 " " 2,430.75 " " 2,560.39 " " 2,495.57 " 552.75 " 1,325.57 " " 2,430.75 " " 1,231.90 " " 1,449.70 " 640.69 " 2,560.39 " Outpatient Rbc leukoreduced irradiated P9040 " 1,368.00 " 505.61 225.34 " 1,126.19 " 351.58 902.74 270.40 932.16 225.34 265.10 935.44 246.24 915.47 225.34 283.66 985.10 238.59 265.10 900.94 " 1,126.19 " 262.45 270.40 265.10 " 1,094.40 " 242.57 " 1,026.00 " " 1,026.00 " " 1,080.72 " " 1,053.36 " 233.29 559.51 " 1,026.00 " 519.98 611.91 270.40 " 1,080.72 " Outpatient "Platelets, hla-m, l/r, unit" P9052 " 4,227.00 " " 1,562.30 " 696.36 " 3,480.24 " " 1,086.34 " " 2,789.40 " 835.64 " 2,880.28 " 696.36 819.25 " 2,890.42 " 760.86 " 2,828.71 " 696.36 876.60 " 3,043.86 " 737.33 819.25 " 2,784.15 " " 3,480.24 " 811.06 835.64 819.25 " 3,381.60 " 749.61 " 3,170.25 " " 3,170.25 " " 3,339.33 " " 3,254.79 " 720.94 " 1,728.84 " " 3,170.25 " " 1,606.68 " " 1,890.74 " 835.64 " 3,339.33 " Outpatient "Plasma, frz between 8-24hour" P9059 374.00 138.23 61.53 307.54 96.12 246.80 73.84 254.84 61.53 72.39 255.74 67.32 250.28 61.53 77.46 269.32 65.15 72.39 246.03 307.54 71.67 73.84 72.39 299.20 66.24 280.50 280.50 295.46 287.98 63.70 152.97 280.50 142.16 167.29 73.84 295.46 Outpatient Platelets pheresis path redu P9073 " 3,065.00 " " 1,132.82 " 504.95 " 2,523.64 " 787.71 " 2,022.59 " 605.94 " 2,088.49 " 504.95 594.06 " 2,095.85 " 551.70 " 2,051.10 " 504.95 635.64 " 2,207.11 " 534.65 594.06 " 2,018.88 " " 2,523.64 " 588.12 605.94 594.06 " 2,452.00 " 543.56 " 2,298.75 " " 2,298.75 " " 2,421.35 " " 2,360.05 " 522.77 " 1,253.59 " " 2,298.75 " " 1,165.01 " " 1,370.97 " 605.94 " 2,421.35 " Outpatient One-way allow prorated trip P9604 43.00 15.89 - 34.40 11.05 28.38 - 29.30 - - 29.40 7.74 28.78 - - 30.96 - - - - - - - 34.40 - 32.25 32.25 33.97 33.11 - 17.59 32.25 16.34 19.23 - 33.97 Outpatient Fern test Q0114 51.00 18.85 8.28 41.75 13.11 40.41 9.93 41.68 8.28 9.74 34.87 9.18 34.13 8.28 10.42 36.73 8.77 9.74 33.40 41.75 9.64 9.93 9.74 40.80 8.91 38.25 38.25 40.29 25.52 8.57 20.86 38.25 19.39 22.81 9.93 40.29 Outpatient Lith-ion batt elec/pneum vad Q0506 " 3,515.00 " " 1,299.14 " 632.70 " 3,594.48 " 903.36 " 2,319.55 " 898.86 " 2,395.12 " 749.05 881.24 " 2,403.56 " 632.70 " 2,352.24 " 749.05 942.93 " 2,531.15 " 793.12 881.24 " 2,875.57 " " 3,594.48 " 872.43 898.86 881.24 " 2,812.00 " 806.33 " 2,636.25 " " 2,636.25 " " 2,776.85 " " 2,706.55 " 775.49 " 1,437.64 " " 2,636.25 " " 1,336.05 " " 1,572.26 " 898.86 " 2,776.85 " Outpatient Telehealth facility fee Q3014 115.00 42.50 - 92.00 29.56 75.89 - 78.36 - - 78.64 20.70 76.96 - - 82.81 - - - - - - - 92.00 - 86.25 86.25 90.85 88.55 - 47.04 86.25 43.71 51.44 - 90.85 Outpatient Cntct lens hydrophil extend V2523 154.00 56.92 27.72 809.71 39.58 101.62 202.48 104.94 168.73 198.51 105.31 27.72 103.06 168.73 212.41 110.90 178.66 198.51 647.76 809.71 196.52 202.48 198.51 123.20 181.64 115.50 115.50 121.66 118.58 174.69 62.99 115.50 58.54 68.88 202.48 121.66 Outpatient Fresnell prism press-on lens V2718 85.00 31.42 15.30 126.94 21.85 56.09 31.74 57.92 26.45 31.12 58.12 15.30 56.88 26.45 33.30 61.21 28.01 31.12 101.55 126.94 30.81 31.74 31.12 68.00 28.47 63.75 63.75 67.15 65.45 27.39 34.77 63.75 32.31 38.02 31.74 67.15 Outpatient Hearing aid dispensing fee V5090 118.00 43.61 - 145.18 30.33 77.87 - 80.41 - - 80.69 21.24 78.97 - - 84.97 - - 116.14 145.18 - - 94.40 - 88.50 88.50 93.22 90.86 - 48.26 88.50 44.85 52.78 - 93.22 Outpatient Dispensing fee binaural V5160 300.00 110.88 - 369.10 77.10 197.97 - 204.42 - - 205.14 54.00 200.76 - - 216.03 - - 295.28 369.10 - - 240.00 - 225.00 225.00 237.00 231.00 - 122.70 225.00 114.03 134.19 - 237.00 Outpatient "Dispensing fee, monaural" V5241 118.00 43.61 - 145.18 30.33 77.87 - 80.41 - - 80.69 21.24 78.97 - - 84.97 - - 116.14 145.18 - - 94.40 - 88.50 88.50 93.22 90.86 - 48.26 88.50 44.85 52.78 - 93.22 Outpatient Ear mold/insert V5264 70.00 25.87 - 86.12 17.99 46.19 - 47.70 - - 47.87 12.60 46.84 - - 50.41 - - 68.90 86.12 - - 56.00 - 52.50 52.50 55.30 53.90 - 28.63 52.50 26.61 31.31 - 55.30 Outpatient "Ear mold/insert, disp" V5265 49.00 18.11 - 60.29 12.59 32.34 - 33.39 - - 33.51 8.82 32.79 - - 35.28 - - 48.23 60.29 - - 39.20 - 36.75 36.75 38.71 37.73 - 20.04 36.75 18.62 21.92 - 38.71 Outpatient Battery for hearing device V5266 67.00 24.76 - 82.43 17.22 44.21 - 45.65 - - 45.81 12.06 44.84 - - 48.25 - - 65.95 82.43 - - 53.60 - 50.25 50.25 52.93 51.59 - 27.40 50.25 25.47 29.97 - 52.93 Outpatient Ear impression V5275 45.00 16.63 - 55.37 11.57 29.70 - 30.66 - - 30.77 8.10 30.11 - - 32.40 - - 44.29 55.37 - - 36.00 - 33.75 33.75 35.55 34.65 - 18.41 33.75 17.10 20.13 - 35.55 Inpatient "ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES" 3 " 862,822.76 " " 271,875.45 " " 171,526.23 " " 690,258.21 " " 518,211.35 " " 173,241.49 " " 535,122.68 " " 171,526.23 " " 498,538.99 " " 171,526.23 " " 585,425.24 " " 183,533.07 " " 612,517.88 " " 171,526.23 " " 218,134.23 " " 272,667.84 " " 173,241.49 " " 174,956.75 " " 171,526.23 " " 690,258.21 " " 647,117.07 " " 647,117.07 " " 681,629.98 " " 582,405.36 " " 647,117.07 " " 174,956.75 " " 681,629.98 " Inpatient "TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES" 4 " 598,466.26 " " 188,576.72 " " 107,218.99 " " 478,773.01 " " 359,438.84 " " 108,291.18 " " 371,168.78 " " 107,218.99 " " 345,793.81 " " 107,218.99 " " 406,059.36 " " 114,724.32 " " 424,851.20 " " 107,218.99 " " 136,249.19 " " 170,311.51 " " 108,291.18 " " 109,363.37 " " 107,218.99 " " 478,773.01 " " 448,849.70 " " 448,849.70 " " 472,788.35 " " 403,964.73 " " 448,849.70 " " 109,363.37 " " 472,788.35 " Inpatient "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC" 11 " 163,935.45 " " 51,656.06 " " 45,435.52 " " 131,148.36 " " 96,144.75 " " 45,889.88 " " 99,278.10 " " 45,435.52 " " 91,632.13 " " 45,435.52 " " 108,085.64 " " 48,616.01 " " 116,377.78 " " 45,435.52 " " 57,614.73 " " 72,018.42 " " 45,889.88 " " 46,344.23 " " 45,435.52 " " 131,148.36 " " 122,951.59 " " 122,951.59 " " 129,509.01 " " 113,483.64 " " 122,951.59 " " 46,344.23 " " 129,509.01 " Inpatient "TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC" 12 " 151,822.31 " " 47,839.21 " " 34,794.34 " " 121,457.85 " " 73,386.62 " " 35,142.28 " " 75,778.29 " " 34,794.34 " " 65,608.80 " " 34,794.34 " " 82,501.02 " " 37,229.94 " " 107,778.66 " " 34,794.34 " " 44,015.08 " " 55,018.86 " " 35,142.28 " " 35,490.23 " " 34,794.34 " " 121,457.85 " " 113,866.73 " " 113,866.73 " " 119,939.62 " " 86,621.28 " " 113,866.73 " " 35,490.23 " " 119,939.62 " Inpatient INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC 20 " 288,874.02 " " 91,024.20 " " 93,024.49 " " 231,099.21 " " 173,497.73 " " 93,954.73 " " 179,159.66 " " 93,024.49 " " 166,911.41 " " 93,024.49 " " 196,001.02 " " 99,536.20 " " 205,071.66 " " 93,024.49 " " 164,022.67 " " 205,042.78 " " 93,954.73 " " 94,884.98 " " 93,024.49 " " 231,099.21 " " 216,655.51 " " 216,655.51 " " 228,210.47 " " 194,989.96 " " 216,655.51 " " 94,884.98 " " 228,210.47 " Inpatient CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITH MCC OR CHEMOTHERAPY IMPLANT OR EPILEPSY WITH NEUROSTIMULATOR 23 " 189,761.33 " " 59,793.80 " " 51,259.25 " " 151,809.07 " " 113,970.66 " " 51,771.84 " " 117,689.98 " " 51,259.25 " " 109,644.10 " " 51,259.25 " " 128,753.07 " " 54,847.40 " " 134,711.57 " " 51,259.25 " " 107,746.49 " " 134,692.59 " " 51,771.84 " " 52,284.44 " " 51,259.25 " " 151,809.07 " " 142,321.00 " " 142,321.00 " " 149,911.45 " " 128,088.90 " " 142,321.00 " " 52,284.44 " " 149,911.45 " Inpatient CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL DIAGNOSIS WITHOUT MCC 24 " 172,291.79 " " 54,289.14 " " 35,745.12 " " 137,833.43 " " 103,478.45 " " 36,102.57 " " 106,855.37 " " 35,745.12 " " 99,550.20 " " 35,745.12 " " 116,899.98 " " 38,247.28 " " 122,309.94 " " 35,745.12 " " 97,827.28 " " 122,292.71 " " 36,102.57 " " 36,460.02 " " 35,745.12 " " 137,833.43 " " 129,218.84 " " 129,218.84 " " 136,110.51 " " 116,296.96 " " 129,218.84 " " 36,460.02 " " 136,110.51 " Inpatient CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH MCC 25 " 125,472.70 " " 39,536.45 " " 40,744.31 " " 100,378.16 " " 75,358.90 " " 41,151.75 " " 77,818.17 " " 40,744.31 " " 72,498.13 " " 40,744.31 " " 85,133.23 " " 43,596.41 " " 89,073.07 " " 40,744.31 " " 71,243.40 " " 89,060.52 " " 41,151.75 " " 41,559.20 " " 40,744.31 " " 100,378.16 " " 94,104.52 " " 94,104.52 " " 99,123.43 " " 84,694.07 " " 94,104.52 " " 41,559.20 " " 99,123.43 " Inpatient CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITH CC 26 " 86,799.27 " " 27,350.45 " " 27,893.60 " " 69,439.42 " " 52,131.64 " " 28,172.54 " " 53,832.91 " " 27,893.60 " " 50,152.62 " " 27,893.60 " " 58,893.31 " " 29,846.15 " " 61,618.80 " " 27,893.60 " " 49,284.63 " " 61,610.12 " " 28,172.54 " " 28,451.47 " " 27,893.60 " " 69,439.42 " " 65,099.45 " " 65,099.45 " " 68,571.43 " " 58,589.51 " " 65,099.45 " " 28,451.47 " " 68,571.43 " Inpatient CRANIOTOMY AND ENDOVASCULAR INTRACRANIAL PROCEDURES WITHOUT CC/MCC 27 " 90,857.26 " " 28,629.12 " " 22,990.21 " " 72,685.81 " " 48,141.30 " " 23,220.11 " " 49,710.23 " " 22,990.21 " " 44,049.07 " " 22,990.21 " " 54,120.31 " " 24,599.52 " " 64,499.57 " " 22,990.21 " " 28,853.31 " " 36,066.64 " " 23,220.11 " " 23,450.01 " " 22,990.21 " " 72,685.81 " " 68,142.95 " " 68,142.95 " " 71,777.24 " " 56,823.18 " " 68,142.95 " " 23,450.01 " " 71,777.24 " Inpatient SPINAL PROCEDURES WITH MCC 28 " 178,317.86 " " 56,187.96 " " 52,612.90 " " 142,654.29 " " 111,494.90 " " 53,139.03 " " 115,128.51 " " 52,612.90 " " 103,551.18 " " 52,612.90 " " 125,342.23 " " 56,295.80 " " 126,587.85 " " 52,612.90 " " 66,849.63 " " 83,562.05 " " 53,139.03 " " 53,665.16 " " 52,612.90 " " 142,654.29 " " 133,738.40 " " 133,738.40 " " 140,871.11 " " 131,602.06 " " 133,738.40 " " 53,665.16 " " 140,871.11 " Inpatient SPINAL PROCEDURES WITH CC OR SPINAL NEUROSTIMULATORS 29 " 91,577.57 " " 28,856.09 " " 29,995.70 " " 74,507.68 " " 63,123.83 " " 30,295.66 " " 65,181.03 " " 29,995.70 " " 60,988.74 " " 29,995.70 " " 70,963.62 " " 32,095.40 " " 65,010.92 " " 29,995.70 " " 37,847.00 " " 47,308.75 " " 30,295.66 " " 30,595.61 " " 29,995.70 " " 73,262.06 " " 68,683.18 " " 68,683.18 " " 72,346.28 " " 74,507.68 " " 68,683.18 " " 30,595.61 " " 72,346.28 " Inpatient SPINAL PROCEDURES WITHOUT CC/MCC 30 " 69,677.89 " " 21,955.50 " " 21,580.16 " " 55,742.31 " " 45,125.65 " " 21,795.96 " " 46,596.29 " " 21,580.16 " " 39,740.11 " " 21,580.16 " " 50,730.12 " " 23,090.77 " " 49,464.33 " " 21,580.16 " " 32,549.11 " " 40,686.39 " " 21,795.96 " " 22,011.76 " " 21,580.16 " " 55,742.31 " " 52,258.42 " " 52,258.42 " " 55,045.53 " " 53,263.68 " " 52,258.42 " " 22,011.76 " " 55,045.53 " Inpatient VENTRICULAR SHUNT PROCEDURES WITH MCC 31 " 114,404.44 " " 36,048.84 " " 39,618.95 " " 91,523.55 " " 68,711.31 " " 40,015.14 " " 70,953.63 " " 39,618.95 " " 75,864.26 " " 39,618.95 " " 77,623.41 " " 42,392.28 " " 81,215.71 " " 39,618.95 " " 64,958.84 " " 81,204.27 " " 40,015.14 " " 40,411.33 " " 39,618.95 " " 91,523.55 " " 85,803.33 " " 85,803.33 " " 90,379.51 " " 77,223.00 " " 85,803.33 " " 40,411.33 " " 90,379.51 " Inpatient VENTRICULAR SHUNT PROCEDURES WITH CC 32 " 71,697.10 " " 22,591.76 " " 20,324.10 " " 57,357.68 " " 43,061.28 " " 20,527.34 " " 44,466.54 " " 20,324.10 " " 39,635.78 " " 20,324.10 " " 48,646.48 " " 21,746.79 " " 50,897.77 " " 20,324.10 " " 40,709.62 " " 50,890.60 " " 20,527.34 " " 20,730.58 " " 20,324.10 " " 57,357.68 " " 53,772.83 " " 53,772.83 " " 56,640.71 " " 48,395.54 " " 53,772.83 " " 20,730.58 " " 56,640.71 " Inpatient VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC 33 " 58,397.08 " " 18,400.92 " " 15,898.78 " " 46,717.66 " " 32,974.96 " " 16,057.77 " " 34,049.62 " " 15,898.78 " " 31,651.26 " " 15,898.78 " " 37,070.36 " " 17,011.69 " " 41,456.09 " " 15,898.78 " " 23,766.24 " " 29,707.80 " " 16,057.77 " " 16,216.76 " " 15,898.78 " " 46,717.66 " " 43,797.81 " " 43,797.81 " " 46,133.69 " " 38,921.72 " " 43,797.81 " " 16,216.76 " " 46,133.69 " Inpatient CAROTID ARTERY STENT PROCEDURES WITH CC 35 " 79,699.68 " " 25,113.37 " " 21,427.07 " " 63,759.74 " " 44,798.24 " " 21,641.34 " " 46,258.21 " " 21,427.07 " " 41,498.71 " " 21,427.07 " " 50,362.04 " " 22,926.96 " " 56,578.80 " " 21,427.07 " " 32,272.92 " " 40,341.15 " " 21,641.34 " " 21,855.61 " " 21,427.07 " " 63,759.74 " " 59,774.76 " " 59,774.76 " " 62,962.75 " " 52,877.22 " " 59,774.76 " " 21,855.61 " " 62,962.75 " Inpatient EXTRACRANIAL PROCEDURES WITH CC 38 " 77,600.13 " " 24,451.80 " " 15,331.18 " " 62,080.11 " " 31,761.04 " " 15,484.49 " " 32,796.13 " " 15,331.18 " " 29,207.07 " " 15,331.18 " " 35,705.67 " " 16,404.36 " " 55,088.34 " " 15,331.18 " " 22,882.42 " " 28,603.03 " " 15,484.49 " " 15,637.80 " " 15,331.18 " " 62,080.11 " " 58,200.10 " " 58,200.10 " " 61,304.11 " " 37,488.88 " " 58,200.10 " " 15,637.80 " " 61,304.11 " Inpatient EXTRACRANIAL PROCEDURES WITHOUT CC/MCC 39 " 52,625.04 " " 16,582.15 " " 10,678.46 " " 42,100.03 " " 21,810.35 " " 10,785.24 " " 22,521.15 " " 10,678.46 " " 20,749.36 " " 10,678.46 " " 24,519.13 " " 11,425.95 " " 37,358.51 " " 10,678.46 " " 15,729.08 " " 19,661.35 " " 10,785.24 " " 10,892.03 " " 10,678.46 " " 42,100.03 " " 39,468.78 " " 39,468.78 " " 41,573.78 " " 25,743.66 " " 39,468.78 " " 10,892.03 " " 41,573.78 " Inpatient "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC" 40 " 246,936.55 " " 77,809.71 " " 35,080.83 " " 197,549.24 " " 148,310.09 " " 35,431.64 " " 153,150.05 " " 35,080.83 " " 70,957.30 " " 35,080.83 " " 167,546.45 " " 37,536.49 " " 175,300.26 " " 35,080.83 " " 45,462.34 " " 56,827.93 " " 35,431.64 " " 35,782.45 " " 35,080.83 " " 197,549.24 " " 185,202.42 " " 185,202.42 " " 195,079.88 " " 166,682.17 " " 185,202.42 " " 35,782.45 " " 195,079.88 " Inpatient "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH CC OR PERIPHERAL NEUROSTIMULATOR" 41 " 120,639.82 " " 38,013.61 " " 21,516.60 " " 96,511.85 " " 72,456.27 " " 21,731.77 " " 74,820.82 " " 21,516.60 " " 43,424.99 " " 21,516.60 " " 81,854.12 " " 23,022.76 " " 85,642.21 " " 21,516.60 " " 32,466.25 " " 40,582.82 " " 21,731.77 " " 21,946.93 " " 21,516.60 " " 96,511.85 " " 90,479.86 " " 90,479.86 " " 95,305.46 " " 81,431.88 " " 90,479.86 " " 21,946.93 " " 95,305.46 " Inpatient "PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC" 42 " 54,939.72 " " 17,311.51 " " 17,501.31 " " 43,951.78 " " 36,402.28 " " 17,676.32 " " 37,588.63 " " 17,501.31 " " 35,574.58 " " 17,501.31 " " 40,923.33 " " 18,726.40 " " 39,001.71 " " 17,501.31 " " 26,031.00 " " 32,538.76 " " 17,676.32 " " 17,851.34 " " 17,501.31 " " 43,951.78 " " 41,204.79 " " 41,204.79 " " 43,402.38 " " 42,967.12 " " 41,204.79 " " 17,851.34 " " 43,402.38 " Inpatient NERVOUS SYSTEM NEOPLASMS WITH MCC 54 " 52,845.31 " " 16,651.56 " " 12,730.42 " " 42,276.25 " " 31,738.89 " " 12,857.72 " " 32,774.66 " " 12,730.42 " " 24,495.72 " " 12,730.42 " " 35,855.54 " " 13,621.55 " " 37,514.89 " " 12,730.42 " " 18,863.85 " " 23,579.81 " " 12,857.72 " " 12,985.03 " " 12,730.42 " " 42,276.25 " " 39,633.98 " " 39,633.98 " " 41,747.80 " " 35,670.59 " " 39,633.98 " " 12,985.03 " " 41,747.80 " Inpatient NERVOUS SYSTEM NEOPLASMS WITHOUT MCC 55 " 35,368.56 " " 11,144.63 " " 9,832.43 " " 28,294.85 " " 21,242.36 " " 9,930.75 " " 21,935.58 " " 9,832.43 " " 18,620.03 " " 9,832.43 " " 23,997.57 " " 10,520.70 " " 25,108.14 " " 9,832.43 " " 14,403.36 " " 18,004.20 " " 9,930.75 " " 10,029.08 " " 9,832.43 " " 28,294.85 " " 26,526.42 " " 26,526.42 " " 27,941.16 " " 23,873.78 " " 26,526.42 " " 10,029.08 " " 27,941.16 " Inpatient DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC 56 " 67,442.53 " " 21,251.14 " " 20,134.30 " " 53,954.02 " " 42,033.41 " " 20,335.64 " " 43,403.28 " " 20,134.30 " " 35,645.37 " " 20,134.30 " " 47,253.83 " " 21,543.70 " " 47,877.45 " " 20,134.30 " " 30,201.49 " " 37,751.86 " " 20,335.64 " " 20,536.99 " " 20,134.30 " " 53,954.02 " " 50,581.89 " " 50,581.89 " " 53,279.60 " " 49,613.78 " " 50,581.89 " " 20,536.99 " " 53,279.60 " Inpatient DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC 57 " 58,308.76 " " 18,373.09 " " 11,827.99 " " 46,647.01 " " 24,268.82 " " 11,946.27 " " 25,059.74 " " 11,827.99 " " 21,146.17 " " 11,827.99 " " 27,282.94 " " 12,655.95 " " 41,393.39 " " 11,827.99 " " 17,455.27 " " 21,819.09 " " 11,946.27 " " 12,064.55 " " 11,827.99 " " 46,647.01 " " 43,731.57 " " 43,731.57 " " 46,063.92 " " 28,645.50 " " 43,731.57 " " 12,064.55 " " 46,063.92 " Inpatient MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC 59 " 54,054.37 " " 17,032.53 " " 10,572.82 " " 43,243.50 " " 21,584.41 " " 10,678.55 " " 22,287.85 " " 10,572.82 " " 19,979.97 " " 10,572.82 " " 24,265.13 " " 11,312.92 " " 38,373.20 " " 10,572.82 " " 15,563.36 " " 19,454.21 " " 10,678.55 " " 10,784.28 " " 10,572.82 " " 43,243.50 " " 40,540.78 " " 40,540.78 " " 42,702.95 " " 25,476.98 " " 40,540.78 " " 10,784.28 " " 42,702.95 " Inpatient MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC 60 " 36,922.27 " " 11,634.21 " " 8,696.33 " " 29,537.82 " " 17,571.20 " " 8,783.29 " " 18,143.85 " " 8,696.33 " " 15,739.94 " " 8,696.33 " " 19,753.49 " " 9,305.07 " " 26,211.12 " " 8,696.33 " " 12,649.55 " " 15,811.94 " " 8,783.29 " " 8,870.26 " " 8,696.33 " " 29,537.82 " " 27,691.70 " " 27,691.70 " " 29,168.59 " " 20,740.02 " " 27,691.70 " " 8,870.26 " " 29,168.59 " Inpatient "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC" 61 " 100,690.01 " " 31,727.42 " " 26,364.48 " " 80,552.01 " " 55,357.81 " " 26,628.12 " " 57,161.92 " " 26,364.48 " " 52,128.62 " " 26,364.48 " " 62,233.08 " " 28,209.99 " " 71,479.84 " " 26,364.48 " " 33,172.12 " " 41,465.15 " " 26,628.12 " " 26,891.77 " " 26,364.48 " " 80,552.01 " " 75,517.51 " " 75,517.51 " " 79,545.11 " " 65,341.12 " " 75,517.51 " " 26,891.77 " " 79,545.11 " Inpatient "ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC" 62 " 77,067.81 " " 24,284.07 " " 18,281.09 " " 61,654.25 " " 38,069.98 " " 18,463.90 " " 39,310.68 " " 18,281.09 " " 35,997.48 " " 18,281.09 " " 42,798.16 " " 19,560.77 " " 54,710.44 " " 18,281.09 " " 27,439.58 " " 34,299.47 " " 18,463.90 " " 18,646.71 " " 18,281.09 " " 61,654.25 " " 57,800.86 " " 57,800.86 " " 60,883.57 " " 44,935.58 " " 57,800.86 " " 18,646.71 " " 60,883.57 " Inpatient INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC 64 " 74,484.57 " " 23,470.09 " " 17,659.77 " " 59,587.66 " " 44,735.43 " " 17,836.37 " " 46,195.33 " " 17,659.77 " " 43,037.19 " " 17,659.77 " " 50,537.78 " " 18,895.95 " " 52,876.60 " " 17,659.77 " " 26,417.67 " " 33,022.09 " " 17,836.37 " " 18,012.97 " " 17,659.77 " " 59,587.66 " " 55,863.43 " " 55,863.43 " " 58,842.81 " " 50,277.09 " " 55,863.43 " " 18,012.97 " " 58,842.81 " Inpatient INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS 65 " 44,462.65 " " 14,010.18 " " 9,612.19 " " 35,570.12 " " 26,704.26 " " 9,708.31 " " 27,575.73 " " 9,612.19 " " 25,690.52 " " 9,612.19 " " 30,167.90 " " 10,285.04 " " 31,564.03 " " 9,612.19 " " 14,058.12 " " 17,572.65 " " 9,708.31 " " 9,804.43 " " 9,612.19 " " 35,570.12 " " 33,346.98 " " 33,346.98 " " 35,125.49 " " 30,012.29 " " 33,346.98 " " 9,804.43 " " 35,125.49 " Inpatient INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC 66 " 29,539.73 " " 9,307.97 " " 6,851.18 " " 23,631.78 " " 17,741.56 " " 6,919.69 " " 18,320.54 " " 6,851.18 " " 13,910.53 " " 6,851.18 " " 20,042.71 " " 7,330.76 " " 20,970.25 " " 6,851.18 " " 9,818.59 " " 12,273.24 " " 6,919.69 " " 6,988.20 " " 6,851.18 " " 23,631.78 " " 22,154.80 " " 22,154.80 " " 23,336.39 " " 19,939.32 " " 22,154.80 " " 6,988.20 " " 23,336.39 " Inpatient TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC 69 " 28,842.90 " " 9,088.40 " " 7,527.11 " " 23,074.32 " " 15,070.60 " " 7,602.38 " " 15,561.75 " " 7,527.11 " " 14,012.98 " " 7,527.11 " " 16,942.33 " " 8,054.01 " " 20,475.57 " " 7,527.11 " " 10,854.31 " " 13,567.88 " " 7,602.38 " " 7,677.65 " " 7,527.11 " " 23,074.32 " " 21,632.18 " " 21,632.18 " " 22,785.89 " " 17,788.46 " " 21,632.18 " " 7,677.65 " " 22,785.89 " Inpatient NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC 70 " 92,373.13 " " 29,106.77 " " 15,517.39 " " 73,898.50 " " 32,159.30 " " 15,672.56 " " 33,207.37 " " 15,517.39 " " 30,712.34 " " 15,517.39 " " 36,153.39 " " 16,603.61 " " 65,575.68 " " 15,517.39 " " 23,144.81 " " 28,931.01 " " 15,672.56 " " 15,827.74 " " 15,517.39 " " 73,898.50 " " 69,279.85 " " 69,279.85 " " 72,974.77 " " 37,958.96 " " 69,279.85 " " 15,827.74 " " 72,974.77 " Inpatient NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC 71 " 42,922.41 " " 13,524.85 " " 9,538.78 " " 34,337.93 " " 19,372.93 " " 9,634.17 " " 20,004.30 " " 9,538.78 " " 18,437.45 " " 9,538.78 " " 21,779.00 " " 10,206.49 " " 30,470.62 " " 9,538.78 " " 13,961.46 " " 17,451.82 " " 9,634.17 " " 9,729.56 " " 9,538.78 " " 34,337.93 " " 32,191.81 " " 32,191.81 " " 33,908.70 " " 22,866.68 " " 32,191.81 " " 9,729.56 " " 33,908.70 " Inpatient CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC 73 " 76,610.23 " " 24,139.88 " " 13,487.82 " " 61,288.19 " " 27,818.68 " " 13,622.70 " " 28,725.29 " " 13,487.82 " " 26,151.87 " " 13,487.82 " " 31,273.67 " " 14,431.97 " " 54,385.61 " " 13,487.82 " " 20,010.04 " " 25,012.55 " " 13,622.70 " " 13,757.58 " " 13,487.82 " " 61,288.19 " " 57,457.68 " " 57,457.68 " " 60,522.09 " " 32,835.54 " " 57,457.68 " " 13,757.58 " " 60,522.09 " Inpatient CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC 74 " 54,330.51 " " 17,119.54 " " 9,603.24 " " 43,464.40 " " 19,510.79 " " 9,699.27 " " 20,146.65 " " 9,603.24 " " 17,764.93 " " 9,603.24 " " 21,933.98 " " 10,275.47 " " 38,569.23 " " 9,603.24 " " 14,058.12 " " 17,572.65 " " 9,699.27 " " 9,795.30 " " 9,603.24 " " 43,464.40 " " 40,747.88 " " 40,747.88 " " 42,921.10 " " 23,029.40 " " 40,747.88 " " 9,795.30 " " 42,921.10 " Inpatient TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC 82 " 63,207.73 " " 19,916.75 " " 20,748.45 " " 50,566.18 " " 37,962.56 " " 20,955.93 " " 39,201.43 " " 20,748.45 " " 40,213.30 " " 20,748.45 " " 42,886.44 " " 22,200.84 " " 44,871.16 " " 20,748.45 " " 31,181.96 " " 38,977.46 " " 20,955.93 " " 21,163.42 " " 20,748.45 " " 50,566.18 " " 47,405.79 " " 47,405.79 " " 49,934.10 " " 42,665.21 " " 47,405.79 " " 21,163.42 " " 49,934.10 " Inpatient TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC 83 " 52,495.13 " " 16,541.22 " " 12,512.87 " " 41,996.11 " " 31,528.58 " " 12,638.00 " " 32,557.48 " " 12,512.87 " " 23,411.51 " " 12,512.87 " " 35,617.95 " " 13,388.77 " " 37,266.30 " " 12,512.87 " " 18,532.42 " " 23,165.52 " " 12,638.00 " " 12,763.13 " " 12,512.87 " " 41,996.11 " " 39,371.35 " " 39,371.35 " " 41,471.16 " " 35,434.22 " " 39,371.35 " " 12,763.13 " " 41,471.16 " Inpatient TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC 85 " 60,595.18 " " 19,093.54 " " 21,176.39 " " 48,476.14 " " 36,393.46 " " 21,388.15 " " 37,581.13 " " 21,176.39 " " 38,164.07 " " 21,176.39 " " 41,113.83 " " 22,658.74 " " 43,016.52 " " 21,176.39 " " 31,844.82 " " 39,806.03 " " 21,388.15 " " 21,599.92 " " 21,176.39 " " 48,476.14 " " 45,446.38 " " 45,446.38 " " 47,870.19 " " 40,901.74 " " 45,446.38 " " 21,599.92 " " 47,870.19 " Inpatient TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC 86 " 42,387.23 " " 13,356.22 " " 11,890.65 " " 33,909.78 " " 25,457.77 " " 12,009.56 " " 26,288.56 " " 11,890.65 " " 22,031.06 " " 11,890.65 " " 28,759.73 " " 12,723.00 " " 30,090.69 " " 11,890.65 " " 17,579.56 " " 21,974.45 " " 12,009.56 " " 12,128.46 " " 11,890.65 " " 33,909.78 " " 31,790.42 " " 31,790.42 " " 33,485.91 " " 28,611.38 " " 31,790.42 " " 12,128.46 " " 33,485.91 " Inpatient TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC 87 " 29,092.82 " " 9,167.15 " " 8,211.99 " " 23,274.26 " " 17,473.15 " " 8,294.11 " " 18,043.37 " " 8,211.99 " " 15,501.47 " " 8,211.99 " " 19,739.48 " " 8,786.83 " " 20,652.99 " " 8,211.99 " " 11,917.64 " " 14,897.05 " " 8,294.11 " " 8,376.23 " " 8,211.99 " " 23,274.26 " " 21,819.62 " " 21,819.62 " " 22,983.33 " " 19,637.65 " " 21,819.62 " " 8,376.23 " " 22,983.33 " Inpatient CONCUSSION WITH CC 89 " 39,006.52 " " 12,290.95 " " 10,001.64 " " 31,205.21 " " 20,362.83 " " 10,101.66 " " 21,026.46 " " 10,001.64 " " 18,756.02 " " 10,001.64 " " 22,891.84 " " 10,701.75 " " 27,690.73 " " 10,001.64 " " 14,651.93 " " 18,314.92 " " 10,101.66 " " 10,201.67 " " 10,001.64 " " 31,205.21 " " 29,254.89 " " 29,254.89 " " 30,815.15 " " 24,035.10 " " 29,254.89 " " 10,201.67 " " 30,815.15 " Inpatient OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC 91 " 69,740.02 " " 21,975.08 " " 15,259.56 " " 55,792.02 " " 41,885.86 " " 15,412.16 " " 43,252.76 " " 15,259.56 " " 40,295.78 " " 15,259.56 " " 47,318.61 " " 16,327.73 " " 49,508.44 " " 15,259.56 " " 22,771.95 " " 28,464.94 " " 15,412.16 " " 15,564.75 " " 15,259.56 " " 55,792.02 " " 52,305.02 " " 52,305.02 " " 55,094.62 " " 47,074.51 " " 52,305.02 " " 15,564.75 " " 55,094.62 " Inpatient OTHER DISORDERS OF NERVOUS SYSTEM WITH CC 92 " 37,305.65 " " 11,755.01 " " 9,333.76 " " 29,844.52 " " 22,405.77 " " 9,427.10 " " 23,136.96 " " 9,333.76 " " 21,555.20 " " 9,333.76 " " 25,311.88 " " 9,987.12 " " 26,483.28 " " 9,333.76 " " 13,616.22 " " 17,020.27 " " 9,427.10 " " 9,520.44 " " 9,333.76 " " 29,844.52 " " 27,979.23 " " 27,979.23 " " 29,471.46 " " 25,181.31 " " 27,979.23 " " 9,520.44 " " 29,471.46 " Inpatient OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC 93 " 36,122.47 " " 11,382.19 " " 7,483.24 " " 28,897.97 " " 21,695.15 " " 7,558.07 " " 22,403.15 " " 7,483.24 " " 13,588.24 " " 7,483.24 " " 24,509.09 " " 8,007.07 " " 25,643.34 " " 7,483.24 " " 10,785.26 " " 13,481.58 " " 7,558.07 " " 7,632.90 " " 7,483.24 " " 28,897.97 " " 27,091.85 " " 27,091.85 " " 28,536.75 " " 24,382.66 " " 27,091.85 " " 7,632.90 " " 28,536.75 " Inpatient BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC 95 " 96,766.53 " " 30,491.13 " " 22,927.54 " " 77,413.23 " " 48,007.27 " " 23,156.82 " " 49,571.83 " " 22,927.54 " " 43,808.75 " " 22,927.54 " " 53,969.63 " " 24,532.47 " " 68,694.56 " " 22,927.54 " " 28,807.36 " " 36,009.21 " " 23,156.82 " " 23,386.09 " " 22,927.54 " " 77,413.23 " " 72,574.90 " " 72,574.90 " " 76,445.56 " " 56,664.98 " " 72,574.90 " " 23,386.09 " " 76,445.56 " Inpatient NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC 98 " 87,589.36 " " 27,599.41 " " 19,393.02 " " 70,071.48 " " 40,448.04 " " 19,586.95 " " 41,766.24 " " 19,393.02 " " 34,905.79 " " 19,393.02 " " 45,471.56 " " 20,750.53 " " 62,179.68 " " 19,393.02 " " 29,151.96 " " 36,439.96 " " 19,586.95 " " 19,780.88 " " 19,393.02 " " 70,071.48 " " 65,692.02 " " 65,692.02 " " 69,195.59 " " 47,742.50 " " 65,692.02 " " 19,780.88 " " 69,195.59 " Inpatient SEIZURES WITH MCC 100 " 65,417.14 " " 20,612.94 " " 17,279.28 " " 52,333.71 " " 39,289.53 " " 17,452.07 " " 40,571.71 " " 17,279.28 " " 37,798.02 " " 17,279.28 " " 44,385.53 " " 18,488.83 " " 46,439.63 " " 17,279.28 " " 25,879.10 " " 32,348.88 " " 17,452.07 " " 17,624.87 " " 17,279.28 " " 52,333.71 " " 49,062.85 " " 49,062.85 " " 51,679.54 " " 44,156.57 " " 49,062.85 " " 17,624.87 " " 51,679.54 " Inpatient SEIZURES WITHOUT MCC 101 " 28,497.99 " " 8,979.72 " " 8,434.02 " " 22,798.40 " " 17,115.90 " " 8,518.36 " " 17,674.46 " " 8,434.02 " " 15,486.57 " " 8,434.02 " " 19,335.89 " " 9,024.40 " " 20,230.73 " " 8,434.02 " " 12,249.07 " " 15,311.34 " " 8,518.36 " " 8,602.70 " " 8,434.02 " " 22,798.40 " " 21,373.50 " " 21,373.50 " " 22,513.42 " " 19,236.15 " " 21,373.50 " " 8,602.70 " " 22,513.42 " Inpatient HEADACHES WITHOUT MCC 103 " 31,920.27 " " 10,058.08 " " 7,906.70 " " 25,536.22 " " 15,882.44 " " 7,985.77 " " 16,400.04 " " 7,906.70 " " 13,970.13 " " 7,906.70 " " 17,854.99 " " 8,460.17 " " 22,660.20 " " 7,906.70 " " 11,434.31 " " 14,292.89 " " 7,985.77 " " 8,064.83 " " 7,906.70 " " 25,536.22 " " 23,940.20 " " 23,940.20 " " 25,217.01 " " 18,746.70 " " 23,940.20 " " 8,064.83 " " 25,217.01 " Inpatient NEUROLOGICAL EYE DISORDERS 123 " 39,368.04 " " 12,404.87 " " 7,345.37 " " 31,494.43 " " 14,681.92 " " 7,418.82 " " 15,160.40 " " 7,345.37 " " 13,953.38 " " 7,345.37 " " 16,505.37 " " 7,859.55 " " 27,947.37 " " 7,345.37 " " 10,564.31 " " 13,205.38 " " 7,418.82 " " 7,492.28 " " 7,345.37 " " 31,494.43 " " 29,526.03 " " 29,526.03 " " 31,100.75 " " 17,329.68 " " 29,526.03 " " 7,492.28 " " 31,100.75 " Inpatient OTHER DISORDERS OF THE EYE WITHOUT MCC 125 " 34,802.57 " " 10,966.29 " " 7,973.85 " " 27,842.06 " " 16,026.04 " " 8,053.59 " " 16,548.33 " " 7,973.85 " " 14,383.72 " " 7,973.85 " " 18,016.43 " " 8,532.02 " " 24,706.35 " " 7,973.85 " " 11,530.97 " " 14,413.72 " " 8,053.59 " " 8,133.33 " " 7,973.85 " " 27,842.06 " " 26,101.93 " " 26,101.93 " " 27,494.03 " " 18,916.20 " " 26,101.93 " " 8,133.33 " " 27,494.03 " Inpatient MAJOR HEAD AND NECK PROCEDURES WITH CC 141 " 102,549.35 " " 32,313.30 " " 20,230.99 " " 82,039.48 " " 42,240.20 " " 20,433.30 " " 43,616.80 " " 20,230.99 " " 41,125.17 " " 20,230.99 " " 47,486.30 " " 21,647.16 " " 72,799.78 " " 20,230.99 " " 30,491.49 " " 38,114.36 " " 20,433.30 " " 20,635.61 " " 20,230.99 " " 82,039.48 " " 76,912.01 " " 76,912.01 " " 81,013.99 " " 49,857.86 " " 76,912.01 " " 20,635.61 " " 81,013.99 " Inpatient "OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC" 145 " 54,857.69 " " 17,285.66 " " 11,443.91 " " 43,886.15 " " 23,447.42 " " 11,558.35 " " 24,211.57 " " 11,443.91 " " 22,607.76 " " 11,443.91 " " 26,359.52 " " 12,244.98 " " 38,943.47 " " 11,443.91 " " 16,764.79 " " 20,956.00 " " 11,558.35 " " 11,672.79 " " 11,443.91 " " 43,886.15 " " 41,143.27 " " 41,143.27 " " 43,337.58 " " 27,675.96 " " 41,143.27 " " 11,672.79 " " 43,337.58 " Inpatient OTITIS MEDIA AND URI WITH MCC 152 " 58,342.52 " " 18,383.73 " " 10,153.83 " " 46,674.02 " " 35,040.52 " " 10,255.37 " " 36,184.03 " " 10,153.83 " " 33,710.31 " " 10,153.83 " " 39,585.40 " " 10,864.60 " " 41,417.36 " " 10,153.83 " " 14,872.89 " " 18,591.11 " " 10,255.37 " " 10,356.91 " " 10,153.83 " " 46,674.02 " " 43,756.89 " " 43,756.89 " " 46,090.59 " " 39,381.20 " " 43,756.89 " " 10,356.91 " " 46,090.59 " Inpatient OTITIS MEDIA AND URI WITHOUT MCC 153 " 20,573.28 " " 6,482.64 " " 6,865.50 " " 16,458.63 " " 12,356.31 " " 6,934.16 " " 12,759.55 " " 6,865.50 " " 13,321.84 " " 6,865.50 " " 13,958.97 " " 7,346.09 " " 14,604.97 " " 6,865.50 " " 9,818.59 " " 12,273.24 " " 6,934.16 " " 7,002.81 " " 6,865.50 " " 16,458.63 " " 15,429.96 " " 15,429.96 " " 16,252.89 " " 13,886.97 " " 15,429.96 " " 7,002.81 " " 16,252.89 " Inpatient "OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC" 155 " 26,004.25 " " 8,193.94 " " 8,622.92 " " 20,803.40 " " 17,414.20 " " 8,709.15 " " 17,981.72 " " 8,622.92 " " 16,719.84 " " 8,622.92 " " 19,576.99 " " 9,226.52 " " 18,460.41 " " 8,622.92 " " 12,525.26 " " 15,656.58 " " 8,709.15 " " 8,795.38 " " 8,622.92 " " 20,803.40 " " 19,503.18 " " 19,503.18 " " 20,543.35 " " 20,554.70 " " 19,503.18 " " 8,795.38 " " 20,543.35 " Inpatient DENTAL AND ORAL DISEASES WITH MCC 157 " 65,676.47 " " 20,694.66 " " 14,591.68 " " 52,541.18 " " 30,179.50 " " 14,737.60 " " 31,163.05 " " 14,591.68 " " 28,815.86 " " 14,591.68 " " 33,927.71 " " 15,613.10 " " 46,623.73 " " 14,591.68 " " 21,708.61 " " 27,135.77 " " 14,737.60 " " 14,883.51 " " 14,591.68 " " 52,541.18 " " 49,257.35 " " 49,257.35 " " 51,884.41 " " 35,622.12 " " 49,257.35 " " 14,883.51 " " 51,884.41 " Inpatient DENTAL AND ORAL DISEASES WITH CC 158 " 31,025.73 " " 9,776.21 " " 8,539.66 " " 24,820.58 " " 17,236.13 " " 8,625.06 " " 17,797.85 " " 8,539.66 " " 16,554.04 " " 8,539.66 " " 19,376.81 " " 9,137.44 " " 22,025.17 " " 8,539.66 " " 12,276.69 " " 15,345.86 " " 8,625.06 " " 8,710.45 " " 8,539.66 " " 24,820.58 " " 23,269.30 " " 23,269.30 " " 24,510.33 " " 20,344.52 " " 23,269.30 " " 8,710.45 " " 24,510.33 " Inpatient MAJOR CHEST PROCEDURES WITH MCC 163 " 204,809.14 " " 64,535.36 " " 45,304.81 " " 163,847.31 " " 123,008.37 " " 45,757.86 " " 127,022.63 " " 45,304.81 " " 118,338.72 " " 45,304.81 " " 138,963.00 " " 48,476.15 " " 145,394.01 " " 45,304.81 " " 65,517.00 " " 81,896.29 " " 45,757.86 " " 46,210.91 " " 45,304.81 " " 163,847.31 " " 153,606.85 " " 153,606.85 " " 161,799.22 " " 138,246.17 " " 153,606.85 " " 46,210.91 " " 161,799.22 " Inpatient MAJOR CHEST PROCEDURES WITH CC 164 " 96,420.39 " " 30,382.06 " " 24,255.23 " " 77,136.31 " " 57,910.08 " " 24,497.78 " " 59,799.92 " " 24,255.23 " " 55,711.70 " " 24,255.23 " " 65,421.23 " " 25,953.10 " " 68,448.83 " " 24,255.23 " " 34,851.72 " " 43,564.66 " " 24,497.78 " " 24,740.33 " " 24,255.23 " " 77,136.31 " " 72,315.29 " " 72,315.29 " " 76,172.11 " " 65,083.76 " " 72,315.29 " " 24,740.33 " " 76,172.11 " Inpatient MAJOR CHEST PROCEDURES WITHOUT CC/MCC 165 " 74,317.83 " " 23,417.55 " " 17,639.18 " " 59,454.26 " " 44,635.29 " " 17,815.57 " " 46,091.92 " " 17,639.18 " " 34,475.46 " " 17,639.18 " " 50,424.65 " " 18,873.92 " " 52,758.23 " " 17,639.18 " " 25,277.07 " " 31,596.35 " " 17,815.57 " " 17,991.96 " " 17,639.18 " " 59,454.26 " " 55,738.37 " " 55,738.37 " " 58,711.08 " " 50,164.53 " " 55,738.37 " " 17,991.96 " " 58,711.08 " Inpatient OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC 166 " 134,820.17 " " 42,481.84 " " 33,815.81 " " 107,856.14 " " 80,972.99 " " 34,153.97 " " 83,615.47 " " 33,815.81 " " 66,089.44 " " 33,815.81 " " 91,475.49 " " 36,182.92 " " 95,708.84 " " 33,815.81 " " 43,544.15 " " 54,430.19 " " 34,153.97 " " 34,492.13 " " 33,815.81 " " 107,856.14 " " 101,115.13 " " 101,115.13 " " 106,507.93 " " 91,003.61 " " 101,115.13 " " 34,492.13 " " 106,507.93 " Inpatient OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC 167 " 84,190.74 " " 26,528.50 " " 16,762.71 " " 67,352.59 " " 34,822.65 " " 16,930.34 " " 35,957.52 " " 16,762.71 " " 34,456.82 " " 16,762.71 " " 39,147.52 " " 17,936.10 " " 59,767.01 " " 16,762.71 " " 25,713.38 " " 32,141.73 " " 16,930.34 " " 17,097.96 " " 16,762.71 " " 67,352.59 " " 63,143.06 " " 63,143.06 " " 66,510.68 " " 41,102.62 " " 63,143.06 " " 17,097.96 " " 66,510.68 " Inpatient OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC 168 " 49,104.74 " " 15,472.90 " " 12,605.98 " " 39,283.79 " " 25,932.70 " " 12,732.04 " " 26,777.84 " " 12,605.98 " " 24,033.71 " " 12,605.98 " " 29,153.46 " " 13,488.40 " " 34,859.45 " " 12,605.98 " " 18,905.27 " " 23,631.60 " " 12,732.04 " " 12,858.10 " " 12,605.98 " " 39,283.79 " " 36,828.55 " " 36,828.55 " " 38,792.74 " " 30,609.44 " " 36,828.55 " " 12,858.10 " " 38,792.74 " Inpatient PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE 175 " 57,688.33 " " 18,177.59 " " 14,321.31 " " 46,150.66 " " 29,601.26 " " 14,464.52 " " 30,565.97 " " 14,321.31 " " 27,347.87 " " 14,321.31 " " 33,277.65 " " 15,323.80 " " 40,952.94 " " 14,321.31 " " 21,321.95 " " 26,652.44 " " 14,464.52 " " 14,607.74 " " 14,321.31 " " 46,150.66 " " 43,266.24 " " 43,266.24 " " 45,573.78 " " 34,939.60 " " 43,266.24 " " 14,607.74 " " 45,573.78 " Inpatient PULMONARY EMBOLISM WITHOUT MCC 176 " 30,704.40 " " 9,674.96 " " 8,428.65 " " 24,563.52 " " 16,998.71 " " 8,512.94 " " 17,552.69 " " 8,428.65 " " 16,678.84 " " 8,428.65 " " 19,109.90 " " 9,018.66 " " 21,797.05 " " 8,428.65 " " 12,249.07 " " 15,311.34 " " 8,512.94 " " 8,597.22 " " 8,428.65 " " 24,563.52 " " 23,028.30 " " 23,028.30 " " 24,256.47 " " 20,064.28 " " 23,028.30 " " 8,597.22 " " 24,256.47 " Inpatient RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC 177 " 47,689.93 " " 15,027.10 " " 17,034.88 " " 41,789.66 " " 35,404.72 " " 17,205.23 " " 36,558.56 " " 17,034.88 " " 34,481.05 " " 17,034.88 " " 39,801.88 " " 18,227.32 " " 33,855.08 " " 17,034.88 " " 25,478.62 " " 31,848.28 " " 17,205.23 " " 17,375.58 " " 17,034.88 " " 38,151.95 " " 35,767.45 " " 35,767.45 " " 37,675.05 " " 41,789.66 " " 35,767.45 " " 17,375.58 " " 37,675.05 " Inpatient RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC 178 " 42,101.24 " " 13,266.10 " " 11,293.51 " " 33,681.00 " " 23,125.75 " " 11,406.45 " " 23,879.41 " " 11,293.51 " " 24,134.31 " " 11,293.51 " " 25,997.90 " " 12,084.06 " " 29,887.67 " " 11,293.51 " " 16,654.32 " " 20,817.90 " " 11,406.45 " " 11,519.38 " " 11,293.51 " " 33,681.00 " " 31,575.93 " " 31,575.93 " " 33,259.98 " " 27,296.28 " " 31,575.93 " " 11,519.38 " " 33,259.98 " Inpatient RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC 179 " 54,100.60 " " 17,047.10 " " 8,293.46 " " 43,280.48 " " 16,709.59 " " 8,376.39 " " 17,254.15 " " 8,293.46 " " 17,327.15 " " 8,293.46 " " 18,784.87 " " 8,874.00 " " 38,406.01 " " 8,293.46 " " 12,028.12 " " 15,035.15 " " 8,376.39 " " 8,459.33 " " 8,293.46 " " 43,280.48 " " 40,575.45 " " 40,575.45 " " 42,739.47 " " 19,723.02 " " 40,575.45 " " 8,459.33 " " 42,739.47 " Inpatient RESPIRATORY NEOPLASMS WITH MCC 180 " 60,165.42 " " 18,958.12 " " 16,057.24 " " 48,132.34 " " 33,313.87 " " 16,217.81 " " 34,399.56 " " 16,057.24 " " 31,472.41 " " 16,057.24 " " 37,451.35 " " 17,181.25 " " 42,711.43 " " 16,057.24 " " 24,001.00 " " 30,001.25 " " 16,217.81 " " 16,378.38 " " 16,057.24 " " 48,132.34 " " 45,124.07 " " 45,124.07 " " 47,530.68 " " 39,321.74 " " 45,124.07 " " 16,378.38 " " 47,530.68 " Inpatient RESPIRATORY NEOPLASMS WITH CC 181 " 42,993.39 " " 13,547.22 " " 10,508.36 " " 34,394.71 " " 21,446.55 " " 10,613.44 " " 22,145.50 " " 10,508.36 " " 21,537.38 " " 10,508.36 " " 24,110.15 " " 11,243.95 " " 30,521.01 " " 10,508.36 " " 15,480.51 " " 19,350.63 " " 10,613.44 " " 10,718.53 " " 10,508.36 " " 34,394.71 " " 32,245.04 " " 32,245.04 " " 33,964.78 " " 25,314.26 " " 32,245.04 " " 10,718.53 " " 33,964.78 " Inpatient MAJOR CHEST TRAUMA WITH MCC 183 " 64,598.44 " " 20,354.97 " " 14,436.80 " " 51,678.75 " " 29,848.26 " " 14,581.17 " " 30,821.01 " " 14,436.80 " " 27,511.80 " " 14,436.80 " " 33,555.32 " " 15,447.38 " " 45,858.43 " " 14,436.80 " " 21,487.66 " " 26,859.58 " " 14,581.17 " " 14,725.54 " " 14,436.80 " " 51,678.75 " " 48,448.83 " " 48,448.83 " " 51,032.77 " " 35,231.14 " " 48,448.83 " " 14,725.54 " " 51,032.77 " Inpatient MAJOR CHEST TRAUMA WITH CC 184 " 55,770.00 " " 17,573.13 " " 9,799.30 " " 44,616.00 " " 19,930.11 " " 9,897.29 " " 20,579.63 " " 9,799.30 " " 18,906.92 " " 9,799.30 " " 22,405.37 " " 10,485.25 " " 39,591.13 " " 9,799.30 " " 14,348.12 " " 17,935.16 " " 9,897.29 " " 9,995.29 " " 9,799.30 " " 44,616.00 " " 41,827.50 " " 41,827.50 " " 44,058.30 " " 23,524.34 " " 41,827.50 " " 9,995.29 " " 44,058.30 " Inpatient PLEURAL EFFUSION WITH MCC 186 " 109,844.66 " " 34,612.05 " " 14,301.62 " " 87,875.73 " " 29,559.14 " " 14,444.64 " " 30,522.47 " " 14,301.62 " " 28,404.17 " " 14,301.62 " " 33,230.30 " " 15,302.73 " " 77,978.72 " " 14,301.62 " " 21,308.14 " " 26,635.17 " " 14,444.64 " " 14,587.65 " " 14,301.62 " " 87,875.73 " " 82,383.49 " " 82,383.49 " " 86,777.28 " " 34,889.88 " " 82,383.49 " " 14,587.65 " " 86,777.28 " Inpatient PLEURAL EFFUSION WITH CC 187 " 41,429.38 " " 13,054.40 " " 9,727.68 " " 33,143.51 " " 19,776.94 " " 9,824.96 " " 20,421.47 " " 9,727.68 " " 19,689.35 " " 9,727.68 " " 22,233.17 " " 10,408.62 " " 29,410.72 " " 9,727.68 " " 14,251.46 " " 17,814.32 " " 9,824.96 " " 9,922.23 " " 9,727.68 " " 33,143.51 " " 31,072.04 " " 31,072.04 " " 32,729.21 " " 23,343.54 " " 31,072.04 " " 9,922.23 " " 32,729.21 " Inpatient PULMONARY EDEMA AND RESPIRATORY FAILURE 189 " 63,153.87 " " 19,899.78 " " 11,457.34 " " 50,523.10 " " 37,930.21 " " 11,571.91 " " 39,168.03 " " 11,457.34 " " 22,724.08 " " 11,457.34 " " 42,849.90 " " 12,259.35 " " 44,832.93 " " 11,457.34 " " 16,916.70 " " 21,145.88 " " 11,571.91 " " 11,686.49 " " 11,457.34 " " 50,523.10 " " 47,365.40 " " 47,365.40 " " 49,891.56 " " 42,628.86 " " 47,365.40 " " 11,686.49 " " 49,891.56 " Inpatient CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC 190 " 43,759.67 " " 13,788.67 " " 10,553.12 " " 35,007.74 " " 21,542.29 " " 10,658.65 " " 22,244.35 " " 10,553.12 " " 21,475.90 " " 10,553.12 " " 24,217.78 " " 11,291.84 " " 31,064.99 " " 10,553.12 " " 15,521.93 " " 19,402.42 " " 10,658.65 " " 10,764.18 " " 10,553.12 " " 35,007.74 " " 32,819.75 " " 32,819.75 " " 34,570.14 " " 25,427.26 " " 32,819.75 " " 10,764.18 " " 34,570.14 " Inpatient CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC 191 " 43,633.87 " " 13,749.03 " " 8,397.31 " " 34,907.10 " " 16,931.69 " " 8,481.28 " " 17,483.50 " " 8,397.31 " " 17,098.02 " " 8,397.31 " " 19,034.56 " " 8,985.12 " " 30,975.68 " " 8,397.31 " " 12,193.83 " " 15,242.29 " " 8,481.28 " " 8,565.26 " " 8,397.31 " " 34,907.10 " " 32,725.40 " " 32,725.40 " " 34,470.76 " " 19,985.18 " " 32,725.40 " " 8,565.26 " " 34,470.76 " Inpatient SIMPLE PNEUMONIA AND PLEURISY WITH MCC 193 " 45,664.36 " " 14,388.84 " " 12,226.38 " " 36,531.49 " " 25,120.86 " " 12,348.64 " " 25,939.55 " " 12,226.38 " " 25,583.67 " " 12,226.38 " " 28,240.80 " " 13,082.23 " " 32,417.13 " " 12,226.38 " " 18,104.32 " " 22,630.40 " " 12,348.64 " " 12,470.91 " " 12,226.38 " " 36,531.49 " " 34,248.27 " " 34,248.27 " " 36,074.85 " " 29,651.20 " " 34,248.27 " " 12,470.91 " " 36,074.85 " Inpatient SIMPLE PNEUMONIA AND PLEURISY WITH CC 194 " 39,382.87 " " 12,409.54 " " 8,214.68 " " 31,506.30 " " 16,541.09 " " 8,296.83 " " 17,080.17 " " 8,214.68 " " 17,386.75 " " 8,214.68 " " 18,595.45 " " 8,789.71 " " 27,957.90 " " 8,214.68 " " 11,917.64 " " 14,897.05 " " 8,296.83 " " 8,378.97 " " 8,214.68 " " 31,506.30 " " 29,537.15 " " 29,537.15 " " 31,112.47 " " 19,524.14 " " 29,537.15 " " 8,378.97 " " 31,112.47 " Inpatient INTERSTITIAL LUNG DISEASE WITH MCC 196 " 126,782.71 " " 39,949.23 " " 16,045.60 " " 101,426.17 " " 33,288.97 " " 16,206.06 " " 34,373.86 " " 16,045.60 " " 29,739.88 " " 16,045.60 " " 37,423.37 " " 17,168.79 " " 90,003.05 " " 16,045.60 " " 23,973.38 " " 29,966.73 " " 16,206.06 " " 16,366.51 " " 16,045.60 " " 101,426.17 " " 95,087.04 " " 95,087.04 " " 100,158.34 " " 39,292.36 " " 95,087.04 " " 16,366.51 " " 100,158.34 " Inpatient PNEUMOTHORAX WITH MCC 199 " 72,004.64 " " 22,688.66 " " 16,505.77 " " 57,603.71 " " 34,273.13 " " 16,670.83 " " 35,390.09 " " 16,505.77 " " 33,657.63 " " 16,505.77 " " 38,529.75 " " 17,661.17 " " 51,116.09 " " 16,505.77 " " 24,691.48 " " 30,864.35 " " 16,670.83 " " 16,835.89 " " 16,505.77 " " 57,603.71 " " 54,003.48 " " 54,003.48 " " 56,883.66 " " 40,454.00 " " 54,003.48 " " 16,835.89 " " 56,883.66 " Inpatient PNEUMOTHORAX WITH CC 200 " 52,173.39 " " 16,439.83 " " 10,118.02 " " 41,738.71 " " 20,611.75 " " 10,219.20 " " 21,283.48 " " 10,118.02 " " 19,769.47 " " 10,118.02 " " 23,171.66 " " 10,826.28 " " 37,037.89 " " 10,118.02 " " 14,845.27 " " 18,556.59 " " 10,219.20 " " 10,320.38 " " 10,118.02 " " 41,738.71 " " 39,130.04 " " 39,130.04 " " 41,216.98 " " 24,328.90 " " 39,130.04 " " 10,320.38 " " 41,216.98 " Inpatient PNEUMOTHORAX WITHOUT CC/MCC 201 " 25,150.77 " " 7,925.01 " " 6,833.28 " " 20,120.61 " " 13,586.71 " " 6,901.61 " " 14,029.50 " " 6,833.28 " " 14,160.16 " " 6,833.28 " " 15,274.14 " " 7,311.61 " " 17,854.53 " " 6,833.28 " " 9,804.78 " " 12,255.98 " " 6,901.61 " " 6,969.95 " " 6,833.28 " " 20,120.61 " " 18,863.08 " " 18,863.08 " " 19,869.11 " " 16,036.96 " " 18,863.08 " " 6,969.95 " " 19,869.11 " Inpatient BRONCHITIS AND ASTHMA WITH CC/MCC 202 " 50,226.83 " " 15,826.47 " " 9,137.70 " " 40,181.46 " " 30,166.23 " " 9,229.08 " " 31,150.68 " " 9,137.70 " " 29,021.06 " " 9,137.70 " " 34,078.90 " " 9,777.34 " " 35,656.03 " " 9,137.70 " " 13,340.03 " " 16,675.03 " " 9,229.08 " " 9,320.45 " " 9,137.70 " " 40,181.46 " " 37,670.12 " " 37,670.12 " " 39,679.19 " " 33,903.11 " " 37,670.12 " " 9,320.45 " " 39,679.19 " Inpatient BRONCHITIS AND ASTHMA WITHOUT CC/MCC 203 " 39,013.78 " " 12,293.24 " " 6,810.00 " " 31,211.02 " " 23,431.68 " " 6,878.10 " " 24,196.35 " " 6,810.00 " " 13,144.86 " " 6,810.00 " " 26,470.85 " " 7,286.70 " " 27,695.88 " " 6,810.00 " " 9,749.54 " " 12,186.93 " " 6,878.10 " " 6,946.20 " " 6,810.00 " " 31,211.02 " " 29,260.33 " " 29,260.33 " " 30,820.89 " " 26,334.30 " " 29,260.33 " " 6,946.20 " " 30,820.89 " Inpatient RESPIRATORY SIGNS AND SYMPTOMS 204 " 35,976.38 " " 11,336.16 " " 7,585.30 " " 28,781.10 " " 15,195.06 " " 7,661.15 " " 15,690.27 " " 7,585.30 " " 14,273.80 " " 7,585.30 " " 17,082.24 " " 8,116.27 " " 25,539.63 " " 7,585.30 " " 10,950.97 " " 13,688.72 " " 7,661.15 " " 7,737.01 " " 7,585.30 " " 28,781.10 " " 26,982.28 " " 26,982.28 " " 28,421.34 " " 17,935.36 " " 26,982.28 " " 7,737.01 " " 28,421.34 " Inpatient OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC 205 " 48,187.23 " " 15,183.80 " " 15,563.95 " " 38,549.78 " " 32,258.87 " " 15,719.59 " " 33,310.18 " " 15,563.95 " " 27,809.87 " " 15,563.95 " " 36,265.32 " " 16,653.43 " " 34,208.11 " " 15,563.95 " " 23,227.66 " " 29,034.58 " " 15,719.59 " " 15,875.23 " " 15,563.95 " " 38,549.78 " " 36,140.42 " " 36,140.42 " " 38,067.91 " " 38,076.48 " " 36,140.42 " " 15,875.23 " " 38,067.91 " Inpatient OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC 206 " 30,973.01 " " 9,759.60 " " 8,412.53 " " 24,778.41 " " 16,964.24 " " 8,496.66 " " 17,517.11 " " 8,412.53 " " 15,868.48 " " 8,412.53 " " 19,071.15 " " 9,001.41 " " 21,987.74 " " 8,412.53 " " 12,207.64 " " 15,259.55 " " 8,496.66 " " 8,580.78 " " 8,412.53 " " 24,778.41 " " 23,229.76 " " 23,229.76 " " 24,468.68 " " 20,023.60 " " 23,229.76 " " 8,580.78 " " 24,468.68 " Inpatient RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS 207 " 299,303.89 " " 94,310.66 " " 51,834.02 " " 239,443.11 " " 179,761.92 " " 52,352.36 " " 185,628.27 " " 51,834.02 " " 172,937.79 " " 51,834.02 " " 203,077.69 " " 55,462.40 " " 212,475.83 " " 51,834.02 " " 65,769.92 " " 82,212.42 " " 52,352.36 " " 52,870.70 " " 51,834.02 " " 239,443.11 " " 224,477.92 " " 224,477.92 " " 236,450.07 " " 202,030.13 " " 224,477.92 " " 52,870.70 " " 236,450.07 " Inpatient RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS 208 " 110,356.43 " " 34,773.31 " " 23,263.27 " " 88,285.14 " " 66,280.07 " " 23,495.90 " " 68,443.06 " " 23,263.27 " " 63,763.94 " " 23,263.27 " " 74,876.84 " " 24,891.70 " " 78,342.03 " " 23,263.27 " " 29,197.89 " " 36,497.38 " " 23,495.90 " " 23,728.54 " " 23,263.27 " " 88,285.14 " " 82,767.32 " " 82,767.32 " " 87,181.58 " " 74,490.59 " " 82,767.32 " " 23,728.54 " " 87,181.58 " Inpatient OTHER HEART ASSIST SYSTEM IMPLANT 215 " 643,613.29 " " 202,802.55 " " 95,006.61 " " 514,890.64 " " 202,161.68 " " 95,956.68 " " 208,750.13 " " 95,006.61 " " 240,059.53 " " 95,006.61 " " 227,269.56 " " 101,657.07 " " 456,901.08 " " 95,006.61 " " 147,357.12 " " 184,196.49 " " 95,956.68 " " 96,906.74 " " 95,006.61 " " 514,890.64 " " 482,709.97 " " 482,709.97 " " 508,454.50 " " 238,619.84 " " 482,709.97 " " 96,906.74 " " 508,454.50 " Inpatient CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZATION WITH MCC 216 " 601,090.42 " " 189,403.59 " " 90,359.27 " " 480,872.33 " " 192,222.48 " " 91,262.86 " " 198,487.00 " " 90,359.27 " " 176,922.85 " " 90,359.27 " " 216,095.93 " " 96,684.42 " " 426,714.09 " " 90,359.27 " " 137,742.86 " " 172,178.65 " " 91,262.86 " " 92,166.46 " " 90,359.27 " " 480,872.33 " " 450,817.81 " " 450,817.81 " " 474,861.43 " " 226,888.18 " " 450,817.81 " " 92,166.46 " " 474,861.43 " Inpatient CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH MCC 219 " 309,403.89 " " 97,493.17 " " 72,617.71 " " 247,523.11 " " 154,278.87 " " 73,343.89 " " 159,306.81 " " 72,617.71 " " 141,668.67 " " 72,617.71 " " 173,439.84 " " 77,700.95 " " 219,645.82 " " 72,617.71 " " 106,377.63 " " 132,972.10 " " 73,343.89 " " 74,070.06 " " 72,617.71 " " 247,523.11 " " 232,052.92 " " 232,052.92 " " 244,429.07 " " 182,101.76 " " 232,052.92 " " 74,070.06 " " 244,429.07 " Inpatient CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITH CC 220 " 230,582.90 " " 72,656.67 " " 48,872.46 " " 184,466.32 " " 103,495.28 " " 49,361.18 " " 106,868.19 " " 48,872.46 " " 95,738.03 " " 48,872.46 " " 116,349.08 " " 52,293.53 " " 163,690.80 " " 48,872.46 " " 71,314.61 " " 89,143.31 " " 49,361.18 " " 49,849.91 " " 48,872.46 " " 184,466.32 " " 172,937.18 " " 172,937.18 " " 182,160.49 " " 122,159.78 " " 172,937.18 " " 49,849.91 " " 182,160.49 " Inpatient CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITHOUT CARDIAC CATHETERIZATION WITHOUT CC/MCC 221 " 210,161.65 " " 66,221.94 " " 41,482.91 " " 168,129.32 " " 87,691.35 " " 41,897.74 " " 90,549.20 " " 41,482.91 " " 85,400.61 " " 41,482.91 " " 98,582.35 " " 44,386.71 " " 149,193.76 " " 41,482.91 " " 60,115.58 " " 75,144.51 " " 41,897.74 " " 42,312.57 " " 41,482.91 " " 168,129.32 " " 157,621.24 " " 157,621.24 " " 166,027.71 " " 103,505.74 " " 157,621.24 " " 42,312.57 " " 166,027.71 " Inpatient CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC 227 " 296,755.91 " " 93,507.79 " " 47,142.80 " " 237,404.73 " " 99,796.08 " " 47,614.23 " " 103,048.43 " " 47,142.80 " " 100,686.00 " " 47,142.80 " " 112,190.45 " " 50,442.80 " " 210,667.02 " " 47,142.80 " " 69,360.07 " " 86,700.12 " " 47,614.23 " " 48,085.66 " " 47,142.80 " " 237,404.73 " " 222,566.93 " " 222,566.93 " " 234,437.17 " " 117,793.46 " " 222,566.93 " " 48,085.66 " " 234,437.17 " Inpatient OTHER CARDIOTHORACIC PROCEDURES WITH MCC 228 " 239,518.84 " " 75,472.38 " " 48,201.01 " " 191,615.07 " " 143,855.01 " " 48,683.02 " " 148,549.58 " " 48,201.01 " " 138,393.98 " " 48,201.01 " " 162,513.53 " " 51,575.08 " " 170,034.42 " " 48,201.01 " " 82,077.84 " " 102,597.34 " " 48,683.02 " " 49,165.03 " " 48,201.01 " " 191,615.07 " " 179,639.13 " " 179,639.13 " " 189,219.88 " " 161,675.21 " " 179,639.13 " " 49,165.03 " " 189,219.88 " Inpatient OTHER CARDIOTHORACIC PROCEDURES WITHOUT MCC 229 " 193,770.92 " " 61,057.22 " " 31,288.47 " " 155,016.74 " " 116,378.82 " " 31,601.35 " " 120,176.73 " " 31,288.47 " " 85,357.76 " " 31,288.47 " " 131,473.57 " " 33,478.66 " " 137,557.98 " " 31,288.47 " " 52,667.16 " " 65,833.98 " " 31,601.35 " " 31,914.24 " " 31,288.47 " " 155,016.74 " " 145,328.19 " " 145,328.19 " " 153,079.03 " " 130,795.37 " " 145,328.19 " " 31,914.24 " " 153,079.03 " Inpatient CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC 233 " 341,037.84 " " 107,461.02 " " 71,406.41 " " 272,830.27 " " 151,688.28 " " 72,120.47 " " 156,631.79 " " 71,406.41 " " 136,808.29 " " 71,406.41 " " 170,527.51 " " 76,404.86 " " 242,102.76 " " 71,406.41 " " 102,917.55 " " 128,647.00 " " 72,120.47 " " 72,834.54 " " 71,406.41 " " 272,830.27 " " 255,778.38 " " 255,778.38 " " 269,419.89 " " 179,043.98 " " 255,778.38 " " 72,834.54 " " 269,419.89 " Inpatient CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC 234 " 201,527.32 " " 63,501.26 " " 48,252.04 " " 161,221.85 " " 102,168.39 " " 48,734.56 " " 105,498.06 " " 48,252.04 " " 94,206.70 " " 48,252.04 " " 114,857.40 " " 51,629.68 " " 143,064.24 " " 48,252.04 " " 70,218.48 " " 87,773.14 " " 48,734.56 " " 49,217.08 " " 48,252.04 " " 161,221.85 " " 151,145.49 " " 151,145.49 " " 159,206.58 " " 120,593.60 " " 151,145.49 " " 49,217.08 " " 159,206.58 " Inpatient CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC 235 " 242,487.02 " " 76,407.66 " " 55,128.61 " " 193,989.62 " " 145,637.71 " " 55,679.90 " " 150,390.45 " " 55,128.61 " " 140,109.00 " " 55,128.61 " " 164,527.44 " " 58,987.61 " " 172,141.54 " " 55,128.61 " " 79,634.65 " " 99,543.36 " " 55,679.90 " " 56,231.18 " " 55,128.61 " " 193,989.62 " " 181,865.27 " " 181,865.27 " " 191,564.75 " " 163,678.74 " " 181,865.27 " " 56,231.18 " " 191,564.75 " Inpatient CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC 236 " 177,290.23 " " 55,864.15 " " 37,159.65 " " 141,832.18 " " 106,480.51 " " 37,531.25 " " 109,955.40 " " 37,159.65 " " 72,348.89 " " 37,159.65 " " 120,291.42 " " 39,760.83 " " 125,858.33 " " 37,159.65 " " 53,895.36 " " 67,369.23 " " 37,531.25 " " 37,902.84 " " 37,159.65 " " 141,832.18 " " 132,967.67 " " 132,967.67 " " 140,059.28 " " 119,670.90 " " 132,967.67 " " 37,902.84 " " 140,059.28 " Inpatient AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC 239 " 185,410.46 " " 58,422.84 " " 43,596.64 " " 148,328.37 " " 92,211.95 " " 44,032.61 " " 95,217.14 " " 43,596.64 " " 86,550.05 " " 43,596.64 " " 103,664.40 " " 46,648.40 " " 131,622.89 " " 43,596.64 " " 63,509.63 " " 79,387.07 " " 44,032.61 " " 44,468.57 " " 43,596.64 " " 148,328.37 " " 139,057.85 " " 139,057.85 " " 146,474.26 " " 108,841.60 " " 139,057.85 " " 44,468.57 " " 146,474.26 " Inpatient AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC 240 " 122,760.73 " " 38,681.91 " " 25,447.73 " " 98,208.58 " " 53,397.15 " " 25,702.21 " " 55,137.36 " " 25,447.73 " " 49,686.30 " " 25,447.73 " " 60,028.92 " " 27,229.07 " " 87,147.84 " " 25,447.73 " " 36,845.88 " " 46,057.38 " " 25,702.21 " " 25,956.68 " " 25,447.73 " " 98,208.58 " " 92,070.55 " " 92,070.55 " " 96,980.97 " " 63,026.88 " " 92,070.55 " " 25,956.68 " " 96,980.97 " Inpatient PERMANENT CARDIAC PACEMAKER IMPLANT WITH MCC 242 " 177,703.08 " " 55,994.24 " " 33,852.52 " " 142,162.46 " " 71,372.36 " " 34,191.05 " " 73,698.38 " " 33,852.52 " " 69,029.16 " " 33,852.52 " " 80,236.59 " " 36,222.20 " " 126,151.41 " " 33,852.52 " " 49,167.46 " " 61,459.36 " " 34,191.05 " " 34,529.57 " " 33,852.52 " " 142,162.46 " " 133,277.31 " " 133,277.31 " " 140,385.43 " " 84,243.76 " " 133,277.31 " " 34,529.57 " " 140,385.43 " Inpatient PERMANENT CARDIAC PACEMAKER IMPLANT WITH CC 243 " 150,044.64 " " 47,279.07 " " 23,027.81 " " 120,035.71 " " 48,221.72 " " 23,258.09 " " 49,793.26 " " 23,027.81 " " 48,602.09 " " 23,027.81 " " 54,210.71 " " 24,639.76 " " 106,516.69 " " 23,027.81 " " 33,451.84 " " 41,814.81 " " 23,258.09 " " 23,488.37 " " 23,027.81 " " 120,035.71 " " 112,533.48 " " 112,533.48 " " 118,535.26 " " 56,918.10 " " 112,533.48 " " 23,488.37 " " 118,535.26 " Inpatient PERMANENT CARDIAC PACEMAKER IMPLANT WITHOUT CC/MCC 244 " 112,240.22 " " 35,366.89 " " 18,952.54 " " 89,792.18 " " 39,506.01 " " 19,142.07 " " 40,793.50 " " 18,952.54 " " 39,859.32 " " 18,952.54 " " 44,412.53 " " 20,279.22 " " 79,679.33 " " 18,952.54 " " 27,284.44 " " 34,105.57 " " 19,142.07 " " 19,331.59 " " 18,952.54 " " 89,792.18 " " 84,180.17 " " 84,180.17 " " 88,669.77 " " 46,630.58 " " 84,180.17 " " 19,331.59 " " 88,669.77 " Inpatient PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITH MCC OR 4+ ARTERIES OR STENTS 246 " 181,026.21 " " 57,041.36 " " 28,451.36 " " 144,820.97 " " 59,820.97 " " 28,735.87 " " 61,770.54 " " 28,451.36 " " 59,805.78 " " 28,451.36 " " 67,250.56 " " 30,442.96 " " 128,510.51 " " 28,451.36 " " 41,283.24 " " 51,604.07 " " 28,735.87 " " 29,020.39 " " 28,451.36 " " 144,820.97 " " 135,769.66 " " 135,769.66 " " 143,010.71 " " 70,609.18 " " 135,769.66 " " 29,020.39 " " 143,010.71 " Inpatient PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH DRUG-ELUTING STENT WITHOUT MCC 247 " 123,520.62 " " 38,921.35 " " 18,145.91 " " 98,816.49 " " 37,780.86 " " 18,327.37 " " 39,012.14 " " 18,145.91 " " 39,415.95 " " 18,145.91 " " 42,473.13 " " 19,416.12 " " 87,687.29 " " 18,145.91 " " 26,254.34 " " 32,817.94 " " 18,327.37 " " 18,508.83 " " 18,145.91 " " 98,816.49 " " 92,640.46 " " 92,640.46 " " 97,581.29 " " 44,594.32 " " 92,640.46 " " 18,508.83 " " 97,581.29 " Inpatient OTHER VASCULAR PROCEDURES WITH MCC 252 " 148,884.78 " " 46,913.59 " " 30,254.43 " " 119,107.83 " " 63,677.18 " " 30,556.97 " " 65,752.41 " " 30,254.43 " " 60,237.97 " " 30,254.43 " " 71,585.69 " " 32,372.24 " " 105,693.31 " " 30,254.43 " " 43,858.49 " " 54,823.13 " " 30,556.97 " " 30,859.52 " " 30,254.43 " " 119,107.83 " " 111,663.59 " " 111,663.59 " " 117,618.98 " " 75,160.82 " " 111,663.59 " " 30,859.52 " " 117,618.98 " Inpatient OTHER VASCULAR PROCEDURES WITH CC 253 " 136,574.17 " " 43,034.52 " " 24,237.32 " " 109,259.34 " " 50,808.48 " " 24,479.69 " " 52,464.33 " " 24,237.32 " " 47,223.51 " " 24,237.32 " " 57,118.74 " " 25,933.93 " " 96,954.00 " " 24,237.32 " " 35,049.81 " " 43,812.29 " " 24,479.69 " " 24,722.07 " " 24,237.32 " " 109,259.34 " " 102,430.63 " " 102,430.63 " " 107,893.59 " " 59,971.36 " " 102,430.63 " " 24,722.07 " " 107,893.59 " Inpatient OTHER VASCULAR PROCEDURES WITHOUT CC/MCC 254 " 70,379.20 " " 22,176.49 " " 16,737.65 " " 56,303.36 " " 34,769.04 " " 16,905.03 " " 35,902.16 " " 16,737.65 " " 33,773.13 " " 16,737.65 " " 39,087.25 " " 17,909.29 " " 49,962.19 " " 16,737.65 " " 23,903.60 " " 29,879.52 " " 16,905.03 " " 17,072.40 " " 16,737.65 " " 56,303.36 " " 52,784.40 " " 52,784.40 " " 55,599.57 " " 41,039.34 " " 52,784.40 " " 17,072.40 " " 55,599.57 " Inpatient OTHER CIRCULATORY SYSTEM O.R. PROCEDURES 264 " 108,471.35 " " 34,179.32 " " 29,608.94 " " 86,777.08 " " 62,296.68 " " 29,905.03 " " 64,326.93 " " 29,608.94 " " 59,941.77 " " 29,608.94 " " 70,033.74 " " 31,681.57 " " 77,003.81 " " 29,608.94 " " 42,894.42 " " 53,618.05 " " 29,905.03 " " 30,201.12 " " 29,608.94 " " 86,777.08 " " 81,353.51 " " 81,353.51 " " 85,692.36 " " 73,531.36 " " 81,353.51 " " 30,201.12 " " 85,692.36 " Inpatient ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC 266 " 346,944.63 " " 109,322.25 " " 63,578.17 " " 277,555.70 " " 134,946.14 " " 64,213.95 " " 139,344.03 " " 63,578.17 " " 144,407.18 " " 63,578.17 " " 151,706.05 " " 68,028.64 " " 246,295.99 " " 63,578.17 " " 93,725.89 " " 117,157.42 " " 64,213.95 " " 64,849.73 " " 63,578.17 " " 277,555.70 " " 260,208.47 " " 260,208.47 " " 274,086.26 " " 159,282.54 " " 260,208.47 " " 64,849.73 " " 274,086.26 " Inpatient ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC 267 " 260,117.11 " " 81,962.90 " " 50,597.65 " " 208,093.69 " " 107,184.91 " " 51,103.63 " " 110,678.06 " " 50,597.65 " " 113,737.70 " " 50,597.65 " " 120,496.95 " " 54,139.49 " " 184,657.14 " " 50,597.65 " " 73,969.10 " " 92,461.42 " " 51,103.63 " " 51,609.60 " " 50,597.65 " " 208,093.69 " " 195,087.83 " " 195,087.83 " " 205,492.52 " " 126,514.80 " " 195,087.83 " " 51,609.60 " " 205,492.52 " Inpatient AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC 268 " 242,228.29 " " 76,326.14 " " 62,820.77 " " 193,782.63 " " 133,326.31 " " 63,448.98 " " 137,671.40 " " 62,820.77 " " 121,535.94 " " 62,820.77 " " 149,885.03 " " 67,218.22 " " 171,957.87 " " 62,820.77 " " 91,850.58 " " 114,813.28 " " 63,448.98 " " 64,077.19 " " 62,820.77 " " 193,782.63 " " 181,671.22 " " 181,671.22 " " 191,360.35 " " 157,370.58 " " 181,671.22 " " 64,077.19 " " 191,360.35 " Inpatient AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC 269 " 161,375.97 " " 50,849.57 " " 39,112.23 " " 129,100.78 " " 82,621.22 " " 39,503.35 " " 85,313.84 " " 39,112.23 " " 77,410.49 " " 39,112.23 " " 92,882.53 " " 41,850.09 " " 114,560.80 " " 39,112.23 " " 56,985.66 " " 71,232.11 " " 39,503.35 " " 39,894.47 " " 39,112.23 " " 129,100.78 " " 121,031.98 " " 121,031.98 " " 127,487.02 " " 97,521.26 " " 121,031.98 " " 39,894.47 " " 127,487.02 " Inpatient OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC 270 " 264,945.67 " " 83,484.38 " " 46,918.09 " " 211,956.54 " " 159,126.37 " " 47,387.27 " " 164,319.31 " " 46,918.09 " " 153,085.61 " " 46,918.09 " " 179,765.64 " " 50,202.36 " " 188,084.93 " " 46,918.09 " " 68,435.62 " " 85,544.56 " " 47,387.27 " " 47,856.45 " " 46,918.09 " " 211,956.54 " " 198,709.26 " " 198,709.26 " " 209,307.08 " " 178,838.33 " " 198,709.26 " " 47,856.45 " " 209,307.08 " Inpatient OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC 271 " 177,578.03 " " 55,954.84 " " 32,400.39 " " 142,062.43 " " 68,266.71 " " 32,724.39 " " 70,491.52 " " 32,400.39 " " 63,028.63 " " 32,400.39 " " 76,745.24 " " 34,668.42 " " 126,062.65 " " 32,400.39 " " 47,080.85 " " 58,851.09 " " 32,724.39 " " 33,048.40 " " 32,400.39 " " 142,062.43 " " 133,183.53 " " 133,183.53 " " 140,286.65 " " 80,578.04 " " 133,183.53 " " 33,048.40 " " 140,286.65 " Inpatient PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC 273 " 277,559.66 " " 87,459.05 " " 34,739.73 " " 222,047.73 " " 73,269.82 " " 35,087.13 " " 75,657.69 " " 34,739.73 " " 66,678.13 " " 34,739.73 " " 82,369.72 " " 37,171.51 " " 197,039.60 " " 34,739.73 " " 50,673.00 " " 63,341.27 " " 35,087.13 " " 35,434.52 " " 34,739.73 " " 222,047.73 " " 208,169.75 " " 208,169.75 " " 219,272.13 " " 86,483.42 " " 208,169.75 " " 35,434.52 " " 219,272.13 " Inpatient PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC 274 " 191,889.91 " " 60,464.51 " " 29,904.38 " " 153,511.93 " " 62,928.53 " " 30,203.42 " " 64,979.37 " " 29,904.38 " " 51,575.32 " " 29,904.38 " " 70,744.07 " " 31,997.69 " " 136,222.65 " " 29,904.38 " " 43,383.06 " " 54,228.85 " " 30,203.42 " " 30,502.47 " " 29,904.38 " " 153,511.93 " " 143,917.43 " " 143,917.43 " " 151,593.03 " " 74,277.16 " " 143,917.43 " " 30,502.47 " " 151,593.03 " Inpatient "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC" 280 " 63,109.78 " " 19,885.89 " " 14,866.53 " " 50,487.82 " " 37,903.73 " " 15,015.20 " " 39,140.68 " " 14,866.53 " " 30,885.58 " " 14,866.53 " " 42,819.98 " " 15,907.19 " " 44,801.63 " " 14,866.53 " " 21,473.62 " " 26,842.04 " " 15,015.20 " " 15,163.86 " " 14,866.53 " " 50,487.82 " " 47,332.33 " " 47,332.33 " " 49,856.73 " " 42,599.10 " " 47,332.33 " " 15,163.86 " " 49,856.73 " Inpatient "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC" 281 " 36,633.24 " " 11,543.13 " " 8,811.82 " " 29,306.59 " " 17,818.20 " " 8,899.94 " " 18,398.89 " " 8,811.82 " " 18,346.17 " " 8,811.82 " " 20,031.17 " " 9,428.65 " " 26,005.94 " " 8,811.82 " " 12,308.37 " " 15,385.47 " " 8,899.94 " " 8,988.06 " " 8,811.82 " " 29,306.59 " " 27,474.93 " " 27,474.93 " " 28,940.26 " " 21,031.56 " " 27,474.93 " " 8,988.06 " " 28,940.26 " Inpatient "ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC" 282 " 32,201.49 " " 10,146.69 " " 6,980.99 " " 25,761.19 " " 13,902.64 " " 7,050.80 " " 14,355.72 " " 6,980.99 " " 14,134.08 " " 6,980.99 " " 15,629.30 " " 7,469.66 " " 22,859.84 " " 6,980.99 " " 9,587.85 " " 11,984.82 " " 7,050.80 " " 7,120.61 " " 6,980.99 " " 25,761.19 " " 24,151.12 " " 24,151.12 " " 25,439.18 " " 16,409.86 " " 24,151.12 " " 7,120.61 " " 25,439.18 " Inpatient "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITH MCC" 286 " 98,740.71 " " 31,113.20 " " 19,606.09 " " 78,992.57 " " 59,303.67 " " 19,802.15 " " 61,238.99 " " 19,606.09 " " 41,508.03 " " 19,606.09 " " 66,995.57 " " 20,978.52 " " 70,096.03 " " 19,606.09 " " 29,238.99 " " 36,548.76 " " 19,802.15 " " 19,998.21 " " 19,606.09 " " 78,992.57 " " 74,055.54 " " 74,055.54 " " 78,005.16 " " 66,649.98 " " 74,055.54 " " 19,998.21 " " 78,005.16 " Inpatient "CIRCULATORY DISORDERS EXCEPT AMI, WITH CARDIAC CATHETERIZATION WITHOUT MCC" 287 " 56,065.71 " " 17,666.30 " " 10,463.59 " " 44,852.56 " " 21,350.82 " " 10,568.23 " " 22,046.64 " " 10,463.59 " " 21,891.33 " " 10,463.59 " " 24,002.53 " " 11,196.04 " " 39,801.04 " " 10,463.59 " " 15,187.37 " " 18,984.22 " " 10,568.23 " " 10,672.86 " " 10,463.59 " " 44,852.56 " " 42,049.28 " " 42,049.28 " " 44,291.91 " " 25,201.26 " " 42,049.28 " " 10,672.86 " " 44,291.91 " Inpatient HEART FAILURE AND SHOCK WITH MCC 291 " 51,626.64 " " 16,267.55 " " 11,835.15 " " 41,301.31 " " 24,284.14 " " 11,953.50 " " 25,075.56 " " 11,835.15 " " 27,498.78 " " 11,835.15 " " 27,300.16 " " 12,663.61 " " 36,649.75 " " 11,835.15 " " 17,709.80 " " 22,137.25 " " 11,953.50 " " 12,071.85 " " 11,835.15 " " 41,301.31 " " 38,719.98 " " 38,719.98 " " 40,785.04 " " 28,663.58 " " 38,719.98 " " 12,071.85 " " 40,785.04 " Inpatient HEART FAILURE AND SHOCK WITH CC 292 " 35,954.71 " " 11,329.33 " " 8,211.10 " " 28,763.77 " " 16,533.43 " " 8,293.21 " " 17,072.26 " " 8,211.10 " " 17,863.67 " " 8,211.10 " " 18,586.84 " " 8,785.88 " " 25,524.25 " " 8,211.10 " " 11,819.74 " " 14,774.68 " " 8,293.21 " " 8,375.32 " " 8,211.10 " " 28,763.77 " " 26,966.03 " " 26,966.03 " " 28,404.22 " " 19,515.10 " " 26,966.03 " " 8,375.32 " " 28,404.22 " Inpatient HEART FAILURE AND SHOCK WITHOUT CC/MCC 293 " 23,576.65 " " 7,429.00 " " 5,761.64 " " 18,861.32 " " 11,294.82 " " 5,819.26 " " 11,662.91 " " 5,761.64 " " 12,550.59 " " 5,761.64 " " 12,697.60 " " 6,164.95 " " 16,737.07 " " 5,761.64 " " 8,623.79 " " 10,779.74 " " 5,819.26 " " 5,876.87 " " 5,761.64 " " 18,861.32 " " 17,682.49 " " 17,682.49 " " 18,625.56 " " 13,331.74 " " 17,682.49 " " 5,876.87 " " 18,625.56 " Inpatient PERIPHERAL VASCULAR DISORDERS WITH MCC 299 " 62,302.63 " " 19,631.56 " " 14,201.35 " " 49,842.11 " " 29,344.69 " " 14,343.36 " " 30,301.03 " " 14,201.35 " " 26,289.72 " " 14,201.35 " " 32,989.22 " " 15,195.44 " " 44,228.64 " " 14,201.35 " " 20,219.01 " " 25,273.78 " " 14,343.36 " " 14,485.38 " " 14,201.35 " " 49,842.11 " " 46,726.98 " " 46,726.98 " " 49,219.08 " " 34,636.76 " " 46,726.98 " " 14,485.38 " " 49,219.08 " Inpatient PERIPHERAL VASCULAR DISORDERS WITH CC 300 " 34,929.56 " " 11,006.30 " " 9,825.27 " " 27,943.64 " " 19,985.64 " " 9,923.52 " " 20,636.97 " " 9,825.27 " " 18,972.13 " " 9,825.27 " " 22,467.80 " " 10,513.04 " " 24,796.49 " " 9,825.27 " " 13,761.08 " " 17,201.36 " " 9,923.52 " " 10,021.78 " " 9,825.27 " " 27,943.64 " " 26,197.17 " " 26,197.17 " " 27,594.35 " " 23,589.88 " " 26,197.17 " " 10,021.78 " " 27,594.35 " Inpatient PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC 301 " 25,922.39 " " 8,168.14 " " 7,133.19 " " 20,737.91 " " 14,228.14 " " 7,204.52 " " 14,691.83 " " 7,133.19 " " 13,508.13 " " 7,133.19 " " 15,995.23 " " 7,632.51 " " 18,402.30 " " 7,133.19 " " 9,812.36 " " 12,265.46 " " 7,204.52 " " 7,275.85 " " 7,133.19 " " 20,737.91 " " 19,441.79 " " 19,441.79 " " 20,478.69 " " 16,794.06 " " 19,441.79 " " 7,275.85 " " 20,478.69 " Inpatient ATHEROSCLEROSIS WITHOUT MCC 303 " 22,121.91 " " 6,970.61 " " 6,546.79 " " 17,697.53 " " 12,974.01 " " 6,612.26 " " 13,396.83 " " 6,546.79 " " 12,351.26 " " 6,546.79 " " 14,585.34 " " 7,005.07 " " 15,704.35 " " 6,546.79 " " 8,927.53 " " 11,159.42 " " 6,612.26 " " 6,677.73 " " 6,546.79 " " 17,697.53 " " 16,591.43 " " 16,591.43 " " 17,476.31 " " 15,313.76 " " 16,591.43 " " 6,677.73 " " 17,476.31 " Inpatient HYPERTENSION WITH MCC 304 " 46,920.19 " " 14,784.55 " " 10,301.55 " " 37,536.15 " " 21,004.26 " " 10,404.57 " " 21,688.79 " " 10,301.55 " " 19,532.85 " " 10,301.55 " " 23,612.93 " " 11,022.66 " " 33,308.64 " " 10,301.55 " " 14,474.23 " " 18,092.79 " " 10,404.57 " " 10,507.58 " " 10,301.55 " " 37,536.15 " " 35,190.14 " " 35,190.14 " " 37,066.95 " " 24,792.20 " " 35,190.14 " " 10,507.58 " " 37,066.95 " Inpatient HYPERTENSION WITHOUT MCC 305 " 30,371.40 " " 9,570.03 " " 7,104.54 " " 24,297.12 " " 14,166.87 " " 7,175.59 " " 14,628.56 " " 7,104.54 " " 12,885.92 " " 7,104.54 " " 15,926.35 " " 7,601.86 " " 21,560.66 " " 7,104.54 " " 9,759.54 " " 12,199.43 " " 7,175.59 " " 7,246.63 " " 7,104.54 " " 24,297.12 " " 22,778.55 " " 22,778.55 " " 23,993.41 " " 16,721.74 " " 22,778.55 " " 7,246.63 " " 23,993.41 " Inpatient CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC 307 " 36,010.12 " " 11,346.79 " " 8,272.87 " " 28,808.10 " " 16,665.55 " " 8,355.60 " " 17,208.68 " " 8,272.87 " " 15,413.92 " " 8,272.87 " " 18,735.36 " " 8,851.97 " " 25,563.58 " " 8,272.87 " " 11,463.16 " " 14,328.96 " " 8,355.60 " " 8,438.33 " " 8,272.87 " " 28,808.10 " " 27,007.59 " " 27,007.59 " " 28,447.99 " " 19,671.04 " " 27,007.59 " " 8,438.33 " " 28,447.99 " Inpatient CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC 308 " 38,129.14 " " 12,014.49 " " 11,231.74 " " 30,503.32 " " 22,993.63 " " 11,344.06 " " 23,742.99 " " 11,231.74 " " 22,140.97 " " 11,231.74 " " 25,849.37 " " 12,017.96 " " 27,067.88 " " 11,231.74 " " 15,834.49 " " 19,793.12 " " 11,344.06 " " 11,456.37 " " 11,231.74 " " 30,503.32 " " 28,596.86 " " 28,596.86 " " 30,122.02 " " 27,140.34 " " 28,596.86 " " 11,456.37 " " 30,122.02 " Inpatient CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC 309 " 27,920.45 " " 8,797.73 " " 7,199.44 " " 22,336.36 " " 14,369.82 " " 7,271.43 " " 14,838.14 " " 7,199.44 " " 14,383.72 " " 7,199.44 " " 16,154.51 " " 7,703.40 " " 19,820.72 " " 7,199.44 " " 9,891.60 " " 12,364.51 " " 7,271.43 " " 7,343.43 " " 7,199.44 " " 22,336.36 " " 20,940.33 " " 20,940.33 " " 22,057.15 " " 16,961.30 " " 20,940.33 " " 7,343.43 " " 22,057.15 " Inpatient CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC 310 " 18,438.81 " " 5,810.07 " " 5,486.79 " " 14,751.05 " " 10,707.00 " " 5,541.66 " " 11,055.94 " " 5,486.79 " " 10,480.87 " " 5,486.79 " " 12,036.78 " " 5,870.87 " " 13,089.71 " " 5,486.79 " " 7,369.18 " " 9,211.48 " " 5,541.66 " " 5,596.53 " " 5,486.79 " " 14,751.05 " " 13,829.11 " " 13,829.11 " " 14,566.66 " " 12,637.92 " " 13,829.11 " " 5,596.53 " " 14,566.66 " Inpatient SYNCOPE AND COLLAPSE 312 " 35,460.07 " " 11,173.47 " " 7,989.07 " " 28,368.06 " " 16,058.59 " " 8,068.96 " " 16,581.94 " " 7,989.07 " " 14,838.27 " " 7,989.07 " " 18,053.02 " " 8,548.30 " " 25,173.11 " " 7,989.07 " " 11,053.77 " " 13,817.21 " " 8,068.96 " " 8,148.85 " " 7,989.07 " " 28,368.06 " " 26,595.05 " " 26,595.05 " " 28,013.46 " " 18,954.62 " " 26,595.05 " " 8,148.85 " " 28,013.46 " Inpatient CHEST PAIN 313 " 22,050.98 " " 6,948.26 " " 6,938.92 " " 17,640.78 " " 13,812.65 " " 7,008.31 " " 14,262.80 " " 6,938.92 " " 13,087.11 " " 6,938.92 " " 15,528.14 " " 7,424.64 " " 15,653.99 " " 6,938.92 " " 9,521.82 " " 11,902.28 " " 7,008.31 " " 7,077.70 " " 6,938.92 " " 17,640.78 " " 16,538.23 " " 16,538.23 " " 17,420.27 " " 16,303.64 " " 16,538.23 " " 7,077.70 " " 17,420.27 " Inpatient OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC 314 " 80,094.10 " " 25,237.65 " " 19,144.13 " " 64,075.28 " " 39,915.75 " " 19,335.57 " " 41,216.60 " " 19,144.13 " " 36,476.25 " " 19,144.13 " " 44,873.17 " " 20,484.22 " " 56,858.80 " " 19,144.13 " " 27,508.95 " " 34,386.21 " " 19,335.57 " " 19,527.01 " " 19,144.13 " " 64,075.28 " " 60,070.57 " " 60,070.57 " " 63,274.34 " " 47,114.22 " " 60,070.57 " " 19,527.01 " " 63,274.34 " Inpatient OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC 315 " 45,384.06 " " 14,300.52 " " 9,195.00 " " 36,307.25 " " 18,637.69 " " 9,286.95 " " 19,245.09 " " 9,195.00 " " 17,992.21 " " 9,195.00 " " 20,952.44 " " 9,838.65 " " 32,218.14 " " 9,195.00 " " 12,876.25 " " 16,095.32 " " 9,286.95 " " 9,378.90 " " 9,195.00 " " 36,307.25 " " 34,038.05 " " 34,038.05 " " 35,853.41 " " 21,998.84 " " 34,038.05 " " 9,378.90 " " 35,853.41 " Inpatient OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC 316 " 34,609.08 " " 10,905.32 " " 6,956.82 " " 27,687.26 " " 13,850.94 " " 7,026.39 " " 14,302.34 " " 6,956.82 " " 13,789.43 " " 6,956.82 " " 15,571.19 " " 7,443.80 " " 24,568.99 " " 6,956.82 " " 9,904.81 " " 12,381.02 " " 7,026.39 " " 7,095.96 " " 6,956.82 " " 27,687.26 " " 25,956.81 " " 25,956.81 " " 27,341.17 " " 16,348.84 " " 25,956.81 " " 7,095.96 " " 27,341.17 " Inpatient "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC" 326 " 152,839.51 " " 48,159.73 " " 48,075.67 " " 122,271.61 " " 101,791.20 " " 48,556.43 " " 105,108.57 " " 48,075.67 " " 84,711.33 " " 48,075.67 " " 114,433.36 " " 51,440.97 " " 108,500.77 " " 48,075.67 " " 61,772.73 " " 77,215.93 " " 48,556.43 " " 49,037.18 " " 48,075.67 " " 122,271.61 " " 114,629.63 " " 114,629.63 " " 120,743.21 " " 120,148.38 " " 114,629.63 " " 49,037.18 " " 120,743.21 " Inpatient "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC" 327 " 105,857.92 " " 33,355.83 " " 23,441.43 " " 84,686.34 " " 49,106.31 " " 23,675.84 " " 50,706.68 " " 23,441.43 " " 39,417.82 " " 23,441.43 " " 55,205.17 " " 25,082.33 " " 75,148.54 " " 23,441.43 " " 29,978.96 " " 37,473.70 " " 23,675.84 " " 23,910.26 " " 23,441.43 " " 84,686.34 " " 79,393.44 " " 79,393.44 " " 83,627.76 " " 57,962.22 " " 79,393.44 " " 23,910.26 " " 83,627.76 " Inpatient "STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC" 328 " 73,902.02 " " 23,286.53 " " 15,403.69 " " 59,121.62 " " 31,916.13 " " 15,557.73 " " 32,956.28 " " 15,403.69 " " 28,022.26 " " 15,403.69 " " 35,880.02 " " 16,481.95 " " 52,463.04 " " 15,403.69 " " 23,006.71 " " 28,758.39 " " 15,557.73 " " 15,711.76 " " 15,403.69 " " 59,121.62 " " 55,426.52 " " 55,426.52 " " 58,382.60 " " 37,671.94 " " 55,426.52 " " 15,711.76 " " 58,382.60 " Inpatient MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC 329 " 136,915.36 " " 43,142.03 " " 44,225.12 " " 110,428.12 " " 93,556.07 " " 44,667.37 " " 96,605.06 " " 44,225.12 " " 91,524.08 " " 44,225.12 " " 105,175.46 " " 47,320.88 " " 97,196.21 " " 44,225.12 " " 77,740.54 " " 97,182.52 " " 44,667.37 " " 45,109.62 " " 44,225.12 " " 109,532.29 " " 102,686.52 " " 102,686.52 " " 108,163.13 " " 110,428.12 " " 102,686.52 " " 45,109.62 " " 108,163.13 " Inpatient MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC 330 " 81,386.14 " " 25,644.77 " " 23,303.56 " " 65,108.91 " " 48,811.45 " " 23,536.60 " " 50,402.21 " " 23,303.56 " " 45,986.52 " " 23,303.56 " " 54,873.68 " " 24,934.81 " " 57,776.02 " " 23,303.56 " " 46,211.05 " " 57,767.88 " " 23,536.60 " " 23,769.63 " " 23,303.56 " " 65,108.91 " " 61,039.61 " " 61,039.61 " " 64,295.05 " " 57,614.18 " " 61,039.61 " " 23,769.63 " " 64,295.05 " Inpatient MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC 331 " 58,105.21 " " 18,308.95 " " 15,794.03 " " 46,484.17 " " 32,750.94 " " 15,951.97 " " 33,818.30 " " 15,794.03 " " 31,217.18 " " 15,794.03 " " 36,818.51 " " 16,899.61 " " 41,248.89 " " 15,794.03 " " 23,614.33 " " 29,517.92 " " 15,951.97 " " 16,109.91 " " 15,794.03 " " 46,484.17 " " 43,578.91 " " 43,578.91 " " 45,903.11 " " 38,657.30 " " 43,578.91 " " 16,109.91 " " 45,903.11 " Inpatient RECTAL RESECTION WITH CC 333 " 72,432.71 " " 22,823.55 " " 19,650.85 " " 57,946.17 " " 40,999.47 " " 19,847.36 " " 42,335.64 " " 19,650.85 " " 37,118.96 " " 19,650.85 " " 46,091.48 " " 21,026.41 " " 51,419.98 " " 19,650.85 " " 29,566.25 " " 36,957.81 " " 19,847.36 " " 20,043.87 " " 19,650.85 " " 57,946.17 " " 54,324.53 " " 54,324.53 " " 57,221.84 " " 48,393.38 " " 54,324.53 " " 20,043.87 " " 57,221.84 " Inpatient PERITONEAL ADHESIOLYSIS WITH MCC 335 " 158,651.47 " " 49,991.08 " " 35,516.83 " " 126,921.17 " " 74,931.78 " " 35,872.00 " " 77,373.81 " " 35,516.83 " " 76,266.65 " " 35,516.83 " " 84,238.09 " " 38,003.01 " " 112,626.68 " " 35,516.83 " " 44,681.28 " " 55,851.61 " " 35,872.00 " " 36,227.17 " " 35,516.83 " " 126,921.17 " " 118,988.60 " " 118,988.60 " " 125,334.66 " " 88,445.10 " " 118,988.60 " " 36,227.17 " " 125,334.66 " Inpatient PERITONEAL ADHESIOLYSIS WITH CC 336 " 82,982.89 " " 26,147.91 " " 20,993.76 " " 66,386.31 " " 43,871.52 " " 21,203.70 " " 45,301.29 " " 20,993.76 " " 43,583.35 " " 20,993.76 " " 49,320.23 " " 22,463.32 " " 58,909.55 " " 20,993.76 " " 31,527.20 " " 39,409.01 " " 21,203.70 " " 21,413.64 " " 20,993.76 " " 66,386.31 " " 62,237.17 " " 62,237.17 " " 65,556.48 " " 51,783.38 " " 62,237.17 " " 21,413.64 " " 65,556.48 " Inpatient PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC 337 " 77,455.46 " " 24,406.22 " " 15,138.69 " " 61,964.37 " " 31,349.38 " " 15,290.08 " " 32,371.06 " " 15,138.69 " " 30,145.99 " " 15,138.69 " " 35,242.88 " " 16,198.40 " " 54,985.63 " " 15,138.69 " " 22,551.00 " " 28,188.75 " " 15,290.08 " " 15,441.46 " " 15,138.69 " " 61,964.37 " " 58,091.60 " " 58,091.60 " " 61,189.81 " " 37,002.98 " " 58,091.60 " " 15,441.46 " " 61,189.81 " Inpatient APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITH CC 339 " 64,058.93 " " 20,184.97 " " 15,676.75 " " 51,247.14 " " 38,473.79 " " 15,833.52 " " 39,729.35 " " 15,676.75 " " 37,013.25 " " 15,676.75 " " 43,463.98 " " 16,774.12 " " 45,475.43 " " 15,676.75 " " 23,407.19 " " 29,258.99 " " 15,833.52 " " 15,990.29 " " 15,676.75 " " 51,247.14 " " 48,044.20 " " 48,044.20 " " 50,606.55 " " 43,239.78 " " 48,044.20 " " 15,990.29 " " 50,606.55 " Inpatient APPENDECTOMY WITH COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC 340 " 55,781.45 " " 17,576.74 " " 11,477.04 " " 44,625.16 " " 33,502.34 " " 11,591.81 " " 34,595.66 " " 11,477.04 " " 22,353.34 " " 11,477.04 " " 37,847.72 " " 12,280.43 " " 39,599.25 " " 11,477.04 " " 16,958.13 " " 21,197.66 " " 11,591.81 " " 11,706.58 " " 11,477.04 " " 44,625.16 " " 41,836.09 " " 41,836.09 " " 44,067.35 " " 37,652.48 " " 41,836.09 " " 11,706.58 " " 44,067.35 " Inpatient APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITH CC 342 " 66,947.74 " " 21,095.23 " " 13,308.76 " " 53,558.19 " " 27,435.74 " " 13,441.85 " " 28,329.87 " " 13,308.76 " " 27,727.91 " " 13,308.76 " " 30,843.17 " " 14,240.37 " " 47,526.20 " " 13,308.76 " " 19,789.09 " " 24,736.36 " " 13,441.85 " " 13,574.94 " " 13,308.76 " " 53,558.19 " " 50,210.80 " " 50,210.80 " " 52,888.71 " " 32,383.54 " " 50,210.80 " " 13,574.94 " " 52,888.71 " Inpatient APPENDECTOMY WITHOUT COMPLICATED PRINCIPAL DIAGNOSIS WITHOUT CC/MCC 343 " 58,537.61 " " 18,445.20 " " 10,405.40 " " 46,830.09 " " 21,226.36 " " 10,509.45 " " 21,918.13 " " 10,405.40 " " 19,670.72 " " 10,405.40 " " 23,862.62 " " 11,133.78 " " 41,555.85 " " 10,405.40 " " 15,314.79 " " 19,143.49 " " 10,509.45 " " 10,613.51 " " 10,405.40 " " 46,830.09 " " 43,903.21 " " 43,903.21 " " 46,244.71 " " 25,054.36 " " 43,903.21 " " 10,613.51 " " 46,244.71 " Inpatient INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC 351 " 78,167.81 " " 24,630.68 " " 13,844.13 " " 62,534.25 " " 28,580.73 " " 13,982.57 " " 29,512.17 " " 13,844.13 " " 27,744.67 " " 13,844.13 " " 32,130.37 " " 14,813.22 " " 55,491.33 " " 13,844.13 " " 20,576.23 " " 25,720.29 " " 13,982.57 " " 14,121.01 " " 13,844.13 " " 62,534.25 " " 58,625.86 " " 58,625.86 " " 61,752.57 " " 33,735.02 " " 58,625.86 " " 14,121.01 " " 61,752.57 " Inpatient HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC 354 " 83,558.11 " " 26,329.16 " " 16,459.22 " " 66,846.48 " " 34,173.57 " " 16,623.81 " " 35,287.28 " " 16,459.22 " " 32,111.39 " " 16,459.22 " " 38,417.82 " " 17,611.37 " " 59,317.90 " " 16,459.22 " " 24,622.43 " " 30,778.04 " " 16,623.81 " " 16,788.40 " " 16,459.22 " " 66,846.48 " " 62,668.58 " " 62,668.58 " " 66,010.90 " " 40,336.48 " " 62,668.58 " " 16,788.40 " " 66,010.90 " Inpatient HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC 355 " 78,329.04 " " 24,681.48 " " 12,657.90 " " 62,663.24 " " 26,043.75 " " 12,784.48 " " 26,892.51 " " 12,657.90 " " 24,601.90 " " 12,657.90 " " 29,278.31 " " 13,543.95 " " 55,605.79 " " 12,657.90 " " 18,767.18 " " 23,458.98 " " 12,784.48 " " 12,911.06 " " 12,657.90 " " 62,663.24 " " 58,746.78 " " 58,746.78 " " 61,879.94 " " 30,740.52 " " 58,746.78 " " 12,911.06 " " 61,879.94 " Inpatient OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC 356 " 136,606.76 " " 43,044.79 " " 39,046.88 " " 109,285.41 " " 82,046.02 " " 39,437.35 " " 84,723.51 " " 39,046.88 " " 70,892.09 " " 39,046.88 " " 92,687.69 " " 41,780.16 " " 96,977.14 " " 39,046.88 " " 49,287.24 " " 61,609.06 " " 39,437.35 " " 39,827.82 " " 39,046.88 " " 109,285.41 " " 102,455.07 " " 102,455.07 " " 107,919.34 " " 92,209.56 " " 102,455.07 " " 39,827.82 " " 107,919.34 " Inpatient OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC 357 " 66,554.04 " " 20,971.18 " " 20,789.64 " " 53,243.23 " " 39,972.36 " " 20,997.54 " " 41,276.82 " " 20,789.64 " " 39,117.89 " " 20,789.64 " " 45,156.92 " " 22,244.91 " " 47,246.71 " " 20,789.64 " " 31,126.73 " " 38,908.41 " " 20,997.54 " " 21,205.43 " " 20,789.64 " " 53,243.23 " " 49,915.53 " " 49,915.53 " " 52,577.69 " " 44,923.98 " " 49,915.53 " " 21,205.43 " " 52,577.69 " Inpatient MAJOR ESOPHAGEAL DISORDERS WITH MCC 368 " 62,059.04 " " 19,554.80 " " 17,930.15 " " 49,647.23 " " 37,319.42 " " 18,109.45 " " 38,535.66 " " 17,930.15 " " 34,229.55 " " 17,930.15 " " 41,954.38 " " 19,185.26 " " 44,055.72 " " 17,930.15 " " 26,818.15 " " 33,522.69 " " 18,109.45 " " 18,288.75 " " 17,930.15 " " 49,647.23 " " 46,544.28 " " 46,544.28 " " 49,026.64 " " 44,049.66 " " 46,544.28 " " 18,288.75 " " 49,026.64 " Inpatient MAJOR ESOPHAGEAL DISORDERS WITH CC 369 " 52,841.24 " " 16,650.27 " " 10,124.29 " " 42,272.99 " " 20,625.15 " " 10,225.53 " " 21,297.32 " " 10,124.29 " " 20,266.85 " " 10,124.29 " " 23,186.73 " " 10,832.99 " " 37,512.00 " " 10,124.29 " " 14,872.89 " " 18,591.11 " " 10,225.53 " " 10,326.78 " " 10,124.29 " " 42,272.99 " " 39,630.93 " " 39,630.93 " " 41,744.58 " " 24,344.72 " " 39,630.93 " " 10,326.78 " " 41,744.58 " Inpatient MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC 371 " 56,137.04 " " 17,688.78 " " 15,979.35 " " 44,909.63 " " 33,715.91 " " 16,139.14 " " 34,816.19 " " 15,979.35 " " 32,128.16 " " 15,979.35 " " 38,088.98 " " 17,097.90 " " 39,851.69 " " 15,979.35 " " 23,862.90 " " 29,828.63 " " 16,139.14 " " 16,298.94 " " 15,979.35 " " 44,909.63 " " 42,102.78 " " 42,102.78 " " 44,348.26 " " 37,892.50 " " 42,102.78 " " 16,298.94 " " 44,348.26 " Inpatient MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC 372 " 37,135.84 " " 11,701.50 " " 9,695.45 " " 29,708.67 " " 22,303.78 " " 9,792.40 " " 23,031.65 " " 9,695.45 " " 19,728.48 " " 9,695.45 " " 25,196.67 " " 10,374.13 " " 26,362.73 " " 9,695.45 " " 14,196.22 " " 17,745.27 " " 9,792.40 " " 9,889.36 " " 9,695.45 " " 29,708.67 " " 27,851.88 " " 27,851.88 " " 29,337.31 " " 25,066.69 " " 27,851.88 " " 9,889.36 " " 29,337.31 " Inpatient MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC 373 " 22,958.87 " " 7,234.34 " " 7,146.62 " " 18,367.10 " " 13,789.10 " " 7,218.09 " " 14,239.09 " " 7,146.62 " " 14,201.14 " " 7,146.62 " " 15,577.59 " " 7,646.88 " " 16,298.50 " " 7,146.62 " " 10,274.31 " " 12,842.88 " " 7,218.09 " " 7,289.55 " " 7,146.62 " " 18,367.10 " " 17,219.15 " " 17,219.15 " " 18,137.51 " " 15,497.24 " " 17,219.15 " " 7,289.55 " " 18,137.51 " Inpatient DIGESTIVE MALIGNANCY WITH MCC 374 " 69,878.61 " " 22,018.75 " " 19,045.65 " " 55,902.89 " " 39,705.13 " " 19,236.11 " " 40,999.12 " " 19,045.65 " " 37,286.62 " " 19,045.65 " " 44,636.39 " " 20,378.85 " " 49,606.83 " " 19,045.65 " " 28,558.15 " " 35,697.69 " " 19,236.11 " " 19,426.56 " " 19,045.65 " " 55,902.89 " " 52,408.96 " " 52,408.96 " " 55,204.10 " " 46,865.62 " " 52,408.96 " " 19,426.56 " " 55,204.10 " Inpatient DIGESTIVE MALIGNANCY WITH CC 375 " 47,256.57 " " 14,890.55 " " 11,291.72 " " 37,805.26 " " 23,121.92 " " 11,404.64 " " 23,875.46 " " 11,291.72 " " 23,001.65 " " 11,291.72 " " 25,993.59 " " 12,082.14 " " 33,547.44 " " 11,291.72 " " 16,640.51 " " 20,800.64 " " 11,404.64 " " 11,517.55 " " 11,291.72 " " 37,805.26 " " 35,442.43 " " 35,442.43 " " 37,332.69 " " 27,291.76 " " 35,442.43 " " 11,517.55 " " 37,332.69 " Inpatient GASTROINTESTINAL HEMORRHAGE WITH MCC 377 " 72,271.39 " " 22,772.72 " " 16,606.04 " " 57,817.11 " " 34,487.58 " " 16,772.10 " " 35,611.53 " " 16,606.04 " " 31,934.42 " " 16,606.04 " " 38,770.83 " " 17,768.46 " " 51,305.46 " " 16,606.04 " " 24,843.38 " " 31,054.23 " " 16,772.10 " " 16,938.16 " " 16,606.04 " " 57,817.11 " " 54,203.55 " " 54,203.55 " " 57,094.40 " " 40,707.12 " " 54,203.55 " " 16,938.16 " " 57,094.40 " Inpatient GASTROINTESTINAL HEMORRHAGE WITH CC 378 " 45,691.63 " " 14,397.43 " " 9,374.95 " " 36,553.31 " " 19,022.54 " " 9,468.70 " " 19,642.49 " " 9,374.95 " " 18,077.92 " " 9,374.95 " " 21,385.09 " " 10,031.20 " " 32,436.49 " " 9,374.95 " " 13,712.88 " " 17,141.11 " " 9,468.70 " " 9,562.45 " " 9,374.95 " " 36,553.31 " " 34,268.72 " " 34,268.72 " " 36,096.39 " " 22,453.10 " " 34,268.72 " " 9,562.45 " " 36,096.39 " Inpatient GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC 379 " 31,156.67 " " 9,817.47 " " 6,185.10 " " 24,925.34 " " 12,200.47 " " 6,246.95 " " 12,598.08 " " 6,185.10 " " 12,010.34 " " 6,185.10 " " 13,715.73 " " 6,618.06 " " 22,118.12 " " 6,185.10 " " 8,796.68 " " 10,995.86 " " 6,246.95 " " 6,308.80 " " 6,185.10 " " 24,925.34 " " 23,367.51 " " 23,367.51 " " 24,613.77 " " 14,400.72 " " 23,367.51 " " 6,308.80 " " 24,613.77 " Inpatient COMPLICATED PEPTIC ULCER WITH MCC 380 " 97,076.56 " " 30,588.82 " " 17,370.60 " " 77,661.25 " " 36,122.73 " " 17,544.31 " " 37,299.97 " " 17,370.60 " " 35,338.00 " " 17,370.60 " " 40,609.07 " " 18,586.54 " " 68,914.65 " " 17,370.60 " " 26,003.38 " " 32,504.23 " " 17,544.31 " " 17,718.01 " " 17,370.60 " " 77,661.25 " " 72,807.42 " " 72,807.42 " " 76,690.48 " " 42,637.16 " " 72,807.42 " " 17,718.01 " " 76,690.48 " Inpatient INFLAMMATORY BOWEL DISEASE WITH MCC 385 " 50,805.99 " " 16,008.97 " " 15,004.40 " " 40,644.79 " " 31,062.18 " " 15,154.44 " " 32,074.49 " " 15,004.40 " " 30,803.62 " " 15,004.40 " " 34,920.01 " " 16,054.71 " " 36,067.17 " " 15,004.40 " " 22,357.66 " " 27,947.08 " " 15,154.44 " " 15,304.49 " " 15,004.40 " " 40,644.79 " " 38,104.49 " " 38,104.49 " " 40,136.73 " " 36,663.98 " " 38,104.49 " " 15,304.49 " " 40,136.73 " Inpatient INFLAMMATORY BOWEL DISEASE WITH CC 386 " 41,331.56 " " 13,023.57 " " 9,389.27 " " 33,065.25 " " 19,053.18 " " 9,483.16 " " 19,674.12 " " 9,389.27 " " 17,919.55 " " 9,389.27 " " 21,419.53 " " 10,046.52 " " 29,341.27 " " 9,389.27 " " 13,726.69 " " 17,158.37 " " 9,483.16 " " 9,577.06 " " 9,389.27 " " 33,065.25 " " 30,998.67 " " 30,998.67 " " 32,651.93 " " 22,489.26 " " 30,998.67 " " 9,577.06 " " 32,651.93 " Inpatient INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC 387 " 30,281.37 " " 9,541.66 " " 6,878.93 " " 24,225.09 " " 13,684.36 " " 6,947.72 " " 14,130.33 " " 6,878.93 " " 13,690.70 " " 6,878.93 " " 15,383.92 " " 7,360.46 " " 21,496.74 " " 6,878.93 " " 9,860.02 " " 12,325.03 " " 6,947.72 " " 7,016.51 " " 6,878.93 " " 24,225.09 " " 22,711.03 " " 22,711.03 " " 23,922.28 " " 16,152.22 " " 22,711.03 " " 7,016.51 " " 23,922.28 " Inpatient GASTROINTESTINAL OBSTRUCTION WITH MCC 388 " 54,298.25 " " 17,109.38 " " 14,040.20 " " 43,438.60 " " 29,000.05 " " 14,180.60 " " 29,945.16 " " 14,040.20 " " 28,391.11 " " 14,040.20 " " 32,601.77 " " 15,023.01 " " 38,546.32 " " 14,040.20 " " 20,880.04 " " 26,100.05 " " 14,180.60 " " 14,321.00 " " 14,040.20 " " 43,438.60 " " 40,723.68 " " 40,723.68 " " 42,895.61 " " 34,229.96 " " 40,723.68 " " 14,321.00 " " 42,895.61 " Inpatient GASTROINTESTINAL OBSTRUCTION WITH CC 389 " 30,994.05 " " 9,766.22 " " 7,850.30 " " 24,795.24 " " 15,761.81 " " 7,928.80 " " 16,275.49 " " 7,850.30 " " 15,903.87 " " 7,850.30 " " 17,719.38 " " 8,399.82 " " 22,002.67 " " 7,850.30 " " 11,351.45 " " 14,189.31 " " 7,928.80 " " 8,007.31 " " 7,850.30 " " 24,795.24 " " 23,245.53 " " 23,245.53 " " 24,485.30 " " 18,604.32 " " 23,245.53 " " 8,007.31 " " 24,485.30 " Inpatient GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC 390 " 23,734.65 " " 7,478.79 " " 5,700.76 " " 18,987.72 " " 11,164.62 " " 5,757.77 " " 11,528.47 " " 5,700.76 " " 11,114.27 " " 5,700.76 " " 12,551.23 " " 6,099.81 " " 16,849.23 " " 5,700.76 " " 8,050.97 " " 10,063.71 " " 5,757.77 " " 5,814.78 " " 5,700.76 " " 18,987.72 " " 17,800.99 " " 17,800.99 " " 18,750.37 " " 13,178.06 " " 17,800.99 " " 5,814.78 " " 18,750.37 " Inpatient "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC" 391 " 49,312.36 " " 15,538.33 " " 11,664.15 " " 39,449.89 " " 23,918.43 " " 11,780.79 " " 24,697.93 " " 11,664.15 " " 23,009.10 " " 11,664.15 " " 26,889.03 " " 12,480.64 " " 35,006.85 " " 11,664.15 " " 17,179.08 " " 21,473.85 " " 11,780.79 " " 11,897.43 " " 11,664.15 " " 39,449.89 " " 36,984.27 " " 36,984.27 " " 38,956.77 " " 28,231.92 " " 36,984.27 " " 11,897.43 " " 38,956.77 " Inpatient "ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC" 392 " 31,422.84 " " 9,901.34 " " 7,336.42 " " 25,138.27 " " 14,662.77 " " 7,409.78 " " 15,140.63 " " 7,336.42 " " 14,147.12 " " 7,336.42 " " 16,483.85 " " 7,849.97 " " 22,307.08 " " 7,336.42 " " 10,550.50 " " 13,188.12 " " 7,409.78 " " 7,483.15 " " 7,336.42 " " 25,138.27 " " 23,567.13 " " 23,567.13 " " 24,824.05 " " 17,307.08 " " 23,567.13 " " 7,483.15 " " 24,824.05 " Inpatient OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC 393 " 64,690.17 " " 20,383.87 " " 15,352.66 " " 51,752.13 " " 38,852.91 " " 15,506.19 " " 40,120.84 " " 15,352.66 " " 30,565.15 " " 15,352.66 " " 43,892.28 " " 16,427.35 " " 45,923.55 " " 15,352.66 " " 22,841.00 " " 28,551.25 " " 15,506.19 " " 15,659.71 " " 15,352.66 " " 51,752.13 " " 48,517.62 " " 48,517.62 " " 51,105.23 " " 43,665.86 " " 48,517.62 " " 15,659.71 " " 51,105.23 " Inpatient OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC 394 " 44,030.25 " " 13,873.93 " " 8,904.03 " " 35,224.20 " " 26,444.57 " " 8,993.07 " " 27,307.56 " " 8,904.03 " " 17,567.47 " " 8,904.03 " " 29,874.52 " " 9,527.31 " " 31,257.07 " " 8,904.03 " " 12,967.17 " " 16,208.96 " " 8,993.07 " " 9,082.11 " " 8,904.03 " " 35,224.20 " " 33,022.69 " " 33,022.69 " " 34,783.90 " " 29,720.42 " " 33,022.69 " " 9,082.11 " " 34,783.90 " Inpatient OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC 395 " 23,248.08 " " 7,325.47 " " 6,313.12 " " 18,598.47 " " 13,962.80 " " 6,376.25 " " 14,418.46 " " 6,313.12 " " 12,569.23 " " 6,313.12 " " 15,773.82 " " 6,755.04 " " 16,503.81 " " 6,313.12 " " 8,976.21 " " 11,220.26 " " 6,376.25 " " 6,439.38 " " 6,313.12 " " 18,598.47 " " 17,436.06 " " 17,436.06 " " 18,365.99 " " 15,692.46 " " 17,436.06 " " 6,439.38 " " 18,365.99 " Inpatient "PANCREAS, LIVER AND SHUNT PROCEDURES WITH MCC" 405 " 164,871.99 " " 51,951.16 " " 51,847.44 " " 131,897.59 " " 99,022.11 " " 52,365.91 " " 102,253.61 " " 51,847.44 " " 98,450.48 " " 51,847.44 " " 111,865.64 " " 55,476.76 " " 117,042.62 " " 51,847.44 " " 65,827.35 " " 82,284.21 " " 52,365.91 " " 52,884.39 " " 51,847.44 " " 131,897.59 " " 123,653.99 " " 123,653.99 " " 130,248.87 " " 111,288.59 " " 123,653.99 " " 52,884.39 " " 130,248.87 " Inpatient "PANCREAS, LIVER AND SHUNT PROCEDURES WITH CC" 406 " 91,760.06 " " 28,913.60 " " 26,272.27 " " 73,408.05 " " 55,160.59 " " 26,534.99 " " 56,958.27 " " 26,272.27 " " 52,048.51 " " 26,272.27 " " 62,011.37 " " 28,111.33 " " 65,140.47 " " 26,272.27 " " 33,045.77 " " 41,307.22 " " 26,534.99 " " 26,797.72 " " 26,272.27 " " 73,408.05 " " 68,820.05 " " 68,820.05 " " 72,490.45 " " 65,108.34 " " 68,820.05 " " 26,797.72 " " 72,490.45 " Inpatient "PANCREAS, LIVER AND SHUNT PROCEDURES WITHOUT CC/MCC" 407 " 88,194.23 " " 27,790.00 " " 19,442.26 " " 70,555.39 " " 40,553.35 " " 19,636.68 " " 41,874.98 " " 19,442.26 " " 37,577.23 " " 19,442.26 " " 45,589.95 " " 20,803.22 " " 62,609.09 " " 19,442.26 " " 29,221.01 " " 36,526.27 " " 19,636.68 " " 19,831.11 " " 19,442.26 " " 70,555.39 " " 66,145.68 " " 66,145.68 " " 69,673.45 " " 47,866.80 " " 66,145.68 " " 19,831.11 " " 69,673.45 " Inpatient BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC 409 " 89,971.37 " " 28,349.98 " " 19,427.93 " " 71,977.10 " " 40,522.71 " " 19,622.21 " " 41,843.34 " " 19,427.93 " " 43,408.23 " " 19,427.93 " " 45,555.51 " " 20,787.89 " " 63,870.68 " " 19,427.93 " " 29,193.39 " " 36,491.74 " " 19,622.21 " " 19,816.49 " " 19,427.93 " " 71,977.10 " " 67,478.53 " " 67,478.53 " " 71,077.38 " " 47,830.64 " " 67,478.53 " " 19,816.49 " " 71,077.38 " Inpatient CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC 415 " 81,865.19 " " 25,795.72 " " 18,669.64 " " 65,492.15 " " 38,900.96 " " 18,856.34 " " 40,168.74 " " 18,669.64 " " 37,642.45 " " 18,669.64 " " 43,732.34 " " 19,976.51 " " 58,116.10 " " 18,669.64 " " 28,061.01 " " 35,076.26 " " 18,856.34 " " 19,043.03 " " 18,669.64 " " 65,492.15 " " 61,398.89 " " 61,398.89 " " 64,673.50 " " 45,916.42 " " 61,398.89 " " 19,043.03 " " 64,673.50 " Inpatient LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC 417 " 95,533.55 " " 30,102.62 " " 22,184.47 " " 76,426.84 " " 46,418.07 " " 22,406.31 " " 47,930.84 " " 22,184.47 " " 44,548.34 " " 22,184.47 " " 52,183.06 " " 23,737.38 " " 67,819.27 " " 22,184.47 " " 33,474.35 " " 41,842.94 " " 22,406.31 " " 22,628.16 " " 22,184.47 " " 76,426.84 " " 71,650.16 " " 71,650.16 " " 75,471.51 " " 54,789.18 " " 71,650.16 " " 22,628.16 " " 75,471.51 " Inpatient LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC 418 " 87,230.62 " " 27,486.37 " " 15,601.55 " " 69,784.50 " " 32,339.28 " " 15,757.57 " " 33,393.22 " " 15,601.55 " " 31,043.93 " " 15,601.55 " " 36,355.73 " " 16,693.66 " " 61,925.02 " " 15,601.55 " " 23,310.52 " " 29,138.15 " " 15,757.57 " " 15,913.58 " " 15,601.55 " " 69,784.50 " " 65,422.97 " " 65,422.97 " " 68,912.19 " " 38,171.40 " " 65,422.97 " " 15,913.58 " " 68,912.19 " Inpatient LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC 419 " 63,129.86 " " 19,892.22 " " 12,255.92 " " 50,503.89 " " 25,184.05 " " 12,378.48 " " 26,004.80 " " 12,255.92 " " 24,316.87 " " 12,255.92 " " 28,311.83 " " 13,113.83 " " 44,815.89 " " 12,255.92 " " 18,159.56 " " 22,699.45 " " 12,378.48 " " 12,501.04 " " 12,255.92 " " 50,503.89 " " 47,347.40 " " 47,347.40 " " 49,872.59 " " 29,725.78 " " 47,347.40 " " 12,501.04 " " 49,872.59 " Inpatient HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC 420 " 119,911.54 " " 37,784.13 " " 31,962.61 " " 95,929.24 " " 67,330.43 " " 32,282.24 " " 69,524.72 " " 31,962.61 " " 75,601.57 " " 31,962.61 " " 75,692.66 " " 34,199.99 " " 85,125.21 " " 31,962.61 " " 40,362.47 " " 50,453.10 " " 32,282.24 " " 32,601.86 " " 31,962.61 " " 95,929.24 " " 89,933.66 " " 89,933.66 " " 94,730.12 " " 79,472.90 " " 89,933.66 " " 32,601.86 " " 94,730.12 " Inpatient HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC 421 " 76,346.37 " " 24,056.74 " " 17,557.71 " " 61,077.10 " " 36,522.90 " " 17,733.29 " " 37,713.18 " " 17,557.71 " " 35,082.77 " " 17,557.71 " " 41,058.94 " " 18,786.75 " " 54,198.29 " " 17,557.71 " " 26,362.43 " " 32,953.04 " " 17,733.29 " " 17,908.86 " " 17,557.71 " " 61,077.10 " " 57,259.78 " " 57,259.78 " " 60,313.63 " " 43,109.50 " " 57,259.78 " " 17,908.86 " " 60,313.63 " Inpatient CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC 432 " 64,771.97 " " 20,409.65 " " 17,318.68 " " 51,817.57 " " 36,011.68 " " 17,491.87 " " 37,185.30 " " 17,318.68 " " 33,540.26 " " 17,318.68 " " 40,484.22 " " 18,530.99 " " 45,981.62 " " 17,318.68 " " 25,989.57 " " 32,486.97 " " 17,491.87 " " 17,665.05 " " 17,318.68 " " 51,817.57 " " 48,578.98 " " 48,578.98 " " 51,169.86 " " 42,506.08 " " 48,578.98 " " 17,665.05 " " 51,169.86 " Inpatient CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC 433 " 52,035.93 " " 16,396.52 " " 9,700.82 " " 41,628.74 " " 19,719.50 " " 9,797.83 " " 20,362.15 " " 9,700.82 " " 19,028.01 " " 9,700.82 " " 22,168.60 " " 10,379.88 " " 36,940.30 " " 9,700.82 " " 14,210.03 " " 17,762.54 " " 9,797.83 " " 9,894.84 " " 9,700.82 " " 41,628.74 " " 39,026.95 " " 39,026.95 " " 41,108.38 " " 23,275.74 " " 39,026.95 " " 9,894.84 " " 41,108.38 " Inpatient MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC 435 " 71,443.39 " " 22,511.81 " " 16,178.10 " " 57,154.71 " " 33,572.35 " " 16,339.88 " " 34,666.47 " " 16,178.10 " " 31,114.71 " " 16,178.10 " " 37,741.94 " " 17,310.57 " " 50,717.66 " " 16,178.10 " " 24,208.14 " " 30,260.18 " " 16,339.88 " " 16,501.66 " " 16,178.10 " " 57,154.71 " " 53,582.54 " " 53,582.54 " " 56,440.27 " " 39,626.84 " " 53,582.54 " " 16,501.66 " " 56,440.27 " Inpatient MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC 436 " 50,040.49 " " 15,767.76 " " 10,520.89 " " 40,032.39 " " 21,473.36 " " 10,626.10 " " 22,173.18 " " 10,520.89 " " 21,153.62 " " 10,520.89 " " 24,140.29 " " 11,257.35 " " 35,523.74 " " 10,520.89 " " 15,466.70 " " 19,333.37 " " 10,626.10 " " 10,731.31 " " 10,520.89 " " 40,032.39 " " 37,530.37 " " 37,530.37 " " 39,531.99 " " 25,345.90 " " 37,530.37 " " 10,731.31 " " 39,531.99 " Inpatient DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC 438 " 66,255.17 " " 20,877.00 " " 14,785.06 " " 53,004.14 " " 39,792.85 " " 14,932.91 " " 41,091.46 " " 14,785.06 " " 30,913.53 " " 14,785.06 " " 44,954.13 " " 15,820.01 " " 47,034.54 " " 14,785.06 " " 22,040.04 " " 27,550.06 " " 14,932.91 " " 15,080.76 " " 14,785.06 " " 53,004.14 " " 49,691.38 " " 49,691.38 " " 52,341.58 " " 44,722.24 " " 49,691.38 " " 15,080.76 " " 52,341.58 " Inpatient DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC 439 " 36,053.29 " " 11,360.39 " " 8,047.26 " " 28,842.64 " " 16,183.04 " " 8,127.73 " " 16,710.45 " " 8,047.26 " " 16,283.91 " " 8,047.26 " " 18,192.93 " " 8,610.57 " " 25,594.23 " " 8,047.26 " " 11,655.26 " " 14,569.08 " " 8,127.73 " " 8,208.21 " " 8,047.26 " " 28,842.64 " " 27,039.97 " " 27,039.97 " " 28,482.10 " " 19,101.52 " " 27,039.97 " " 8,208.21 " " 28,482.10 " Inpatient DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC 440 " 23,651.79 " " 7,452.68 " " 5,908.46 " " 18,921.43 " " 11,608.83 " " 5,967.54 " " 11,987.16 " " 5,908.46 " " 11,887.38 " " 5,908.46 " " 13,050.61 " " 6,322.05 " " 16,790.40 " " 5,908.46 " " 8,368.59 " " 10,460.74 " " 5,967.54 " " 6,026.63 " " 5,908.46 " " 18,921.43 " " 17,738.84 " " 17,738.84 " " 18,684.91 " " 13,702.38 " " 17,738.84 " " 6,026.63 " " 18,684.91 " Inpatient "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC" 441 " 75,200.57 " " 23,695.70 " " 17,307.04 " " 60,160.45 " " 35,986.79 " " 17,480.11 " " 37,159.59 " " 17,307.04 " " 33,827.15 " " 17,307.04 " " 40,456.24 " " 18,518.53 " " 53,384.88 " " 17,307.04 " " 26,017.19 " " 32,521.49 " " 17,480.11 " " 17,653.18 " " 17,307.04 " " 60,160.45 " " 56,400.42 " " 56,400.42 " " 59,408.45 " " 42,476.70 " " 56,400.42 " " 17,653.18 " " 59,408.45 " Inpatient "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC" 442 " 45,383.60 " " 14,300.37 " " 8,806.45 " " 36,306.88 " " 17,806.71 " " 8,894.51 " " 18,387.03 " " 8,806.45 " " 17,500.40 " " 8,806.45 " " 20,018.25 " " 9,422.90 " " 32,217.82 " " 8,806.45 " " 12,870.50 " " 16,088.13 " " 8,894.51 " " 8,982.58 " " 8,806.45 " " 36,306.88 " " 34,037.70 " " 34,037.70 " " 35,853.05 " " 21,018.00 " " 34,037.70 " " 8,982.58 " " 35,853.05 " Inpatient "DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC" 443 " 32,967.86 " " 10,388.17 " " 6,417.87 " " 26,374.29 " " 12,698.29 " " 6,482.05 " " 13,112.13 " " 6,417.87 " " 12,645.59 " " 6,417.87 " " 14,275.38 " " 6,867.12 " " 23,403.88 " " 6,417.87 " " 9,155.73 " " 11,444.67 " " 6,482.05 " " 6,546.23 " " 6,417.87 " " 26,374.29 " " 24,725.89 " " 24,725.89 " " 26,044.61 " " 14,988.32 " " 24,725.89 " " 6,546.23 " " 26,044.61 " Inpatient DISORDERS OF THE BILIARY TRACT WITH MCC 444 " 77,787.19 " " 24,510.74 " " 15,445.77 " " 62,229.75 " " 46,718.99 " " 15,600.23 " " 48,243.62 " " 15,445.77 " " 29,801.36 " " 15,445.77 " " 52,778.61 " " 16,526.97 " " 55,221.13 " " 15,445.77 " " 23,048.14 " " 28,810.18 " " 15,600.23 " " 15,754.69 " " 15,445.77 " " 62,229.75 " " 58,340.40 " " 58,340.40 " " 61,451.88 " " 52,506.36 " " 58,340.40 " " 15,754.69 " " 61,451.88 " Inpatient DISORDERS OF THE BILIARY TRACT WITH CC 445 " 69,908.35 " " 22,028.12 " " 10,126.97 " " 55,926.68 " " 41,986.96 " " 10,228.24 " " 43,357.16 " " 10,126.97 " " 19,711.70 " " 10,126.97 " " 47,432.82 " " 10,835.86 " " 49,627.94 " " 10,126.97 " " 14,872.89 " " 18,591.11 " " 10,228.24 " " 10,329.51 " " 10,126.97 " " 55,926.68 " " 52,431.26 " " 52,431.26 " " 55,227.60 " " 47,188.14 " " 52,431.26 " " 10,329.51 " " 55,227.60 " Inpatient DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC 446 " 43,832.35 " " 13,811.57 " " 7,791.21 " " 35,065.88 " " 26,325.71 " " 7,869.12 " " 27,184.82 " " 7,791.21 " " 14,746.98 " " 7,791.21 " " 29,740.25 " " 8,336.59 " " 31,116.58 " " 7,791.21 " " 11,268.59 " " 14,085.74 " " 7,869.12 " " 7,947.03 " " 7,791.21 " " 35,065.88 " " 32,874.26 " " 32,874.26 " " 34,627.56 " " 29,586.84 " " 32,874.26 " " 7,947.03 " " 34,627.56 " Inpatient COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH MCC 453 " 364,416.76 " " 114,827.72 " " 82,737.84 " " 291,533.41 " " 175,922.64 " " 83,565.22 " " 181,655.95 " " 82,737.84 " " 181,460.94 " " 82,737.84 " " 197,771.70 " " 88,529.49 " " 258,699.46 " " 82,737.84 " " 206,915.84 " " 258,663.01 " " 83,565.22 " " 84,392.60 " " 82,737.84 " " 291,533.41 " " 273,312.57 " " 273,312.57 " " 287,889.24 " " 207,648.80 " " 273,312.57 " " 84,392.60 " " 287,889.24 " Inpatient COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITH CC 454 " 229,875.24 " " 72,433.69 " " 55,030.13 " " 183,900.19 " " 116,664.59 " " 55,580.43 " " 120,466.68 " " 55,030.13 " " 121,031.10 " " 55,030.13 " " 131,153.98 " " 58,882.24 " " 163,188.43 " " 55,030.13 " " 130,523.16 " " 163,165.45 " " 55,580.43 " " 56,130.73 " " 55,030.13 " " 183,900.19 " " 172,406.43 " " 172,406.43 " " 181,601.44 " " 137,704.06 " " 172,406.43 " " 56,130.73 " " 181,601.44 " Inpatient COMBINED ANTERIOR AND POSTERIOR SPINAL FUSION WITHOUT CC/MCC 455 " 173,351.65 " " 54,623.10 " " 43,285.98 " " 138,681.32 " " 91,547.55 " " 43,718.84 " " 94,531.08 " " 43,285.98 " " 94,609.10 " " 43,285.98 " " 102,917.48 " " 46,316.00 " " 123,062.34 " " 43,285.98 " " 98,429.07 " " 123,045.00 " " 43,718.84 " " 44,151.70 " " 43,285.98 " " 138,681.32 " " 130,013.74 " " 130,013.74 " " 136,947.80 " " 108,057.38 " " 130,013.74 " " 44,151.70 " " 136,947.80 " Inpatient "SPINAL FUSION EXCEPT CERVICAL WITH SPINAL CURVATURE, MALIGNANCY, INFECTION OR EXTENSIVE FUSIONS WITH CC" 457 " 230,275.24 " " 72,559.73 " " 58,636.28 " " 184,220.19 " " 138,303.31 " " 59,222.64 " " 142,816.71 " " 58,636.28 " " 133,053.03 " " 58,636.28 " " 156,241.75 " " 62,740.82 " " 163,472.39 " " 58,636.28 " " 74,683.21 " " 93,354.03 " " 59,222.64 " " 59,809.01 " " 58,636.28 " " 184,220.19 " " 172,706.43 " " 172,706.43 " " 181,917.44 " " 155,435.79 " " 172,706.43 " " 59,809.01 " " 181,917.44 " Inpatient SPINAL FUSION EXCEPT CERVICAL WITH MCC 459 " 230,817.75 " " 72,730.67 " " 60,763.44 " " 184,654.20 " " 138,629.14 " " 61,371.07 " " 143,153.17 " " 60,763.44 " " 133,366.50 " " 60,763.44 " " 156,609.84 " " 65,016.88 " " 163,857.52 " " 60,763.44 " " 131,058.32 " " 163,834.44 " " 61,371.07 " " 61,978.71 " " 60,763.44 " " 184,654.20 " " 173,113.31 " " 173,113.31 " " 182,346.02 " " 155,801.98 " " 173,113.31 " " 61,978.71 " " 182,346.02 " Inpatient SPINAL FUSION EXCEPT CERVICAL WITHOUT MCC 460 " 170,907.55 " " 53,852.97 " " 35,670.81 " " 136,726.04 " " 75,261.11 " " 36,027.52 " " 77,713.87 " " 35,670.81 " " 74,802.38 " " 35,670.81 " " 84,608.32 " " 38,167.77 " " 121,327.27 " " 35,670.81 " " 97,041.31 " " 121,310.18 " " 36,027.52 " " 36,384.23 " " 35,670.81 " " 136,726.04 " " 128,180.66 " " 128,180.66 " " 135,016.96 " " 88,833.82 " " 128,180.66 " " 36,384.23 " " 135,016.96 " Inpatient BILATERAL OR MULTIPLE MAJOR JOINT PROCEDURES OF LOWER EXTREMITY WITHOUT MCC 462 " 146,603.74 " " 46,194.84 " " 28,604.45 " " 117,282.99 " " 60,148.39 " " 28,890.49 " " 62,108.62 " " 28,604.45 " " 60,808.03 " " 28,604.45 " " 67,618.64 " " 30,606.76 " " 104,073.99 " " 28,604.45 " " 36,112.58 " " 45,140.73 " " 28,890.49 " " 29,176.54 " " 28,604.45 " " 117,282.99 " " 109,952.80 " " 109,952.80 " " 115,816.95 " " 70,995.64 " " 109,952.80 " " 29,176.54 " " 115,816.95 " Inpatient WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC 463 " 214,467.99 " " 67,578.86 " " 48,559.12 " " 171,574.39 " " 102,825.13 " " 49,044.71 " " 106,176.20 " " 48,559.12 " " 93,441.04 " " 48,559.12 " " 115,595.71 " " 51,958.26 " " 152,250.83 " " 48,559.12 " " 61,623.41 " " 77,029.28 " " 49,044.71 " " 49,530.30 " " 48,559.12 " " 171,574.39 " " 160,851.00 " " 160,851.00 " " 169,429.71 " " 121,368.78 " " 160,851.00 " " 49,530.30 " " 169,429.71 " Inpatient WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC 464 " 145,698.03 " " 45,909.45 " " 27,122.78 " " 116,558.43 " " 56,979.56 " " 27,394.01 " " 58,836.52 " " 27,122.78 " " 52,968.80 " " 27,122.78 " " 64,056.25 " " 29,021.37 " " 103,431.03 " " 27,122.78 " " 34,171.42 " " 42,714.28 " " 27,394.01 " " 27,665.24 " " 27,122.78 " " 116,558.43 " " 109,273.52 " " 109,273.52 " " 115,101.45 " " 67,255.34 " " 109,273.52 " " 27,665.24 " " 115,101.45 " Inpatient WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC 465 " 112,671.54 " " 35,502.80 " " 16,990.11 " " 90,137.23 " " 35,308.98 " " 17,160.01 " " 36,459.70 " " 16,990.11 " " 35,038.06 " " 16,990.11 " " 39,694.25 " " 18,179.42 " " 79,985.52 " " 16,990.11 " " 25,464.81 " " 31,831.02 " " 17,160.01 " " 17,329.91 " " 16,990.11 " " 90,137.23 " " 84,503.65 " " 84,503.65 " " 89,010.51 " " 41,676.66 " " 84,503.65 " " 17,329.91 " " 89,010.51 " Inpatient REVISION OF HIP OR KNEE REPLACEMENT WITH MCC 466 " 198,754.60 " " 62,627.57 " " 48,338.88 " " 159,003.68 " " 102,354.12 " " 48,822.27 " " 105,689.83 " " 48,338.88 " " 93,932.85 " " 48,338.88 " " 115,066.19 " " 51,722.60 " " 141,095.89 " " 48,338.88 " " 61,393.69 " " 76,742.12 " " 48,822.27 " " 49,305.66 " " 48,338.88 " " 159,003.68 " " 149,065.95 " " 149,065.95 " " 157,016.13 " " 120,812.82 " " 149,065.95 " " 49,305.66 " " 157,016.13 " Inpatient REVISION OF HIP OR KNEE REPLACEMENT WITH CC 467 " 131,037.84 " " 41,290.02 " " 32,508.72 " " 104,830.27 " " 68,498.39 " " 32,833.81 " " 70,730.75 " " 32,508.72 " " 64,783.53 " " 32,508.72 " " 77,005.69 " " 34,784.33 " " 93,023.76 " " 32,508.72 " " 41,074.62 " " 51,343.28 " " 32,833.81 " " 33,158.89 " " 32,508.72 " " 104,830.27 " " 98,278.38 " " 98,278.38 " " 103,519.89 " " 80,851.50 " " 98,278.38 " " 33,158.89 " " 103,519.89 " Inpatient REVISION OF HIP OR KNEE REPLACEMENT WITHOUT CC/MCC 468 " 117,232.13 " " 36,939.84 " " 25,569.48 " " 93,785.70 " " 53,657.55 " " 25,825.17 " " 55,406.25 " " 25,569.48 " " 52,462.09 " " 25,569.48 " " 60,321.66 " " 27,359.34 " " 83,223.09 " " 25,569.48 " " 32,207.28 " " 40,259.10 " " 25,825.17 " " 26,080.87 " " 25,569.48 " " 93,785.70 " " 87,924.10 " " 87,924.10 " " 92,613.38 " " 63,334.24 " " 87,924.10 " " 26,080.87 " " 92,613.38 " Inpatient MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITH MCC OR TOTAL ANKLE REPLACEMENT 469 " 158,114.03 " " 49,821.73 " " 28,107.57 " " 126,491.23 " " 59,085.73 " " 28,388.65 " " 61,011.33 " " 28,107.57 " " 59,634.38 " " 28,107.57 " " 66,424.00 " " 30,075.10 " " 112,245.15 " " 28,107.57 " " 35,423.41 " " 44,279.27 " " 28,388.65 " " 28,669.72 " " 28,107.57 " " 126,491.23 " " 118,585.52 " " 118,585.52 " " 124,910.09 " " 69,741.34 " " 118,585.52 " " 28,669.72 " " 124,910.09 " Inpatient MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT MCC 470 " 111,050.73 " " 34,992.08 " " 17,493.25 " " 88,840.58 " " 36,385.04 " " 17,668.18 " " 37,570.83 " " 17,493.25 " " 38,272.12 " " 17,493.25 " " 40,903.96 " " 18,717.78 " " 78,834.91 " " 17,493.25 " " 26,238.15 " " 32,797.69 " " 17,668.18 " " 17,843.12 " " 17,493.25 " " 88,840.58 " " 83,288.05 " " 83,288.05 " " 87,730.07 " " 42,946.78 " " 83,288.05 " " 17,843.12 " " 87,730.07 " Inpatient CERVICAL SPINAL FUSION WITH MCC 471 " 195,667.71 " " 61,654.90 " " 45,420.30 " " 156,534.17 " " 117,518.03 " " 45,874.50 " " 121,353.11 " " 45,420.30 " " 91,643.30 " " 45,420.30 " " 132,760.54 " " 48,599.72 " " 138,904.51 " " 45,420.30 " " 111,100.13 " " 138,884.94 " " 45,874.50 " " 46,328.71 " " 45,420.30 " " 156,534.17 " " 146,750.78 " " 146,750.78 " " 154,577.49 " " 132,075.70 " " 146,750.78 " " 46,328.71 " " 154,577.49 " Inpatient CERVICAL SPINAL FUSION WITH CC 472 " 132,674.54 " " 41,805.75 " " 27,819.30 " " 106,139.63 " " 58,469.19 " " 28,097.49 " " 60,374.70 " " 27,819.30 " " 53,160.68 " " 27,819.30 " " 65,730.89 " " 29,766.65 " " 94,185.65 " " 27,819.30 " " 75,332.60 " " 94,172.39 " " 28,097.49 " " 28,375.69 " " 27,819.30 " " 106,139.63 " " 99,505.90 " " 99,505.90 " " 104,812.88 " " 69,013.62 " " 99,505.90 " " 28,375.69 " " 104,812.88 " Inpatient CERVICAL SPINAL FUSION WITHOUT CC/MCC 473 " 118,724.73 " " 37,410.16 " " 23,211.34 " " 94,979.78 " " 48,614.23 " " 23,443.45 " " 50,198.57 " " 23,211.34 " " 42,696.58 " " 23,211.34 " " 54,651.98 " " 24,836.13 " " 84,282.69 " " 23,211.34 " " 29,174.92 " " 36,468.66 " " 23,443.45 " " 23,675.57 " " 23,211.34 " " 94,979.78 " " 89,043.55 " " 89,043.55 " " 93,792.54 " " 57,381.40 " " 89,043.55 " " 23,675.57 " " 93,792.54 " Inpatient AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC 474 " 235,931.71 " " 74,342.08 " " 36,972.54 " " 188,745.37 " " 78,045.09 " " 37,342.27 " " 80,588.57 " " 36,972.54 " " 71,950.23 " " 36,972.54 " " 87,738.05 " " 39,560.62 " " 167,487.92 " " 36,972.54 " " 46,783.25 " " 58,479.08 " " 37,342.27 " " 37,711.99 " " 36,972.54 " " 188,745.37 " " 176,948.78 " " 176,948.78 " " 186,386.05 " " 92,119.86 " " 176,948.78 " " 37,711.99 " " 186,386.05 " Inpatient AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC 475 " 92,481.64 " " 29,140.96 " " 20,143.25 " " 73,985.31 " " 42,052.56 " " 20,344.68 " " 43,423.05 " " 20,143.25 " " 40,088.47 " " 20,143.25 " " 47,275.36 " " 21,553.28 " " 65,652.71 " " 20,143.25 " " 30,298.15 " " 37,872.70 " " 20,344.68 " " 20,546.12 " " 20,143.25 " " 73,985.31 " " 69,361.23 " " 69,361.23 " " 73,060.49 " " 49,636.38 " " 69,361.23 " " 20,546.12 " " 73,060.49 " Inpatient BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC 477 " 112,908.82 " " 35,577.57 " " 30,551.66 " " 90,327.06 " " 64,312.86 " " 30,857.18 " " 66,408.81 " " 30,551.66 " " 60,232.39 " " 30,551.66 " " 72,300.32 " " 32,690.28 " " 80,153.97 " " 30,551.66 " " 38,559.14 " " 48,198.93 " " 30,857.18 " " 31,162.69 " " 30,551.66 " " 90,327.06 " " 84,681.62 " " 84,681.62 " " 89,197.97 " " 75,911.14 " " 84,681.62 " " 31,162.69 " " 89,197.97 " Inpatient BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC 478 " 80,439.58 " " 25,346.51 " " 21,594.48 " " 64,351.66 " " 45,156.28 " " 21,810.42 " " 46,627.93 " " 21,594.48 " " 41,705.50 " " 21,594.48 " " 50,764.56 " " 23,106.09 " " 57,104.06 " " 21,594.48 " " 32,549.11 " " 40,686.39 " " 21,810.42 " " 22,026.37 " " 21,594.48 " " 64,351.66 " " 60,329.69 " " 60,329.69 " " 63,547.27 " " 53,299.84 " " 60,329.69 " " 22,026.37 " " 63,547.27 " Inpatient HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC 480 " 128,467.20 " " 40,480.01 " " 27,569.52 " " 102,773.76 " " 57,934.99 " " 27,845.22 " " 59,823.09 " " 27,569.52 " " 56,262.46 " " 27,569.52 " " 65,130.35 " " 29,499.39 " " 91,198.86 " " 27,569.52 " " 34,745.72 " " 43,432.16 " " 27,845.22 " " 28,120.91 " " 27,569.52 " " 102,773.76 " " 96,350.40 " " 96,350.40 " " 101,489.09 " " 68,383.08 " " 96,350.40 " " 28,120.91 " " 101,489.09 " Inpatient HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC 481 " 103,199.15 " " 32,518.05 " " 19,246.19 " " 82,559.32 " " 40,134.03 " " 19,438.65 " " 41,441.99 " " 19,246.19 " " 38,193.87 " " 19,246.19 " " 45,118.55 " " 20,593.42 " " 73,261.07 " " 19,246.19 " " 28,944.82 " " 36,181.03 " " 19,438.65 " " 19,631.11 " " 19,246.19 " " 82,559.32 " " 77,399.36 " " 77,399.36 " " 81,527.32 " " 47,371.86 " " 77,399.36 " " 19,631.11 " " 81,527.32 " Inpatient HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC 482 " 88,807.24 " " 27,983.16 " " 15,214.79 " " 71,045.79 " " 31,512.13 " " 15,366.94 " " 32,539.11 " " 15,214.79 " " 31,097.95 " " 15,214.79 " " 35,425.85 " " 16,279.83 " " 63,044.26 " " 15,214.79 " " 22,744.33 " " 28,430.42 " " 15,366.94 " " 15,519.09 " " 15,214.79 " " 71,045.79 " " 66,605.43 " " 66,605.43 " " 70,157.72 " " 37,195.08 " " 66,605.43 " " 15,519.09 " " 70,157.72 " Inpatient MAJOR JOINT OR LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITIES 483 " 103,188.89 " " 32,514.82 " " 21,838.89 " " 82,551.11 " " 45,679.00 " " 22,057.28 " " 47,167.67 " " 21,838.89 " " 45,202.23 " " 21,838.89 " " 51,352.19 " " 23,367.61 " " 73,253.79 " " 21,838.89 " " 32,949.59 " " 41,186.99 " " 22,057.28 " " 22,275.67 " " 21,838.89 " " 82,551.11 " " 77,391.67 " " 77,391.67 " " 81,519.22 " " 53,916.82 " " 77,391.67 " " 22,275.67 " " 81,519.22 " Inpatient KNEE PROCEDURES WITHOUT PRINCIPAL DIAGNOSIS OF INFECTION WITH CC/MCC 488 " 177,651.62 " " 55,978.03 " " 18,168.29 " " 142,121.30 " " 37,828.73 " " 18,349.97 " " 39,061.56 " " 18,168.29 " " 37,193.48 " " 18,168.29 " " 42,526.94 " " 19,440.07 " " 126,114.89 " " 18,168.29 " " 27,273.86 " " 34,092.33 " " 18,349.97 " " 18,531.66 " " 18,168.29 " " 142,121.30 " " 133,238.72 " " 133,238.72 " " 140,344.78 " " 44,650.82 " " 133,238.72 " " 18,531.66 " " 140,344.78 " Inpatient "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH MCC" 492 " 242,651.52 " " 76,459.49 " " 31,546.30 " " 194,121.22 " " 66,440.09 " " 31,861.76 " " 68,605.37 " " 31,546.30 " " 61,495.45 " " 31,546.30 " " 74,691.75 " " 33,754.54 " " 172,258.31 " " 31,546.30 " " 39,834.11 " " 49,792.64 " " 31,861.76 " " 32,177.23 " " 31,546.30 " " 194,121.22 " " 181,988.64 " " 181,988.64 " " 191,694.70 " " 78,422.00 " " 181,988.64 " " 32,177.23 " " 191,694.70 " Inpatient "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITH CC" 493 " 139,512.73 " " 43,960.46 " " 21,302.63 " " 111,610.18 " " 44,532.09 " " 21,515.66 " " 45,983.39 " " 21,302.63 " " 41,053.47 " " 21,302.63 " " 50,062.85 " " 22,793.81 " " 99,040.09 " " 21,302.63 " " 32,107.20 " " 40,134.01 " " 21,515.66 " " 21,728.68 " " 21,302.63 " " 111,610.18 " " 104,634.55 " " 104,634.55 " " 110,215.06 " " 52,563.08 " " 104,634.55 " " 21,728.68 " " 110,215.06 " Inpatient "LOWER EXTREMITY AND HUMERUS PROCEDURES EXCEPT HIP, FOOT AND FEMUR WITHOUT CC/MCC" 494 " 129,090.02 " " 40,676.27 " " 17,058.15 " " 103,272.02 " " 35,454.50 " " 17,228.73 " " 36,609.96 " " 17,058.15 " " 32,718.70 " " 17,058.15 " " 39,857.84 " " 18,252.22 " " 91,641.01 " " 17,058.15 " " 25,575.29 " " 31,969.11 " " 17,228.73 " " 17,399.31 " " 17,058.15 " " 103,272.02 " " 96,817.52 " " 96,817.52 " " 101,981.12 " " 41,848.42 " " 96,817.52 " " 17,399.31 " " 101,981.12 " Inpatient LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC 496 " 80,870.12 " " 25,482.17 " " 18,264.08 " " 64,696.10 " " 38,033.60 " " 18,446.72 " " 39,273.11 " " 18,264.08 " " 36,761.26 " " 18,264.08 " " 42,757.26 " " 19,542.57 " " 57,409.70 " " 18,264.08 " " 27,425.77 " " 34,282.21 " " 18,446.72 " " 18,629.36 " " 18,264.08 " " 64,696.10 " " 60,652.59 " " 60,652.59 " " 63,887.39 " " 44,892.64 " " 60,652.59 " " 18,629.36 " " 63,887.39 " Inpatient LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC 497 " 50,125.37 " " 15,794.50 " " 13,475.28 " " 40,100.30 " " 27,791.87 " " 13,610.03 " " 28,697.61 " " 13,475.28 " " 25,835.17 " " 13,475.28 " " 31,243.54 " " 14,418.55 " " 35,584.00 " " 13,475.28 " " 20,148.13 " " 25,185.17 " " 13,610.03 " " 13,744.79 " " 13,475.28 " " 40,100.30 " " 37,594.03 " " 37,594.03 " " 39,599.04 " " 32,803.90 " " 37,594.03 " " 13,744.79 " " 39,599.04 " Inpatient SOFT TISSUE PROCEDURES WITH MCC 500 " 138,268.54 " " 43,568.42 " " 29,035.07 " " 110,614.83 " " 61,069.36 " " 29,325.42 " " 63,059.60 " " 29,035.07 " " 55,101.86 " " 29,035.07 " " 68,653.99 " " 31,067.52 " " 98,156.83 " " 29,035.07 " " 36,227.44 " " 45,284.31 " " 29,325.42 " " 29,615.77 " " 29,035.07 " " 110,614.83 " " 103,701.40 " " 103,701.40 " " 109,232.14 " " 72,082.70 " " 103,701.40 " " 29,615.77 " " 109,232.14 " Inpatient SOFT TISSUE PROCEDURES WITH CC 501 " 92,162.27 " " 29,040.33 " " 16,184.37 " " 73,729.82 " " 33,585.75 " " 16,346.21 " " 34,680.31 " " 16,184.37 " " 31,461.22 " " 16,184.37 " " 37,757.00 " " 17,317.28 " " 65,426.00 " " 16,184.37 " " 24,097.66 " " 30,122.09 " " 16,346.21 " " 16,508.06 " " 16,184.37 " " 73,729.82 " " 69,121.70 " " 69,121.70 " " 72,808.19 " " 39,642.66 " " 69,121.70 " " 16,508.06 " " 72,808.19 " Inpatient SOFT TISSUE PROCEDURES WITHOUT CC/MCC 502 " 86,850.40 " " 27,366.56 " " 12,412.60 " " 69,480.32 " " 25,519.12 " " 12,536.73 " " 26,350.79 " " 12,412.60 " " 23,536.30 " " 12,412.60 " " 28,688.52 " " 13,281.48 " " 61,655.10 " " 12,412.60 " " 18,380.51 " " 22,975.64 " " 12,536.73 " " 12,660.85 " " 12,412.60 " " 69,480.32 " " 65,137.80 " " 65,137.80 " " 68,611.82 " " 30,121.28 " " 65,137.80 " " 12,660.85 " " 68,611.82 " Inpatient OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC 515 " 117,616.56 " " 37,060.98 " " 28,597.29 " " 94,093.25 " " 60,133.07 " " 28,883.26 " " 62,092.80 " " 28,597.29 " " 54,390.22 " " 28,597.29 " " 67,601.42 " " 30,599.10 " " 83,496.00 " " 28,597.29 " " 36,032.18 " " 45,040.23 " " 28,883.26 " " 29,169.24 " " 28,597.29 " " 94,093.25 " " 88,212.42 " " 88,212.42 " " 92,917.09 " " 70,977.56 " " 88,212.42 " " 29,169.24 " " 92,917.09 " Inpatient OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC 516 " 79,214.78 " " 24,960.58 " " 18,052.80 " " 63,371.82 " " 37,581.73 " " 18,233.33 " " 38,806.52 " " 18,052.80 " " 35,060.42 " " 18,052.80 " " 42,249.27 " " 19,316.50 " " 56,234.57 " " 18,052.80 " " 27,080.53 " " 33,850.66 " " 18,233.33 " " 18,413.86 " " 18,052.80 " " 63,371.82 " " 59,411.08 " " 59,411.08 " " 62,579.68 " " 44,359.28 " " 59,411.08 " " 18,413.86 " " 62,579.68 " Inpatient OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC 517 " 77,064.16 " " 24,282.92 " " 12,998.10 " " 61,651.33 " " 26,771.34 " " 13,128.08 " " 27,643.81 " " 12,998.10 " " 26,753.61 " " 12,998.10 " " 30,096.26 " " 13,907.97 " " 54,707.85 " " 12,998.10 " " 19,291.94 " " 24,114.93 " " 13,128.08 " " 13,258.06 " " 12,998.10 " " 61,651.33 " " 57,798.12 " " 57,798.12 " " 60,880.69 " " 31,599.32 " " 57,798.12 " " 13,258.06 " " 60,880.69 " Inpatient BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR 518 " 157,092.29 " " 49,499.78 " " 32,592.88 " " 125,673.83 " " 68,678.37 " " 32,918.81 " " 70,916.60 " " 32,592.88 " " 53,889.09 " " 32,592.88 " " 77,208.02 " " 34,874.38 " " 111,519.81 " " 32,592.88 " " 41,166.50 " " 51,458.14 " " 32,918.81 " " 33,244.74 " " 32,592.88 " " 125,673.83 " " 117,819.21 " " 117,819.21 " " 124,102.91 " " 81,063.94 " " 117,819.21 " " 33,244.74 " " 124,102.91 " Inpatient BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC 519 " 84,511.46 " " 26,629.56 " " 18,027.73 " " 67,609.17 " " 37,528.12 " " 18,208.01 " " 38,751.16 " " 18,027.73 " " 33,596.15 " " 18,027.73 " " 42,189.00 " " 19,289.67 " " 59,994.69 " " 18,027.73 " " 27,039.10 " " 33,798.88 " " 18,208.01 " " 18,388.28 " " 18,027.73 " " 67,609.17 " " 63,383.59 " " 63,383.59 " " 66,764.05 " " 44,296.00 " " 63,383.59 " " 18,388.28 " " 66,764.05 " Inpatient BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC 520 " 80,509.49 " " 25,368.54 " " 13,178.05 " " 64,407.59 " " 27,156.19 " " 13,309.83 " " 28,041.21 " " 13,178.05 " " 24,149.21 " " 13,178.05 " " 30,528.91 " " 14,100.51 " " 57,153.69 " " 13,178.05 " " 19,568.13 " " 24,460.17 " " 13,309.83 " " 13,441.61 " " 13,178.05 " " 64,407.59 " " 60,382.12 " " 60,382.12 " " 63,602.50 " " 32,053.58 " " 60,382.12 " " 13,441.61 " " 63,602.50 " Inpatient HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC 521 " 134,126.01 " " 42,263.10 " " 27,931.21 " " 107,300.80 " " 58,708.53 " " 28,210.52 " " 60,621.84 " " 27,931.21 " " 57,070.36 " " 27,931.21 " " 65,999.96 " " 29,886.39 " " 95,216.05 " " 27,931.21 " " 35,182.20 " " 43,977.76 " " 28,210.52 " " 28,489.83 " " 27,931.21 " " 107,300.80 " " 100,594.50 " " 100,594.50 " " 105,959.54 " " 69,296.12 " " 100,594.50 " " 28,489.83 " " 105,959.54 " Inpatient HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC 522 " 100,501.19 " " 31,667.93 " " 20,081.48 " " 80,400.95 " " 41,920.44 " " 20,282.29 " " 43,286.63 " " 20,081.48 " " 40,782.35 " " 20,081.48 " " 47,126.84 " " 21,487.18 " " 71,345.80 " " 20,081.48 " " 30,229.10 " " 37,786.39 " " 20,282.29 " " 20,483.11 " " 20,081.48 " " 80,400.95 " " 75,375.90 " " 75,375.90 " " 79,395.94 " " 49,480.44 " " 75,375.90 " " 20,483.11 " " 79,395.94 " Inpatient FRACTURES OF HIP AND PELVIS WITHOUT MCC 536 " 37,710.44 " " 11,882.56 " " 7,389.24 " " 30,168.35 " " 14,775.74 " " 7,463.13 " " 15,257.28 " " 7,389.24 " " 14,055.84 " " 7,389.24 " " 16,610.84 " " 7,906.49 " " 26,770.64 " " 7,389.24 " " 10,660.97 " " 13,326.22 " " 7,463.13 " " 7,537.02 " " 7,389.24 " " 30,168.35 " " 28,282.83 " " 28,282.83 " " 29,791.25 " " 17,440.42 " " 28,282.83 " " 7,537.02 " " 29,791.25 " Inpatient OSTEOMYELITIS WITH CC 540 " 46,151.48 " " 14,542.33 " " 12,133.27 " " 36,921.18 " " 24,921.74 " " 12,254.60 " " 25,733.93 " " 12,133.27 " " 24,061.65 " " 12,133.27 " " 28,016.94 " " 12,982.60 " " 32,762.94 " " 12,133.27 " " 17,883.37 " " 22,354.21 " " 12,254.60 " " 12,375.94 " " 12,133.27 " " 36,921.18 " " 34,613.61 " " 34,613.61 " " 36,459.67 " " 29,416.16 " " 34,613.61 " " 12,375.94 " " 36,459.67 " Inpatient PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC 542 " 66,246.42 " " 20,874.25 " " 16,677.66 " " 52,997.14 " " 34,640.75 " " 16,844.44 " " 35,769.69 " " 16,677.66 " " 33,726.56 " " 16,677.66 " " 38,943.03 " " 17,845.10 " " 47,028.34 " " 16,677.66 " " 24,926.24 " " 31,157.80 " " 16,844.44 " " 17,011.21 " " 16,677.66 " " 52,997.14 " " 49,684.82 " " 49,684.82 " " 52,334.67 " " 40,887.92 " " 49,684.82 " " 17,011.21 " " 52,334.67 " Inpatient PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC 543 " 39,483.65 " " 12,441.30 " " 9,837.80 " " 31,586.92 " " 20,012.44 " " 9,936.18 " " 20,664.65 " " 9,837.80 " " 20,114.10 " " 9,837.80 " " 22,497.93 " " 10,526.45 " " 28,029.45 " " 9,837.80 " " 14,403.36 " " 18,004.20 " " 9,936.18 " " 10,034.56 " " 9,837.80 " " 31,586.92 " " 29,612.74 " " 29,612.74 " " 31,192.09 " " 23,621.52 " " 29,612.74 " " 10,034.56 " " 31,192.09 " Inpatient CONNECTIVE TISSUE DISORDERS WITH MCC 545 " 113,299.73 " " 35,700.74 " " 22,889.94 " " 90,639.78 " " 47,926.86 " " 23,118.84 " " 49,488.79 " " 22,889.94 " " 44,011.81 " " 22,889.94 " " 53,879.23 " " 24,492.24 " " 80,431.48 " " 22,889.94 " " 28,715.48 " " 35,894.35 " " 23,118.84 " " 23,347.74 " " 22,889.94 " " 90,639.78 " " 84,974.80 " " 84,974.80 " " 89,506.79 " " 56,570.06 " " 84,974.80 " " 23,347.74 " " 89,506.79 " Inpatient CONNECTIVE TISSUE DISORDERS WITH CC 546 " 40,639.85 " " 12,805.62 " " 11,295.30 " " 32,511.88 " " 23,129.58 " " 11,408.25 " " 23,883.37 " " 11,295.30 " " 20,989.68 " " 11,295.30 " " 26,002.20 " " 12,085.97 " " 28,850.23 " " 11,295.30 " " 16,668.13 " " 20,835.16 " " 11,408.25 " " 11,521.21 " " 11,295.30 " " 32,511.88 " " 30,479.89 " " 30,479.89 " " 32,105.48 " " 27,300.80 " " 30,479.89 " " 11,521.21 " " 32,105.48 " Inpatient CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC 547 " 45,285.28 " " 14,269.39 " " 7,943.41 " " 36,228.22 " " 15,960.94 " " 8,022.84 " " 16,481.11 " " 7,943.41 " " 15,188.50 " " 7,943.41 " " 17,943.24 " " 8,499.45 " " 32,148.02 " " 7,943.41 " " 11,503.36 " " 14,379.20 " " 8,022.84 " " 8,102.28 " " 7,943.41 " " 36,228.22 " " 33,963.96 " " 33,963.96 " " 35,775.37 " " 18,839.36 " " 33,963.96 " " 8,102.28 " " 35,775.37 " Inpatient MEDICAL BACK PROBLEMS WITH MCC 551 " 63,267.03 " " 19,935.44 " " 15,050.06 " " 50,613.63 " " 31,159.83 " " 15,200.56 " " 32,175.33 " " 15,050.06 " " 28,936.95 " " 15,050.06 " " 35,029.79 " " 16,103.56 " " 44,913.27 " " 15,050.06 " " 22,412.90 " " 28,016.13 " " 15,200.56 " " 15,351.06 " " 15,050.06 " " 50,613.63 " " 47,450.28 " " 47,450.28 " " 49,980.96 " " 36,779.24 " " 47,450.28 " " 15,351.06 " " 49,980.96 " Inpatient MEDICAL BACK PROBLEMS WITHOUT MCC 552 " 36,536.18 " " 11,512.55 " " 8,926.42 " " 29,228.94 " " 18,063.28 " " 9,015.68 " " 18,651.96 " " 8,926.42 " " 16,650.91 " " 8,926.42 " " 20,306.69 " " 9,551.27 " " 25,937.03 " " 8,926.42 " " 13,008.60 " " 16,260.75 " " 9,015.68 " " 9,104.95 " " 8,926.42 " " 29,228.94 " " 27,402.13 " " 27,402.13 " " 28,863.58 " " 21,320.84 " " 27,402.13 " " 9,104.95 " " 28,863.58 " Inpatient BONE DISEASES AND ARTHROPATHIES WITHOUT MCC 554 " 30,997.51 " " 9,767.31 " " 7,575.45 " " 24,798.01 " " 15,174.00 " " 7,651.20 " " 15,668.52 " " 7,575.45 " " 14,003.67 " " 7,575.45 " " 17,058.56 " " 8,105.73 " " 22,005.13 " " 7,575.45 " " 10,909.54 " " 13,636.93 " " 7,651.20 " " 7,726.96 " " 7,575.45 " " 24,798.01 " " 23,248.13 " " 23,248.13 " " 24,488.03 " " 17,910.50 " " 23,248.13 " " 7,726.96 " " 24,488.03 " Inpatient SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC 556 " 41,742.89 " " 13,153.18 " " 7,720.49 " " 33,394.31 " " 15,484.18 " " 7,797.69 " " 15,988.81 " " 7,720.49 " " 14,510.40 " " 7,720.49 " " 17,407.27 " " 8,260.92 " " 29,633.27 " " 7,720.49 " " 11,130.50 " " 13,913.12 " " 7,797.69 " " 7,874.90 " " 7,720.49 " " 33,394.31 " " 31,307.16 " " 31,307.16 " " 32,976.88 " " 18,276.62 " " 31,307.16 " " 7,874.90 " " 32,976.88 " Inpatient "TENDONITIS, MYOSITIS AND BURSITIS WITH MCC" 557 " 40,618.75 " " 12,798.97 " " 13,006.16 " " 32,495.00 " " 26,788.57 " " 13,136.22 " " 27,661.61 " " 13,006.16 " " 26,889.59 " " 13,006.16 " " 30,115.63 " " 13,916.59 " " 28,835.25 " " 13,006.16 " " 19,250.51 " " 24,063.14 " " 13,136.22 " " 13,266.28 " " 13,006.16 " " 32,495.00 " " 30,464.06 " " 30,464.06 " " 32,088.81 " " 31,619.66 " " 30,464.06 " " 13,266.28 " " 32,088.81 " Inpatient "TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC" 558 " 26,392.16 " " 8,316.17 " " 8,192.29 " " 21,113.73 " " 16,493.23 " " 8,274.21 " " 17,030.74 " " 8,192.29 " " 15,959.77 " " 8,192.29 " " 18,541.64 " " 8,765.75 " " 18,735.80 " " 8,192.29 " " 11,848.59 " " 14,810.74 " " 8,274.21 " " 8,356.14 " " 8,192.29 " " 21,113.73 " " 19,794.12 " " 19,794.12 " " 20,849.81 " " 19,467.64 " " 19,794.12 " " 8,356.14 " " 20,849.81 " Inpatient "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC" 562 " 39,616.22 " " 12,483.07 " " 13,119.86 " " 31,906.68 " " 27,031.73 " " 13,251.06 " " 27,912.70 " " 13,119.86 " " 25,749.47 " " 13,119.86 " " 30,389.00 " " 14,038.25 " " 28,123.56 " " 13,119.86 " " 19,443.85 " " 24,304.81 " " 13,251.06 " " 13,382.26 " " 13,119.86 " " 31,692.98 " " 29,712.17 " " 29,712.17 " " 31,296.82 " " 31,906.68 " " 29,712.17 " " 13,382.26 " " 31,296.82 " Inpatient "FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC" 563 " 36,461.60 " " 11,489.05 " " 8,288.98 " " 29,169.28 " " 16,700.01 " " 8,371.87 " " 17,244.27 " " 8,288.98 " " 15,341.27 " " 8,288.98 " " 18,774.11 " " 8,869.21 " " 25,884.09 " " 8,288.98 " " 12,028.12 " " 15,035.15 " " 8,371.87 " " 8,454.76 " " 8,288.98 " " 29,169.28 " " 27,346.20 " " 27,346.20 " " 28,804.66 " " 19,711.72 " " 27,346.20 " " 8,454.76 " " 28,804.66 " Inpatient OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC 565 " 46,788.03 " " 14,742.91 " " 9,516.40 " " 37,430.42 " " 19,325.07 " " 9,611.56 " " 19,954.87 " " 9,516.40 " " 17,746.31 " " 9,516.40 " " 21,725.18 " " 10,182.55 " " 33,214.82 " " 9,516.40 " " 13,892.41 " " 17,365.51 " " 9,611.56 " " 9,706.73 " " 9,516.40 " " 37,430.42 " " 35,091.02 " " 35,091.02 " " 36,962.54 " " 22,810.18 " " 35,091.02 " " 9,706.73 " " 36,962.54 " Inpatient SKIN DEBRIDEMENT WITH CC 571 " 63,749.93 " " 20,087.60 " " 15,121.68 " " 50,999.94 " " 31,313.00 " " 15,272.90 " " 32,333.49 " " 15,121.68 " " 30,341.61 " " 15,121.68 " " 35,201.99 " " 16,180.20 " " 45,256.07 " " 15,121.68 " " 22,551.00 " " 28,188.75 " " 15,272.90 " " 15,424.11 " " 15,121.68 " " 50,999.94 " " 47,812.45 " " 47,812.45 " " 50,362.44 " " 36,960.04 " " 47,812.45 " " 15,424.11 " " 50,362.44 " Inpatient SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC 577 " 159,255.14 " " 50,181.30 " " 23,306.24 " " 127,404.11 " " 48,817.19 " " 23,539.30 " " 50,408.14 " " 23,306.24 " " 45,490.98 " " 23,306.24 " " 54,880.14 " " 24,937.68 " " 113,055.23 " " 23,306.24 " " 29,255.33 " " 36,569.16 " " 23,539.30 " " 23,772.36 " " 23,306.24 " " 127,404.11 " " 119,441.36 " " 119,441.36 " " 125,811.56 " " 57,620.96 " " 119,441.36 " " 23,772.36 " " 125,811.56 " Inpatient "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC" 579 " 106,216.50 " " 33,468.82 " " 28,635.78 " " 84,973.20 " " 60,215.40 " " 28,922.14 " " 62,177.82 " " 28,635.78 " " 49,563.36 " " 28,635.78 " " 67,693.97 " " 30,640.28 " " 75,403.09 " " 28,635.78 " " 33,631.56 " " 42,039.46 " " 28,922.14 " " 29,208.50 " " 28,635.78 " " 84,973.20 " " 79,662.37 " " 79,662.37 " " 83,911.03 " " 71,074.74 " " 79,662.37 " " 29,208.50 " " 83,911.03 " Inpatient "OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC" 580 " 55,410.56 " " 17,459.87 " " 15,957.87 " " 44,328.45 " " 33,101.33 " " 16,117.45 " " 34,180.10 " " 15,957.87 " " 28,985.39 " " 15,957.87 " " 37,212.42 " " 17,074.92 " " 39,335.96 " " 15,957.87 " " 22,136.71 " " 27,670.89 " " 16,117.45 " " 16,277.03 " " 15,957.87 " " 44,328.45 " " 41,557.92 " " 41,557.92 " " 43,774.35 " " 39,070.88 " " 41,557.92 " " 16,277.03 " " 43,774.35 " Inpatient MAJOR SKIN DISORDERS WITHOUT MCC 596 " 35,080.28 " " 11,053.80 " " 9,385.69 " " 28,064.22 " " 19,045.52 " " 9,479.55 " " 19,666.21 " " 9,385.69 " " 18,239.99 " " 9,385.69 " " 21,410.92 " " 10,042.69 " " 24,903.49 " " 9,385.69 " " 13,657.64 " " 17,072.06 " " 9,479.55 " " 9,573.40 " " 9,385.69 " " 28,064.22 " " 26,310.21 " " 26,310.21 " " 27,713.42 " " 22,480.22 " " 26,310.21 " " 9,573.40 " " 27,713.42 " Inpatient CELLULITIS WITH MCC 602 " 52,940.82 " " 16,681.65 " " 13,461.85 " " 42,352.66 " " 27,763.15 " " 13,596.47 " " 28,667.95 " " 13,461.85 " " 26,947.34 " " 13,461.85 " " 31,211.25 " " 14,404.18 " " 37,582.69 " " 13,461.85 " " 19,844.32 " " 24,805.41 " " 13,596.47 " " 13,731.09 " " 13,461.85 " " 42,352.66 " " 39,705.62 " " 39,705.62 " " 41,823.25 " " 32,770.00 " " 39,705.62 " " 13,731.09 " " 41,823.25 " Inpatient CELLULITIS WITHOUT MCC 603 " 30,455.05 " " 9,596.38 " " 8,122.46 " " 24,364.04 " " 16,343.88 " " 8,203.68 " " 16,876.53 " " 8,122.46 " " 15,840.53 " " 8,122.46 " " 18,373.74 " " 8,691.03 " " 21,620.04 " " 8,122.46 " " 11,669.07 " " 14,586.34 " " 8,203.68 " " 8,284.91 " " 8,122.46 " " 24,364.04 " " 22,841.28 " " 22,841.28 " " 24,059.49 " " 19,291.36 " " 22,841.28 " " 8,284.91 " " 24,059.49 " Inpatient "TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC" 605 " 38,644.41 " " 12,176.85 " " 8,572.78 " " 30,915.53 " " 17,306.97 " " 8,658.51 " " 17,871.01 " " 8,572.78 " " 15,758.56 " " 8,572.78 " " 19,456.45 " " 9,172.87 " " 27,433.67 " " 8,572.78 " " 12,552.88 " " 15,691.10 " " 8,658.51 " " 8,744.24 " " 8,572.78 " " 30,915.53 " " 28,983.31 " " 28,983.31 " " 30,529.09 " " 20,428.14 " " 28,983.31 " " 8,744.24 " " 30,529.09 " Inpatient MINOR SKIN DISORDERS WITHOUT MCC 607 " 25,340.53 " " 7,984.80 " " 7,895.07 " " 20,272.43 " " 15,857.55 " " 7,974.02 " " 16,374.34 " " 7,895.07 " " 14,711.58 " " 7,895.07 " " 17,827.01 " " 8,447.72 " " 17,989.25 " " 7,895.07 " " 11,406.69 " " 14,258.36 " " 7,974.02 " " 8,052.97 " " 7,895.07 " " 20,272.43 " " 19,005.40 " " 19,005.40 " " 20,019.02 " " 18,717.32 " " 19,005.40 " " 8,052.97 " " 20,019.02 " Inpatient ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC 614 " 87,255.31 " " 27,494.15 " " 21,874.70 " " 69,804.24 " " 45,755.59 " " 22,093.45 " " 47,246.76 " " 21,874.70 " " 43,743.55 " " 21,874.70 " " 51,438.29 " " 23,405.93 " " 61,942.54 " " 21,874.70 " " 32,963.40 " " 41,204.25 " " 22,093.45 " " 22,312.19 " " 21,874.70 " " 69,804.24 " " 65,441.48 " " 65,441.48 " " 68,931.69 " " 54,007.22 " " 65,441.48 " " 22,312.19 " " 68,931.69 " Inpatient "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC" 616 " 133,140.52 " " 41,952.58 " " 35,988.63 " " 106,512.41 " " 75,940.83 " " 36,348.52 " " 78,415.74 " " 35,988.63 " " 75,331.46 " " 35,988.63 " " 85,372.46 " " 38,507.83 " " 94,516.45 " " 35,988.63 " " 45,818.41 " " 57,273.02 " " 36,348.52 " " 36,708.40 " " 35,988.63 " " 106,512.41 " " 99,855.39 " " 99,855.39 " " 105,181.01 " " 89,636.12 " " 99,855.39 " " 36,708.40 " " 105,181.01 " Inpatient "AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC" 617 " 105,003.88 " " 33,086.72 " " 18,652.63 " " 84,003.10 " " 38,864.58 " " 18,839.16 " " 40,131.18 " " 18,652.63 " " 39,088.08 " " 18,652.63 " " 43,691.45 " " 19,958.31 " " 74,542.25 " " 18,652.63 " " 28,088.62 " " 35,110.79 " " 18,839.16 " " 19,025.68 " " 18,652.63 " " 84,003.10 " " 78,752.91 " " 78,752.91 " " 82,953.07 " " 45,873.48 " " 78,752.91 " " 19,025.68 " " 82,953.07 " Inpatient O.R. PROCEDURES FOR OBESITY WITH CC 620 " 53,338.08 " " 16,806.83 " " 16,261.36 " " 42,670.46 " " 33,750.42 " " 16,423.97 " " 34,850.34 " " 16,261.36 " " 34,186.69 " " 16,261.36 " " 37,942.12 " " 17,399.66 " " 37,864.70 " " 16,261.36 " " 24,318.62 " " 30,398.28 " " 16,423.97 " " 16,586.59 " " 16,261.36 " " 42,670.46 " " 40,003.56 " " 40,003.56 " " 42,137.08 " " 39,837.02 " " 40,003.56 " " 16,586.59 " " 42,137.08 " Inpatient O.R. PROCEDURES FOR OBESITY WITHOUT CC/MCC 621 " 43,625.96 " " 13,746.54 " " 14,778.80 " " 36,094.46 " " 30,579.67 " " 14,926.59 " " 31,576.26 " " 14,778.80 " " 29,486.51 " " 14,778.80 " " 34,377.58 " " 15,813.32 " " 30,970.07 " " 14,778.80 " " 22,040.04 " " 27,550.06 " " 14,926.59 " " 15,074.38 " " 14,778.80 " " 34,900.77 " " 32,719.47 " " 32,719.47 " " 34,464.51 " " 36,094.46 " " 32,719.47 " " 15,074.38 " " 34,464.51 " Inpatient "OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC" 629 " 153,270.77 " " 48,295.62 " " 21,477.20 " " 122,616.61 " " 44,905.46 " " 21,691.97 " " 46,368.93 " " 21,477.20 " " 43,145.54 " " 21,477.20 " " 50,482.58 " " 22,980.60 " " 108,806.92 " " 21,477.20 " " 32,411.01 " " 40,513.77 " " 21,691.97 " " 21,906.74 " " 21,477.20 " " 122,616.61 " " 114,953.08 " " 114,953.08 " " 121,083.91 " " 53,003.78 " " 114,953.08 " " 21,906.74 " " 121,083.91 " Inpatient DIABETES WITH MCC 637 " 47,431.95 " " 14,945.81 " " 12,804.73 " " 37,945.56 " " 28,487.63 " " 12,932.78 " " 29,417.29 " " 12,804.73 " " 27,406.18 " " 12,804.73 " " 32,182.58 " " 13,701.06 " " 33,671.94 " " 12,804.73 " " 18,988.13 " " 23,735.17 " " 12,932.78 " " 13,060.82 " " 12,804.73 " " 37,945.56 " " 35,573.96 " " 35,573.96 " " 37,471.24 " " 32,016.56 " " 35,573.96 " " 13,060.82 " " 37,471.24 " Inpatient DIABETES WITH CC 638 " 31,140.08 " " 9,812.24 " " 8,353.44 " " 24,912.06 " " 18,702.73 " " 8,436.97 " " 19,313.08 " " 8,353.44 " " 17,992.74 " " 8,353.44 " " 21,128.54 " " 8,938.18 " " 22,106.34 " " 8,353.44 " " 12,138.59 " " 15,173.25 " " 8,436.97 " " 8,520.51 " " 8,353.44 " " 24,912.06 " " 23,355.06 " " 23,355.06 " " 24,600.66 " " 21,019.55 " " 23,355.06 " " 8,520.51 " " 24,600.66 " Inpatient DIABETES WITHOUT CC/MCC 639 " 21,984.90 " " 6,927.44 " " 5,938.01 " " 17,587.92 " " 13,204.13 " " 5,997.39 " " 13,635.04 " " 5,938.01 " " 11,658.25 " " 5,938.01 " " 14,916.76 " " 6,353.67 " " 15,607.08 " " 5,938.01 " " 8,410.02 " " 10,512.52 " " 5,997.39 " " 6,056.77 " " 5,938.01 " " 17,587.92 " " 16,488.68 " " 16,488.68 " " 17,368.07 " " 14,839.81 " " 16,488.68 " " 6,056.77 " " 17,368.07 " Inpatient "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC" 640 " 50,056.29 " " 15,772.74 " " 11,499.42 " " 40,045.03 " " 30,063.81 " " 11,614.41 " " 31,044.91 " " 11,499.42 " " 28,922.53 " " 11,499.42 " " 33,963.19 " " 12,304.38 " " 35,534.96 " " 11,499.42 " " 16,958.13 " " 21,197.66 " " 11,614.41 " " 11,729.41 " " 11,499.42 " " 40,045.03 " " 37,542.22 " " 37,542.22 " " 39,544.47 " " 33,788.00 " " 37,542.22 " " 11,729.41 " " 39,544.47 " Inpatient "MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC" 641 " 33,673.90 " " 10,610.65 " " 7,232.57 " " 26,939.12 " " 20,224.55 " " 7,304.90 " " 20,884.55 " " 7,232.57 " " 13,899.36 " " 7,232.57 " " 22,847.74 " " 7,738.85 " " 23,905.10 " " 7,232.57 " " 10,398.59 " " 12,998.24 " " 7,304.90 " " 7,377.22 " " 7,232.57 " " 26,939.12 " " 25,255.43 " " 25,255.43 " " 26,602.38 " " 22,729.88 " " 25,255.43 " " 7,377.22 " " 26,602.38 " Inpatient INBORN AND OTHER DISORDERS OF METABOLISM 642 " 31,981.48 " " 10,077.36 " " 12,027.63 " " 29,149.48 " " 24,695.80 " " 12,147.91 " " 25,500.64 " " 12,027.63 " " 23,305.31 " " 12,027.63 " " 27,762.95 " " 12,869.56 " " 22,703.65 " " 12,027.63 " " 17,786.70 " " 22,233.38 " " 12,147.91 " " 12,268.18 " " 12,027.63 " " 25,585.18 " " 23,986.11 " " 23,986.11 " " 25,265.37 " " 29,149.48 " " 23,986.11 " " 12,268.18 " " 25,265.37 " Inpatient ENDOCRINE DISORDERS WITH MCC 643 " 63,011.22 " " 19,854.84 " " 15,410.86 " " 50,408.97 " " 31,931.45 " " 15,564.97 " " 32,972.10 " " 15,410.86 " " 29,648.59 " " 15,410.86 " " 35,897.24 " " 16,489.62 " " 44,731.66 " " 15,410.86 " " 22,965.28 " " 28,706.61 " " 15,564.97 " " 15,719.08 " " 15,410.86 " " 50,408.97 " " 47,258.41 " " 47,258.41 " " 49,778.86 " " 37,690.02 " " 47,258.41 " " 15,719.08 " " 49,778.86 " Inpatient ENDOCRINE DISORDERS WITH CC 644 " 34,581.20 " " 10,896.54 " " 9,610.40 " " 27,664.96 " " 19,526.11 " " 9,706.50 " " 20,162.47 " " 9,610.40 " " 18,672.18 " " 9,610.40 " " 21,951.20 " " 10,283.13 " " 24,549.19 " " 9,610.40 " " 14,058.12 " " 17,572.65 " " 9,706.50 " " 9,802.61 " " 9,610.40 " " 27,664.96 " " 25,935.90 " " 25,935.90 " " 27,319.15 " " 23,047.48 " " 25,935.90 " " 9,802.61 " " 27,319.15 " Inpatient MAJOR BLADDER PROCEDURES WITH CC 654 " 115,482.59 " " 36,388.56 " " 26,468.33 " " 92,386.07 " " 55,579.91 " " 26,733.01 " " 57,391.26 " " 26,468.33 " " 51,625.62 " " 26,468.33 " " 62,482.77 " " 28,321.11 " " 81,981.09 " " 26,468.33 " " 33,309.95 " " 41,637.45 " " 26,733.01 " " 26,997.70 " " 26,468.33 " " 92,386.07 " " 86,611.94 " " 86,611.94 " " 91,231.24 " " 65,603.28 " " 86,611.94 " " 26,997.70 " " 91,231.24 " Inpatient MAJOR BLADDER PROCEDURES WITHOUT CC/MCC 655 " 107,428.32 " " 33,850.66 " " 19,104.74 " " 85,942.66 " " 39,831.50 " " 19,295.79 " " 41,129.61 " " 19,104.74 " " 38,173.37 " " 19,104.74 " " 44,778.46 " " 20,442.07 " " 76,263.36 " " 19,104.74 " " 28,723.86 " " 35,904.84 " " 19,295.79 " " 19,486.83 " " 19,104.74 " " 85,942.66 " " 80,571.24 " " 80,571.24 " " 84,868.37 " " 47,014.78 " " 80,571.24 " " 19,486.83 " " 84,868.37 " Inpatient KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC 656 " 197,776.79 " " 62,319.47 " " 29,890.06 " " 158,221.43 " " 62,897.90 " " 30,188.96 " " 64,947.74 " " 29,890.06 " " 60,619.87 " " 29,890.06 " " 70,709.63 " " 31,982.36 " " 140,401.74 " " 29,890.06 " " 37,697.68 " " 47,122.10 " " 30,188.96 " " 30,487.86 " " 29,890.06 " " 158,221.43 " " 148,332.59 " " 148,332.59 " " 156,243.66 " " 74,241.00 " " 148,332.59 " " 30,487.86 " " 156,243.66 " Inpatient KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC 657 " 68,493.57 " " 21,582.32 " " 17,801.23 " " 54,794.85 " " 37,043.70 " " 17,979.24 " " 38,250.95 " " 17,801.23 " " 36,837.66 " " 17,801.23 " " 41,644.42 " " 19,047.32 " " 48,623.58 " " 17,801.23 " " 26,707.67 " " 33,384.59 " " 17,979.24 " " 18,157.25 " " 17,801.23 " " 54,794.85 " " 51,370.18 " " 51,370.18 " " 54,109.92 " " 43,724.22 " " 51,370.18 " " 18,157.25 " " 54,109.92 " Inpatient KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC 658 " 61,914.98 " " 19,509.41 " " 14,606.90 " " 49,531.98 " " 30,212.05 " " 14,752.97 " " 31,196.66 " " 14,606.90 " " 29,112.07 " " 14,606.90 " " 33,964.30 " " 15,629.38 " " 43,953.44 " " 14,606.90 " " 21,805.28 " " 27,256.60 " " 14,752.97 " " 14,899.04 " " 14,606.90 " " 49,531.98 " " 46,436.23 " " 46,436.23 " " 48,912.83 " " 35,660.54 " " 46,436.23 " " 14,899.04 " " 48,912.83 " Inpatient KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC 659 " 105,444.11 " " 33,225.44 " " 24,351.92 " " 84,355.29 " " 51,053.56 " " 24,595.44 " " 52,717.39 " " 24,351.92 " " 63,580.07 " " 24,351.92 " " 57,394.26 " " 26,056.55 " " 74,854.77 " " 24,351.92 " " 30,610.70 " " 38,263.38 " " 24,595.44 " " 24,838.96 " " 24,351.92 " " 84,355.29 " " 79,083.08 " " 79,083.08 " " 83,300.84 " " 60,260.64 " " 79,083.08 " " 24,838.96 " " 83,300.84 " Inpatient KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC 660 " 67,141.35 " " 21,156.24 " " 13,400.08 " " 53,713.08 " " 27,631.04 " " 13,534.08 " " 28,531.53 " " 13,400.08 " " 33,394.96 " " 13,400.08 " " 31,062.73 " " 14,338.09 " " 47,663.65 " " 13,400.08 " " 19,927.18 " " 24,908.98 " " 13,534.08 " " 13,668.08 " " 13,400.08 " " 53,713.08 " " 50,356.02 " " 50,356.02 " " 53,041.67 " " 32,614.06 " " 50,356.02 " " 13,668.08 " " 53,041.67 " Inpatient KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC 661 " 49,750.74 " " 15,676.46 " " 10,003.43 " " 39,800.59 " " 20,366.66 " " 10,103.46 " " 21,030.41 " " 10,003.43 " " 27,087.05 " " 10,003.43 " " 22,896.14 " " 10,703.67 " " 35,318.05 " " 10,003.43 " " 14,693.36 " " 18,366.70 " " 10,103.46 " " 10,203.50 " " 10,003.43 " " 39,800.59 " " 37,313.05 " " 37,313.05 " " 39,303.08 " " 24,039.62 " " 37,313.05 " " 10,203.50 " " 39,303.08 " Inpatient OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC 673 " 169,793.23 " " 53,501.85 " " 31,531.09 " " 135,834.58 " " 66,407.54 " " 31,846.40 " " 68,571.76 " " 31,531.09 " " 65,659.11 " " 31,531.09 " " 74,655.16 " " 33,738.27 " " 120,536.21 " " 31,531.09 " " 39,776.68 " " 49,720.85 " " 31,846.40 " " 32,161.71 " " 31,531.09 " " 135,834.58 " " 127,344.92 " " 127,344.92 " " 134,136.65 " " 78,383.58 " " 127,344.92 " " 32,161.71 " " 134,136.65 " Inpatient OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC 674 " 93,533.65 " " 29,472.45 " " 21,816.51 " " 74,826.92 " " 45,631.13 " " 22,034.68 " " 47,118.25 " " 21,816.51 " " 43,156.73 " " 21,816.51 " " 51,298.38 " " 23,343.67 " " 66,399.54 " " 21,816.51 " " 32,866.73 " " 41,083.42 " " 22,034.68 " " 22,252.84 " " 21,816.51 " " 74,826.92 " " 70,150.24 " " 70,150.24 " " 73,891.58 " " 53,860.32 " " 70,150.24 " " 22,252.84 " " 73,891.58 " Inpatient RENAL FAILURE WITH MCC 682 " 55,175.75 " " 17,385.88 " " 13,665.08 " " 44,140.60 " " 28,197.79 " " 13,801.73 " " 29,116.75 " " 13,665.08 " " 27,655.25 " " 13,665.08 " " 31,699.87 " " 14,621.64 " " 39,169.26 " " 13,665.08 " " 20,300.04 " " 25,375.05 " " 13,801.73 " " 13,938.38 " " 13,665.08 " " 44,140.60 " " 41,381.81 " " 41,381.81 " " 43,588.84 " " 33,283.02 " " 41,381.81 " " 13,938.38 " " 43,588.84 " Inpatient RENAL FAILURE WITH CC 683 " 31,855.36 " " 10,037.62 " " 8,352.55 " " 25,484.29 " " 16,835.96 " " 8,436.08 " " 17,384.64 " " 8,352.55 " " 17,312.23 " " 8,352.55 " " 18,926.93 " " 8,937.23 " " 22,614.12 " " 8,352.55 " " 12,124.78 " " 15,155.98 " " 8,436.08 " " 8,519.60 " " 8,352.55 " " 25,484.29 " " 23,891.52 " " 23,891.52 " " 25,165.74 " " 19,872.18 " " 23,891.52 " " 8,519.60 " " 25,165.74 " Inpatient RENAL FAILURE WITHOUT CC/MCC 684 " 22,367.70 " " 7,048.06 " " 5,922.79 " " 17,894.16 " " 11,639.46 " " 5,982.02 " " 12,018.79 " " 5,922.79 " " 11,708.54 " " 5,922.79 " " 13,085.05 " " 6,337.39 " " 15,878.83 " " 5,922.79 " " 8,396.21 " " 10,495.26 " " 5,982.02 " " 6,041.25 " " 5,922.79 " " 17,894.16 " " 16,775.78 " " 16,775.78 " " 17,670.48 " " 13,738.54 " " 16,775.78 " " 6,041.25 " " 17,670.48 " Inpatient KIDNEY AND URINARY TRACT INFECTIONS WITH MCC 689 " 43,855.74 " " 13,818.94 " " 10,455.54 " " 35,084.59 " " 21,333.59 " " 10,560.10 " " 22,028.85 " " 10,455.54 " " 20,110.37 " " 10,455.54 " " 23,983.16 " " 11,187.43 " " 31,133.19 " " 10,455.54 " " 15,342.41 " " 19,178.02 " " 10,560.10 " " 10,664.65 " " 10,455.54 " " 35,084.59 " " 32,891.81 " " 32,891.81 " " 34,646.04 " " 25,180.92 " " 32,891.81 " " 10,664.65 " " 34,646.04 " Inpatient KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC 690 " 31,392.23 " " 9,891.69 " " 7,588.88 " " 25,113.78 " " 15,202.72 " " 7,664.77 " " 15,698.17 " " 7,588.88 " " 14,802.87 " " 7,588.88 " " 17,090.85 " " 8,120.10 " " 22,285.34 " " 7,588.88 " " 10,937.16 " " 13,671.46 " " 7,664.77 " " 7,740.66 " " 7,588.88 " " 25,113.78 " " 23,544.17 " " 23,544.17 " " 24,799.86 " " 17,944.40 " " 23,544.17 " " 7,740.66 " " 24,799.86 " Inpatient URINARY STONES WITHOUT MCC 694 " 32,671.25 " " 10,294.71 " " 7,384.76 " " 26,137.00 " " 14,766.17 " " 7,458.61 " " 15,247.40 " " 7,384.76 " " 15,169.88 " " 7,384.76 " " 16,600.08 " " 7,901.69 " " 23,193.32 " " 7,384.76 " " 10,067.16 " " 12,583.95 " " 7,458.61 " " 7,532.46 " " 7,384.76 " " 26,137.00 " " 24,503.44 " " 24,503.44 " " 25,810.29 " " 17,429.12 " " 24,503.44 " " 7,532.46 " " 25,810.29 " Inpatient OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC 698 " 65,071.93 " " 20,504.17 " " 14,899.66 " " 52,057.55 " " 30,838.16 " " 15,048.66 " " 31,843.17 " " 14,899.66 " " 29,585.26 " " 14,899.66 " " 34,668.17 " " 15,942.64 " " 46,194.56 " " 14,899.66 " " 22,191.95 " " 27,739.94 " " 15,048.66 " " 15,197.65 " " 14,899.66 " " 52,057.55 " " 48,803.95 " " 48,803.95 " " 51,406.83 " " 36,399.56 " " 48,803.95 " " 15,197.65 " " 51,406.83 " Inpatient OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC 699 " 37,386.63 " " 11,780.53 " " 9,674.86 " " 29,909.30 " " 19,663.97 " " 9,771.61 " " 20,304.82 " " 9,674.86 " " 19,497.48 " " 9,674.86 " " 22,106.18 " " 10,352.10 " " 26,540.77 " " 9,674.86 " " 14,154.79 " " 17,693.49 " " 9,771.61 " " 9,868.36 " " 9,674.86 " " 29,909.30 " " 28,039.97 " " 28,039.97 " " 29,535.44 " " 23,210.20 " " 28,039.97 " " 9,868.36 " " 29,535.44 " Inpatient MAJOR MALE PELVIC PROCEDURES WITH CC/MCC 707 " 116,403.53 " " 36,678.75 " " 17,689.32 " " 93,122.82 " " 36,804.36 " " 17,866.21 " " 38,003.82 " " 17,689.32 " " 33,549.58 " " 17,689.32 " " 41,375.36 " " 18,927.57 " " 82,634.86 " " 17,689.32 " " 26,528.15 " " 33,160.19 " " 17,866.21 " " 18,043.11 " " 17,689.32 " " 93,122.82 " " 87,302.64 " " 87,302.64 " " 91,958.79 " " 43,441.72 " " 87,302.64 " " 18,043.11 " " 91,958.79 " Inpatient MAJOR MALE PELVIC PROCEDURES WITHOUT CC/MCC 708 " 107,820.13 " " 33,974.12 " " 13,830.70 " " 86,256.10 " " 28,552.01 " " 13,969.01 " " 29,482.52 " " 13,830.70 " " 25,775.55 " " 13,830.70 " " 32,098.08 " " 14,798.85 " " 76,541.51 " " 13,830.70 " " 20,590.04 " " 25,737.55 " " 13,969.01 " " 14,107.31 " " 13,830.70 " " 86,256.10 " " 80,865.09 " " 80,865.09 " " 85,177.90 " " 33,701.12 " " 80,865.09 " " 14,107.31 " " 85,177.90 " Inpatient INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC 728 " 33,318.85 " " 10,498.77 " " 7,693.63 " " 26,655.08 " " 15,426.74 " " 7,770.57 " " 15,929.49 " " 7,693.63 " " 15,119.56 " " 7,693.63 " " 17,342.69 " " 8,232.18 " " 23,653.05 " " 7,693.63 " " 11,102.88 " " 13,878.60 " " 7,770.57 " " 7,847.50 " " 7,693.63 " " 26,655.08 " " 24,989.14 " " 24,989.14 " " 26,321.89 " " 18,208.82 " " 24,989.14 " " 7,847.50 " " 26,321.89 " Inpatient UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC 742 " 70,737.61 " " 22,289.42 " " 15,862.07 " " 56,590.09 " " 32,896.46 " " 16,020.69 " " 33,968.56 " " 15,862.07 " " 30,524.17 " " 15,862.07 " " 36,982.10 " " 16,972.41 " " 50,216.63 " " 15,862.07 " " 23,711.00 " " 29,638.75 " " 16,020.69 " " 16,179.31 " " 15,862.07 " " 56,590.09 " " 53,053.21 " " 53,053.21 " " 55,882.71 " " 38,829.06 " " 53,053.21 " " 16,179.31 " " 55,882.71 " Inpatient UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC 743 " 52,925.71 " " 16,676.89 " " 10,622.06 " " 42,340.57 " " 21,689.72 " " 10,728.28 " " 22,396.59 " " 10,622.06 " " 20,017.22 " " 10,622.06 " " 24,383.52 " " 11,365.60 " " 37,571.96 " " 10,622.06 " " 15,632.41 " " 19,540.52 " " 10,728.28 " " 10,834.50 " " 10,622.06 " " 42,340.57 " " 39,694.28 " " 39,694.28 " " 41,811.31 " " 25,601.28 " " 39,694.28 " " 10,834.50 " " 41,811.31 " Inpatient "MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC" 755 " 64,676.16 " " 20,379.46 " " 10,590.72 " " 51,740.93 " " 21,622.71 " " 10,696.63 " " 22,327.39 " " 10,590.72 " " 20,447.56 " " 10,590.72 " " 24,308.18 " " 11,332.07 " " 45,913.61 " " 10,590.72 " " 15,577.17 " " 19,471.47 " " 10,696.63 " " 10,802.53 " " 10,590.72 " " 51,740.93 " " 48,507.12 " " 48,507.12 " " 51,094.17 " " 25,522.18 " " 48,507.12 " " 10,802.53 " " 51,094.17 " Inpatient MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC 760 " 44,479.44 " " 14,015.47 " " 8,717.82 " " 35,583.55 " " 17,617.15 " " 8,805.00 " " 18,191.30 " " 8,717.82 " " 15,995.15 " " 8,717.82 " " 19,805.15 " " 9,328.07 " " 31,575.95 " " 8,717.82 " " 12,746.21 " " 15,932.77 " " 8,805.00 " " 8,892.18 " " 8,717.82 " " 35,583.55 " " 33,359.58 " " 33,359.58 " " 35,138.76 " " 20,794.26 " " 33,359.58 " " 8,892.18 " " 35,138.76 " Inpatient VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C 768 " 30,193.16 " " 9,513.86 " " 10,951.52 " " 26,432.96 " " 22,394.33 " " 11,061.04 " " 23,124.16 " " 10,951.52 " " 21,123.80 " " 10,951.52 " " 25,175.64 " " 11,718.13 " " 21,434.12 " " 10,951.52 " " 14,371.04 " " 17,963.80 " " 11,061.04 " " 11,170.55 " " 10,951.52 " " 24,154.53 " " 22,644.87 " " 22,644.87 " " 23,852.59 " " 26,432.96 " " 22,644.87 " " 11,170.55 " " 23,852.59 " Inpatient POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES 776 " 21,168.49 " " 6,670.19 " " 7,414.31 " " 17,503.70 " " 14,829.35 " " 7,488.45 " " 15,312.64 " " 7,414.31 " " 15,041.34 " " 7,414.31 " " 16,671.11 " " 7,933.31 " " 15,027.51 " " 7,414.31 " " 10,619.54 " " 13,274.43 " " 7,488.45 " " 7,562.60 " " 7,414.31 " " 16,934.80 " " 15,876.37 " " 15,876.37 " " 16,723.11 " " 17,503.70 " " 15,876.37 " " 7,562.60 " " 16,723.11 " Inpatient CESAREAN SECTION WITH STERILIZATION WITH MCC 783 " 43,906.90 " " 13,835.06 " " 17,265.85 " " 42,372.74 " " 35,898.71 " " 17,438.51 " " 37,068.65 " " 17,265.85 " " 21,928.60 " " 17,265.85 " " 40,357.22 " " 18,474.46 " " 31,169.51 " " 17,265.85 " " 29,913.38 " " 37,391.73 " " 17,438.51 " " 17,611.17 " " 17,265.85 " " 35,125.52 " " 32,930.18 " " 32,930.18 " " 34,686.45 " " 42,372.74 " " 32,930.18 " " 17,611.17 " " 34,686.45 " Inpatient CESAREAN SECTION WITH STERILIZATION WITH CC 784 " 34,782.00 " " 10,959.81 " " 10,291.70 " " 27,825.60 " " 20,983.20 " " 10,394.62 " " 21,667.04 " " 10,291.70 " " 21,928.60 " " 10,291.70 " " 23,589.25 " " 11,012.12 " " 24,691.74 " " 10,291.70 " " 17,488.07 " " 21,860.09 " " 10,394.62 " " 10,497.53 " " 10,291.70 " " 27,825.60 " " 26,086.50 " " 26,086.50 " " 27,477.78 " " 24,767.34 " " 26,086.50 " " 10,497.53 " " 27,477.78 " Inpatient CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC 785 " 28,589.80 " " 9,008.65 " " 8,688.27 " " 22,871.84 " " 17,553.97 " " 8,775.15 " " 18,126.05 " " 8,688.27 " " 15,596.49 " " 8,688.27 " " 19,734.12 " " 9,296.45 " " 20,295.90 " " 8,688.27 " " 14,613.32 " " 18,266.65 " " 8,775.15 " " 8,862.04 " " 8,688.27 " " 22,871.84 " " 21,442.35 " " 21,442.35 " " 22,585.94 " " 20,719.68 " " 21,442.35 " " 8,862.04 " " 22,585.94 " Inpatient CESAREAN SECTION WITHOUT STERILIZATION WITH MCC 786 " 34,924.97 " " 11,004.86 " " 14,754.62 " " 36,033.44 " " 30,527.98 " " 14,902.17 " " 31,522.88 " " 14,754.62 " " 21,928.60 " " 14,754.62 " " 34,319.46 " " 15,787.44 " " 24,793.23 " " 14,754.62 " " 25,409.61 " " 31,762.01 " " 14,902.17 " " 15,049.71 " " 14,754.62 " " 27,939.97 " " 26,193.73 " " 26,193.73 " " 27,590.72 " " 36,033.44 " " 26,193.73 " " 15,049.71 " " 27,590.72 " Inpatient CESAREAN SECTION WITHOUT STERILIZATION WITH CC 787 " 33,231.56 " " 10,471.27 " " 10,009.69 " " 26,585.25 " " 20,380.07 " " 10,109.79 " " 21,044.25 " " 10,009.69 " " 21,928.60 " " 10,009.69 " " 22,911.21 " " 10,710.37 " " 23,591.09 " " 10,009.69 " " 16,977.00 " " 21,221.25 " " 10,109.79 " " 10,209.88 " " 10,009.69 " " 26,585.25 " " 24,923.67 " " 24,923.67 " " 26,252.93 " " 24,055.44 " " 24,923.67 " " 10,209.88 " " 26,252.93 " Inpatient CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC 788 " 27,753.13 " " 8,745.01 " " 8,425.06 " " 22,202.51 " " 16,991.05 " " 8,509.31 " " 17,544.79 " " 8,425.06 " " 15,596.49 " " 8,425.06 " " 19,101.29 " " 9,014.81 " " 19,701.95 " " 8,425.06 " " 14,166.14 " " 17,707.67 " " 8,509.31 " " 8,593.56 " " 8,425.06 " " 22,202.51 " " 20,814.85 " " 20,814.85 " " 21,924.97 " " 20,055.24 " " 20,814.85 " " 8,593.56 " " 21,924.97 " Inpatient "NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY" 789 " 141,689.14 " " 44,646.25 " " 15,879.08 " " 113,351.31 " " 85,098.50 " " 16,037.87 " " 87,875.60 " " 15,879.08 " " 81,867.98 " " 15,879.08 " " 96,136.08 " " 16,990.62 " " 100,585.12 " " 15,879.08 " " 80,451.09 " " 100,570.95 " " 16,037.87 " " 16,196.66 " " 15,879.08 " " 113,351.31 " " 106,266.85 " " 106,266.85 " " 111,934.42 " " 95,640.17 " " 106,266.85 " " 16,196.66 " " 111,934.42 " Inpatient "EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE" 790 " 354,765.04 " " 111,786.47 " " 51,261.04 " " 283,812.03 " " 213,071.89 " " 51,773.65 " " 220,025.28 " " 51,261.04 " " 204,983.24 " " 51,261.04 " " 240,708.08 " " 54,849.31 " " 251,847.70 " " 51,261.04 " " 201,435.59 " " 251,812.23 " " 51,773.65 " " 52,286.26 " " 51,261.04 " " 283,812.03 " " 266,073.78 " " 266,073.78 " " 280,264.38 " " 239,466.40 " " 266,073.78 " " 52,286.26 " " 280,264.38 " Inpatient PREMATURITY WITH MAJOR PROBLEMS 791 " 115,195.20 " " 36,298.01 " " 35,161.40 " " 92,156.16 " " 69,186.24 " " 35,513.01 " " 71,444.06 " " 35,161.40 " " 66,559.79 " " 35,161.40 " " 78,159.94 " " 37,622.70 " " 81,777.07 " " 35,161.40 " " 65,407.84 " " 81,765.55 " " 35,513.01 " " 35,864.63 " " 35,161.40 " " 92,156.16 " " 86,396.40 " " 86,396.40 " " 91,004.21 " " 77,756.76 " " 86,396.40 " " 35,864.63 " " 91,004.21 " Inpatient PREMATURITY WITHOUT MAJOR PROBLEMS 792 " 37,058.16 " " 11,677.03 " " 15,451.14 " " 29,646.53 " " 22,257.13 " " 21,620.54 " " 22,983.47 " " 21,406.48 " " 21,412.20 " " 21,406.48 " " 25,143.96 " " 22,904.93 " " 26,307.59 " " 21,406.48 " " 15,451.14 " " 19,313.91 " " 21,620.54 " " 21,834.61 " " 21,406.48 " " 29,646.53 " " 27,793.62 " " 27,793.62 " " 29,275.94 " " 25,014.26 " " 27,793.62 " " 21,834.61 " " 29,275.94 " Inpatient FULL TERM NEONATE WITH MAJOR PROBLEMS 793 " 81,327.77 " " 25,626.38 " " 26,309.95 " " 65,062.21 " " 48,845.46 " " 36,466.07 " " 50,439.48 " " 36,105.02 " " 46,991.18 " " 36,105.02 " " 55,180.89 " " 38,632.37 " " 57,734.58 " " 36,105.02 " " 26,309.95 " " 32,887.40 " " 36,466.07 " " 36,827.12 " " 36,105.02 " " 65,062.21 " " 60,995.82 " " 60,995.82 " " 64,248.94 " " 54,896.24 " " 60,995.82 " " 36,827.12 " " 64,248.94 " Inpatient NEONATE WITH OTHER SIGNIFICANT PROBLEMS 794 " 17,674.77 " " 5,569.32 " " 9,310.39 " " 27,845.48 " " 26,966.63 " " 13,220.31 " " 27,845.48 " " 13,089.42 " " 25,035.96 " " 13,089.42 " " 11,992.33 " " 14,005.68 " " 12,547.32 " " 13,089.42 " " 9,310.39 " " 11,637.97 " " 13,220.31 " " 13,351.21 " " 13,089.42 " " 14,139.81 " " 13,256.08 " " 13,256.08 " " 13,963.07 " " 11,930.47 " " 13,256.08 " " 13,351.21 " " 13,963.07 " Inpatient NORMAL NEWBORN 795 " 13,491.96 " " 4,251.32 " " 1,591.80 " " 10,793.57 " " 3,651.33 " " 2,209.60 " " 3,770.33 " " 2,187.72 " " 3,388.67 " " 2,187.72 " " 4,104.82 " " 2,340.86 " " 9,577.95 " " 2,187.72 " " 1,591.80 " " 1,989.75 " " 2,209.60 " " 2,231.47 " " 2,187.72 " " 10,793.57 " " 10,118.97 " " 10,118.97 " " 10,658.65 " " 4,309.82 " " 10,118.97 " " 2,231.47 " " 10,658.65 " Inpatient VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC 805 " 28,570.92 " " 9,002.70 " " 9,700.82 " " 23,275.74 " " 19,719.50 " " 9,797.83 " " 20,362.15 " " 9,700.82 " " 15,471.66 " " 9,700.82 " " 22,168.60 " " 10,379.88 " " 20,282.50 " " 9,700.82 " " 12,603.81 " " 15,754.76 " " 9,797.83 " " 9,894.84 " " 9,700.82 " " 22,856.74 " " 21,428.19 " " 21,428.19 " " 22,571.03 " " 23,275.74 " " 21,428.19 " " 9,894.84 " " 22,571.03 " Inpatient VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC 806 " 26,289.75 " " 8,283.90 " " 7,057.09 " " 21,031.80 " " 14,065.39 " " 7,127.66 " " 14,523.78 " " 7,057.09 " " 15,471.66 " " 7,057.09 " " 15,812.27 " " 7,551.09 " " 18,663.09 " " 7,057.09 " " 9,007.98 " " 11,259.97 " " 7,127.66 " " 7,198.23 " " 7,057.09 " " 21,031.80 " " 19,717.31 " " 19,717.31 " " 20,768.90 " " 16,601.96 " " 19,717.31 " " 7,198.23 " " 20,768.90 " Inpatient VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC 807 " 22,603.99 " " 7,122.52 " " 6,230.76 " " 18,083.19 " " 12,298.12 " " 6,293.07 " " 12,698.91 " " 6,230.76 " " 12,025.25 " " 6,230.76 " " 13,825.51 " " 6,666.91 " " 16,046.57 " " 6,230.76 " " 7,866.64 " " 9,833.30 " " 6,293.07 " " 6,355.38 " " 6,230.76 " " 18,083.19 " " 16,952.99 " " 16,952.99 " " 17,857.15 " " 14,515.98 " " 16,952.99 " " 6,355.38 " " 17,857.15 " Inpatient MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC 808 " 75,484.50 " " 23,785.16 " " 20,049.25 " " 60,387.60 " " 41,851.51 " " 20,249.74 " " 43,215.45 " " 20,049.25 " " 39,650.69 " " 20,049.25 " " 47,049.35 " " 21,452.70 " " 53,586.44 " " 20,049.25 " " 30,077.20 " " 37,596.51 " " 20,249.74 " " 20,450.24 " " 20,049.25 " " 60,387.60 " " 56,613.37 " " 56,613.37 " " 59,632.75 " " 49,399.08 " " 56,613.37 " " 20,450.24 " " 59,632.75 " Inpatient MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC 809 " 48,187.21 " " 15,183.79 " " 11,433.17 " " 38,549.77 " " 23,424.44 " " 11,547.50 " " 24,187.84 " " 11,433.17 " " 22,286.27 " " 11,433.17 " " 26,333.69 " " 12,233.49 " " 34,208.10 " " 11,433.17 " " 16,875.27 " " 21,094.09 " " 11,547.50 " " 11,661.83 " " 11,433.17 " " 38,549.77 " " 36,140.41 " " 36,140.41 " " 38,067.90 " " 27,648.84 " " 36,140.41 " " 11,661.83 " " 38,067.90 " Inpatient RED BLOOD CELL DISORDERS WITH MCC 811 " 69,865.13 " " 22,014.50 " " 12,828.90 " " 55,892.11 " " 26,409.46 " " 12,957.19 " " 27,270.14 " " 12,828.90 " " 24,920.46 " " 12,828.90 " " 29,689.43 " " 13,726.92 " " 49,597.26 " " 12,828.90 " " 19,029.56 " " 23,786.95 " " 12,957.19 " " 13,085.48 " " 12,828.90 " " 55,892.11 " " 52,398.85 " " 52,398.85 " " 55,193.46 " " 31,172.18 " " 52,398.85 " " 13,085.48 " " 55,193.46 " Inpatient RED BLOOD CELL DISORDERS WITHOUT MCC 812 " 41,620.35 " " 13,114.57 " " 8,361.50 " " 33,296.28 " " 16,855.10 " " 8,445.12 " " 17,404.41 " " 8,361.50 " " 16,447.85 " " 8,361.50 " " 18,948.46 " " 8,946.81 " " 29,546.29 " " 8,361.50 " " 12,152.40 " " 15,190.51 " " 8,445.12 " " 8,528.73 " " 8,361.50 " " 33,296.28 " " 31,215.26 " " 31,215.26 " " 32,880.08 " " 19,894.78 " " 31,215.26 " " 8,528.73 " " 32,880.08 " Inpatient COAGULATION DISORDERS 813 " 67,947.81 " " 21,410.35 " " 14,313.25 " " 54,358.24 " " 40,809.45 " " 14,456.38 " " 42,141.23 " " 14,313.25 " " 32,245.53 " " 14,313.25 " " 46,102.59 " " 15,315.18 " " 48,236.15 " " 14,313.25 " " 21,335.75 " " 26,669.70 " " 14,456.38 " " 14,599.52 " " 14,313.25 " " 54,358.24 " " 50,960.85 " " 50,960.85 " " 53,678.77 " " 45,864.77 " " 50,960.85 " " 14,599.52 " " 53,678.77 " Inpatient RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC 814 " 60,677.89 " " 19,119.60 " " 17,416.26 " " 48,542.32 " " 36,220.38 " " 17,590.42 " " 37,400.80 " " 17,416.26 " " 32,694.49 " " 17,416.26 " " 40,718.84 " " 18,635.40 " " 43,075.24 " " 17,416.26 " " 26,113.86 " " 32,642.33 " " 17,590.42 " " 17,764.59 " " 17,416.26 " " 48,542.32 " " 45,508.42 " " 45,508.42 " " 47,935.54 " " 42,752.42 " " 45,508.42 " " 17,764.59 " " 47,935.54 " Inpatient RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC 815 " 55,749.56 " " 17,566.69 " " 9,374.05 " " 44,599.64 " " 19,020.63 " " 9,467.79 " " 19,640.51 " " 9,374.05 " " 18,662.88 " " 9,374.05 " " 21,382.94 " " 10,030.23 " " 39,576.61 " " 9,374.05 " " 13,712.88 " " 17,141.11 " " 9,467.79 " " 9,561.53 " " 9,374.05 " " 44,599.64 " " 41,812.17 " " 41,812.17 " " 44,042.15 " " 22,450.84 " " 41,812.17 " " 9,561.53 " " 44,042.15 " Inpatient LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC 821 " 125,868.82 " " 39,661.27 " " 19,775.30 " " 100,695.06 " " 41,265.61 " " 19,973.05 " " 42,610.46 " " 19,775.30 " " 43,460.39 " " 19,775.30 " " 46,390.68 " " 21,159.57 " " 89,354.28 " " 19,775.30 " " 29,759.58 " " 37,199.48 " " 19,973.05 " " 20,170.81 " " 19,775.30 " " 100,695.06 " " 94,401.62 " " 94,401.62 " " 99,436.37 " " 48,707.52 " " 94,401.62 " " 20,170.81 " " 99,436.37 " Inpatient LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC 823 " 229,057.36 " " 72,175.97 " " 40,783.70 " " 183,245.89 " " 86,195.96 " " 41,191.54 " " 89,005.09 " " 40,783.70 " " 80,298.04 " " 40,783.70 " " 96,901.25 " " 43,638.56 " " 162,607.82 " " 40,783.70 " " 51,653.40 " " 64,566.76 " " 41,191.54 " " 41,599.37 " " 40,783.70 " " 183,245.89 " " 171,793.02 " " 171,793.02 " " 180,955.31 " " 101,740.68 " " 171,793.02 " " 41,599.37 " " 180,955.31 " Inpatient LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC 824 " 136,728.63 " " 43,083.19 " " 21,648.20 " " 109,382.90 " " 45,271.17 " " 21,864.68 " " 46,746.55 " " 21,648.20 " " 40,701.37 " " 21,648.20 " " 50,893.71 " " 23,163.57 " " 97,063.65 " " 21,648.20 " " 32,631.97 " " 40,789.96 " " 21,864.68 " " 22,081.16 " " 21,648.20 " " 109,382.90 " " 102,546.47 " " 102,546.47 " " 108,015.62 " " 53,435.44 " " 102,546.47 " " 22,081.16 " " 108,015.62 " Inpatient MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC 827 " 86,301.87 " " 27,193.72 " " 22,867.56 " " 69,041.49 " " 47,878.99 " " 23,096.24 " " 49,439.36 " " 22,867.56 " " 44,054.67 " " 22,867.56 " " 53,825.42 " " 24,468.29 " " 61,265.69 " " 22,867.56 " " 34,496.26 " " 43,120.33 " " 23,096.24 " " 23,324.91 " " 22,867.56 " " 69,041.49 " " 64,726.40 " " 64,726.40 " " 68,178.47 " " 56,513.56 " " 64,726.40 " " 23,324.91 " " 68,178.47 " Inpatient MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC 828 " 65,960.31 " " 20,784.09 " " 15,467.26 " " 52,768.24 " " 32,052.08 " " 15,621.93 " " 33,096.65 " " 15,467.26 " " 30,160.91 " " 15,467.26 " " 36,032.85 " " 16,549.97 " " 46,825.22 " " 15,467.26 " " 23,172.42 " " 28,965.54 " " 15,621.93 " " 15,776.61 " " 15,467.26 " " 52,768.24 " " 49,470.23 " " 49,470.23 " " 52,108.64 " " 37,832.40 " " 49,470.23 " " 15,776.61 " " 52,108.64 " Inpatient MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC 829 " 91,773.13 " " 28,917.71 " " 29,204.28 " " 73,418.50 " " 61,431.23 " " 29,496.32 " " 63,433.28 " " 29,204.28 " " 58,289.34 " " 29,204.28 " " 69,060.81 " " 31,248.58 " " 65,149.74 " " 29,204.28 " " 36,824.73 " " 46,030.91 " " 29,496.32 " " 29,788.37 " " 29,204.28 " " 73,418.50 " " 68,829.85 " " 68,829.85 " " 72,500.77 " " 72,509.84 " " 68,829.85 " " 29,788.37 " " 72,500.77 " Inpatient OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC 831 " 37,950.83 " " 11,958.30 " " 10,523.58 " " 30,360.66 " " 21,479.10 " " 10,628.82 " " 22,179.11 " " 10,523.58 " " 19,152.82 " " 10,523.58 " " 24,146.75 " " 11,260.23 " " 26,941.29 " " 10,523.58 " " 15,480.51 " " 19,350.63 " " 10,628.82 " " 10,734.05 " " 10,523.58 " " 30,360.66 " " 28,463.12 " " 28,463.12 " " 29,981.15 " " 25,352.68 " " 28,463.12 " " 10,734.05 " " 29,981.15 " Inpatient OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC 832 " 22,897.30 " " 7,214.94 " " 7,448.33 " " 18,317.84 " " 14,902.11 " " 7,522.81 " " 15,387.77 " " 7,448.33 " " 13,390.77 " " 7,448.33 " " 16,752.91 " " 7,969.71 " " 16,254.79 " " 7,448.33 " " 10,771.45 " " 13,464.31 " " 7,522.81 " " 7,597.30 " " 7,448.33 " " 18,317.84 " " 17,172.97 " " 17,172.97 " " 18,088.86 " " 17,589.58 " " 17,172.97 " " 7,597.30 " " 18,088.86 " Inpatient OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC 833 " 21,308.60 " " 6,714.34 " " 5,288.04 " " 17,046.88 " " 10,281.94 " " 5,340.92 " " 10,617.03 " " 5,288.04 " " 8,947.68 " " 5,288.04 " " 11,558.93 " " 5,658.20 " " 15,126.98 " " 5,288.04 " " 7,401.92 " " 9,252.40 " " 5,340.92 " " 5,393.80 " " 5,288.04 " " 17,046.88 " " 15,981.45 " " 15,981.45 " " 16,833.80 " " 12,136.20 " " 15,981.45 " " 5,393.80 " " 16,833.80 " Inpatient ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC 834 " 255,252.29 " " 80,430.00 " " 54,663.96 " " 204,201.83 " " 153,304.53 " " 55,210.60 " " 158,307.47 " " 54,663.96 " " 147,484.77 " " 54,663.96 " " 173,188.68 " " 58,490.44 " " 181,203.60 " " 54,663.96 " " 144,932.25 " " 181,178.08 " " 55,210.60 " " 55,757.24 " " 54,663.96 " " 204,201.83 " " 191,439.22 " " 191,439.22 " " 201,649.31 " " 172,295.30 " " 191,439.22 " " 55,757.24 " " 201,649.31 " Inpatient ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC 835 " 162,374.34 " " 51,164.15 " " 19,403.76 " " 129,899.47 " " 97,522.03 " " 19,597.80 " " 100,704.57 " " 19,403.76 " " 93,819.89 " " 19,403.76 " " 110,170.99 " " 20,762.02 " " 115,269.54 " " 19,403.76 " " 92,196.15 " " 115,253.31 " " 19,597.80 " " 19,791.84 " " 19,403.76 " " 129,899.47 " " 121,780.75 " " 121,780.75 " " 128,275.73 " " 109,602.68 " " 121,780.75 " " 19,791.84 " " 128,275.73 " Inpatient CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC 837 " 82,211.41 " " 25,904.81 " " 51,504.56 " " 128,804.18 " " 109,124.50 " " 52,019.61 " " 112,680.86 " " 51,504.56 " " 106,164.87 " " 51,504.56 " " 122,677.43 " " 55,109.88 " " 58,361.88 " " 51,504.56 " " 65,459.80 " " 81,824.76 " " 52,019.61 " " 52,534.65 " " 51,504.56 " " 65,769.13 " " 61,658.56 " " 61,658.56 " " 64,947.01 " " 128,804.18 " " 61,658.56 " " 52,534.65 " " 64,947.01 " Inpatient CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT 838 " 84,951.06 " " 26,768.08 " " 20,715.33 " " 67,960.85 " " 43,276.05 " " 20,922.48 " " 44,686.41 " " 20,715.33 " " 43,814.34 " " 20,715.33 " " 48,650.81 " " 22,165.40 " " 60,306.76 " " 20,715.33 " " 31,195.77 " " 38,994.72 " " 20,922.48 " " 21,129.64 " " 20,715.33 " " 67,960.85 " " 63,713.29 " " 63,713.29 " " 67,111.34 " " 51,080.52 " " 63,713.29 " " 21,129.64 " " 67,111.34 " Inpatient CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC 839 " 32,656.33 " " 10,290.01 " " 13,794.89 " " 33,610.72 " " 28,475.42 " " 13,932.84 " " 29,403.43 " " 13,794.89 " " 24,818.00 " " 13,794.89 " " 32,011.98 " " 14,760.53 " " 23,182.73 " " 13,794.89 " " 20,520.99 " " 25,651.24 " " 13,932.84 " " 14,070.79 " " 13,794.89 " " 26,125.06 " " 24,492.25 " " 24,492.25 " " 25,798.50 " " 33,610.72 " " 24,492.25 " " 14,070.79 " " 25,798.50 " Inpatient LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC 840 " 136,398.62 " " 42,979.21 " " 29,312.61 " " 109,118.90 " " 81,921.01 " " 29,605.74 " " 84,594.42 " " 29,312.61 " " 78,811.12 " " 29,312.61 " " 92,546.46 " " 31,364.49 " " 96,829.38 " " 29,312.61 " " 77,447.14 " " 96,815.74 " " 29,605.74 " " 29,898.86 " " 29,312.61 " " 109,118.90 " " 102,298.97 " " 102,298.97 " " 107,754.91 " " 92,069.07 " " 102,298.97 " " 29,898.86 " " 107,754.91 " Inpatient LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC 841 " 72,773.14 " " 22,930.82 " " 14,998.14 " " 58,218.51 " " 43,707.55 " " 15,148.12 " " 45,133.90 " " 14,998.14 " " 42,048.32 " " 14,998.14 " " 49,376.58 " " 16,048.01 " " 51,661.65 " " 14,998.14 " " 41,320.59 " " 51,654.38 " " 15,148.12 " " 15,298.10 " " 14,998.14 " " 58,218.51 " " 54,579.86 " " 54,579.86 " " 57,490.78 " " 49,121.87 " " 54,579.86 " " 15,298.10 " " 57,490.78 " Inpatient LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC 842 " 52,798.89 " " 16,636.93 " " 10,301.55 " " 42,239.11 " " 31,711.02 " " 10,404.57 " " 32,745.87 " " 10,301.55 " " 20,941.24 " " 10,301.55 " " 35,824.05 " " 11,022.66 " " 37,481.93 " " 10,301.55 " " 15,121.46 " " 18,901.82 " " 10,404.57 " " 10,507.58 " " 10,301.55 " " 42,239.11 " " 39,599.17 " " 39,599.17 " " 41,711.13 " " 35,639.25 " " 39,599.17 " " 10,507.58 " " 41,711.13 " Inpatient CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC 846 " 46,959.24 " " 14,796.86 " " 24,410.11 " " 60,407.54 " " 51,178.02 " " 24,654.21 " " 52,845.91 " " 24,410.11 " " 44,283.80 " " 24,410.11 " " 57,534.17 " " 26,118.82 " " 33,336.37 " " 24,410.11 " " 30,668.13 " " 38,335.17 " " 24,654.21 " " 24,898.31 " " 24,410.11 " " 37,567.39 " " 35,219.43 " " 35,219.43 " " 37,097.80 " " 60,407.54 " " 35,219.43 " " 24,898.31 " " 37,097.80 " Inpatient CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC 847 " 34,651.48 " " 10,918.68 " " 12,442.14 " " 30,195.86 " " 25,582.31 " " 12,566.56 " " 26,416.03 " " 12,442.14 " " 23,474.84 " " 12,442.14 " " 28,759.55 " " 13,313.09 " " 24,599.09 " " 12,442.14 " " 18,435.75 " " 23,044.69 " " 12,566.56 " " 12,690.98 " " 12,442.14 " " 27,721.18 " " 25,988.61 " " 25,988.61 " " 27,374.67 " " 30,195.86 " " 25,988.61 " " 12,690.98 " " 27,374.67 " Inpatient CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC 848 " 30,168.95 " " 9,506.23 " " 9,722.31 " " 24,135.16 " " 19,765.45 " " 9,819.53 " " 20,409.60 " " 9,722.31 " " 17,364.41 " " 9,722.31 " " 22,220.26 " " 10,402.87 " " 21,416.93 " " 9,722.31 " " 14,210.03 " " 17,762.54 " " 9,819.53 " " 9,916.76 " " 9,722.31 " " 24,135.16 " " 22,626.71 " " 22,626.71 " " 23,833.47 " " 23,329.98 " " 22,626.71 " " 9,916.76 " " 23,833.47 " Inpatient INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC 853 " 227,825.07 " " 71,787.68 " " 44,955.66 " " 182,260.06 " " 136,831.74 " " 45,405.22 " " 141,297.11 " " 44,955.66 " " 131,637.33 " " 44,955.66 " " 154,579.31 " " 48,102.56 " " 161,733.02 " " 44,955.66 " " 56,799.21 " " 70,999.02 " " 45,405.22 " " 45,854.77 " " 44,955.66 " " 182,260.06 " " 170,868.80 " " 170,868.80 " " 179,981.81 " " 153,781.92 " " 170,868.80 " " 45,854.77 " " 179,981.81 " Inpatient INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC 854 " 89,150.67 " " 28,091.38 " " 19,479.86 " " 71,320.53 " " 53,543.89 " " 19,674.66 " " 55,291.24 " " 19,479.86 " " 51,511.26 " " 19,479.86 " " 60,488.73 " " 20,843.45 " " 63,288.06 " " 19,479.86 " " 28,917.20 " " 36,146.50 " " 19,674.66 " " 19,869.46 " " 19,479.86 " " 71,320.53 " " 66,863.00 " " 66,863.00 " " 70,429.03 " " 60,176.70 " " 66,863.00 " " 19,869.46 " " 70,429.03 " Inpatient POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC 856 " 151,291.42 " " 47,671.93 " " 42,234.93 " " 121,033.13 " " 90,865.62 " " 42,657.28 " " 93,830.94 " " 42,234.93 " " 87,416.18 " " 42,234.93 " " 102,651.23 " " 45,191.38 " " 107,401.78 " " 42,234.93 " " 52,216.22 " " 65,270.29 " " 42,657.28 " " 43,079.63 " " 42,234.93 " " 121,033.13 " " 113,468.56 " " 113,468.56 " " 119,520.22 " " 102,121.71 " " 113,468.56 " " 43,079.63 " " 119,520.22 " Inpatient POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC 857 " 73,930.25 " " 23,295.42 " " 19,302.59 " " 59,144.20 " " 40,254.65 " " 19,495.62 " " 41,566.55 " " 19,302.59 " " 37,031.40 " " 19,302.59 " " 45,254.16 " " 20,653.77 " " 52,483.09 " " 19,302.59 " " 28,102.43 " " 35,128.05 " " 19,495.62 " " 19,688.64 " " 19,302.59 " " 59,144.20 " " 55,447.69 " " 55,447.69 " " 58,404.90 " " 47,514.24 " " 55,447.69 " " 19,688.64 " " 58,404.90 " Inpatient POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC 862 " 67,863.89 " " 21,383.91 " " 17,461.02 " " 54,291.11 " " 36,316.11 " " 17,635.63 " " 37,499.66 " " 17,461.02 " " 34,140.13 " " 17,461.02 " " 40,826.47 " " 18,683.29 " " 48,176.57 " " 17,461.02 " " 25,948.14 " " 32,435.19 " " 17,635.63 " " 17,810.24 " " 17,461.02 " " 54,291.11 " " 50,897.92 " " 50,897.92 " " 53,612.47 " " 42,865.42 " " 50,897.92 " " 17,810.24 " " 53,612.47 " Inpatient POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC 863 " 33,704.92 " " 10,620.42 " " 9,535.20 " " 26,963.94 " " 19,365.28 " " 9,630.55 " " 19,996.39 " " 9,535.20 " " 18,761.60 " " 9,535.20 " " 21,770.39 " " 10,202.66 " " 23,927.13 " " 9,535.20 " " 13,491.93 " " 16,864.92 " " 9,630.55 " " 9,725.90 " " 9,535.20 " " 26,963.94 " " 25,278.69 " " 25,278.69 " " 26,626.89 " " 22,857.64 " " 25,278.69 " " 9,725.90 " " 26,626.89 " Inpatient FEVER AND INFLAMMATORY CONDITIONS 864 " 34,817.85 " " 10,971.10 " " 8,327.48 " " 27,854.28 " " 16,782.35 " " 8,410.75 " " 17,329.28 " " 8,327.48 " " 16,209.40 " " 8,327.48 " " 18,866.66 " " 8,910.40 " " 24,717.19 " " 8,327.48 " " 12,083.36 " " 15,104.20 " " 8,410.75 " " 8,494.03 " " 8,327.48 " " 27,854.28 " " 26,113.39 " " 26,113.39 " " 27,506.10 " " 19,808.90 " " 26,113.39 " " 8,494.03 " " 27,506.10 " Inpatient VIRAL ILLNESS WITHOUT MCC 866 " 27,003.52 " " 8,508.81 " " 7,991.75 " " 21,602.82 " " 16,218.32 " " 8,071.67 " " 16,747.59 " " 7,991.75 " " 14,912.78 " " 7,991.75 " " 18,321.89 " " 8,551.17 " " 19,169.80 " " 7,991.75 " " 11,558.59 " " 14,448.24 " " 8,071.67 " " 8,151.59 " " 7,991.75 " " 21,602.82 " " 20,252.64 " " 20,252.64 " " 21,332.78 " " 18,227.38 " " 20,252.64 " " 8,151.59 " " 21,332.78 " Inpatient OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC 868 " 39,789.85 " " 12,537.78 " " 10,024.02 " " 31,831.88 " " 20,410.70 " " 10,124.26 " " 21,075.89 " " 10,024.02 " " 19,737.78 " " 10,024.02 " " 22,945.65 " " 10,725.70 " " 28,246.82 " " 10,024.02 " " 14,610.50 " " 18,263.13 " " 10,124.26 " " 10,224.50 " " 10,024.02 " " 31,831.88 " " 29,842.39 " " 29,842.39 " " 31,433.98 " " 24,091.60 " " 29,842.39 " " 10,224.50 " " 31,433.98 " Inpatient SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS 870 " 324,759.85 " " 102,331.83 " " 58,126.87 " " 259,807.88 " " 195,050.77 " " 58,708.14 " " 201,416.06 " " 58,126.87 " " 187,646.24 " " 58,126.87 " " 220,349.56 " " 62,195.75 " " 230,547.02 " " 58,126.87 " " 73,798.77 " " 92,248.48 " " 58,708.14 " " 59,289.41 " " 58,126.87 " " 259,807.88 " " 243,569.89 " " 243,569.89 " " 256,560.28 " " 219,212.90 " " 243,569.89 " " 59,289.41 " " 256,560.28 " Inpatient SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC 871 " 81,998.41 " " 25,837.70 " " 17,241.68 " " 65,598.73 " " 49,248.24 " " 17,414.10 " " 50,855.41 " " 17,241.68 " " 47,378.68 " " 17,241.68 " " 55,635.92 " " 18,448.60 " " 58,210.67 " " 17,241.68 " " 25,796.24 " " 32,245.30 " " 17,414.10 " " 17,586.51 " " 17,241.68 " " 65,598.73 " " 61,498.81 " " 61,498.81 " " 64,778.74 " " 55,348.93 " " 61,498.81 " " 17,586.51 " " 64,778.74 " Inpatient SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC 872 " 43,917.71 " " 13,838.47 " " 9,668.59 " " 35,134.17 " " 26,376.98 " " 9,765.28 " " 27,237.77 " " 9,668.59 " " 19,648.37 " " 9,668.59 " " 29,798.17 " " 10,345.39 " " 31,177.18 " " 9,668.59 " " 14,113.36 " " 17,641.70 " " 9,765.28 " " 9,861.96 " " 9,668.59 " " 35,134.17 " " 32,938.28 " " 32,938.28 " " 34,694.99 " " 29,644.46 " " 32,938.28 " " 9,861.96 " " 34,694.99 " Inpatient ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION 880 " 38,521.25 " " 12,138.04 " " 8,220.05 " " 30,817.00 " " 16,552.58 " " 8,302.25 " " 17,092.03 " " 8,220.05 " " 15,063.68 " " 8,220.05 " " 18,608.36 " " 8,795.45 " " 27,346.23 " " 8,220.05 " " 11,931.45 " " 14,914.32 " " 8,302.25 " " 8,384.45 " " 8,220.05 " " 30,817.00 " " 28,890.93 " " 28,890.93 " " 30,431.78 " " 19,537.70 " " 28,890.93 " " 8,384.45 " " 30,431.78 " Inpatient DISORDERS OF PERSONALITY AND IMPULSE CONTROL 883 " 83,705.20 " " 26,375.51 " " 14,641.82 " " 66,964.16 " " 30,286.72 " " 14,788.24 " " 31,273.77 " " 14,641.82 " " 21,926.74 " " 14,641.82 " " 34,048.25 " " 15,666.75 " " 59,422.32 " " 14,641.82 " " 21,791.47 " " 27,239.34 " " 14,788.24 " " 14,934.66 " " 14,641.82 " " 66,964.16 " " 62,778.90 " " 62,778.90 " " 66,127.11 " " 35,748.68 " " 62,778.90 " " 14,934.66 " " 66,127.11 " Inpatient ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY 884 " 56,948.95 " " 17,944.62 " " 13,437.68 " " 45,559.16 " " 27,711.45 " " 13,572.06 " " 28,614.57 " " 13,437.68 " " 22,994.20 " " 13,437.68 " " 31,153.13 " " 14,378.32 " " 40,428.06 " " 13,437.68 " " 19,940.99 " " 24,926.24 " " 13,572.06 " " 13,706.43 " " 13,437.68 " " 45,559.16 " " 42,711.71 " " 42,711.71 " " 44,989.67 " " 32,708.98 " " 42,711.71 " " 13,706.43 " " 44,989.67 " Inpatient PSYCHOSES 885 " 48,353.86 " " 15,236.30 " " 11,576.41 " " 38,683.09 " " 23,730.79 " " 11,692.17 " " 24,504.18 " " 11,576.41 " " 21,863.39 " " 11,576.41 " " 26,678.09 " " 12,386.76 " " 34,326.40 " " 11,576.41 " " 17,082.41 " " 21,353.02 " " 11,692.17 " " 11,807.94 " " 11,576.41 " " 38,683.09 " " 36,265.39 " " 36,265.39 " " 38,199.55 " " 28,010.44 " " 36,265.39 " " 11,807.94 " " 38,199.55 " Inpatient OTHER MENTAL DISORDER DIAGNOSES 887 " 70,834.17 " " 22,319.85 " " 10,147.56 " " 56,667.34 " " 20,674.93 " " 10,249.04 " " 21,348.73 " " 10,147.56 " " 20,009.77 " " 10,147.56 " " 23,242.70 " " 10,857.89 " " 50,285.18 " " 10,147.56 " " 14,900.50 " " 18,625.63 " " 10,249.04 " " 10,350.51 " " 10,147.56 " " 56,667.34 " " 53,125.63 " " 53,125.63 " " 55,959.00 " " 24,403.48 " " 53,125.63 " " 10,350.51 " " 55,959.00 " Inpatient "ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA" 894 " 20,403.09 " " 6,429.01 " " 5,395.47 " " 16,322.47 " " 10,511.70 " " 5,449.42 " " 10,854.28 " " 5,395.47 " " 9,769.24 " " 5,395.47 " " 11,817.23 " " 5,773.15 " " 14,484.15 " " 5,395.47 " " 7,567.63 " " 9,459.54 " " 5,449.42 " " 5,503.38 " " 5,395.47 " " 16,322.47 " " 15,302.31 " " 15,302.31 " " 16,118.44 " " 12,407.40 " " 15,302.31 " " 5,503.38 " " 16,118.44 " Inpatient "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC" 896 " 52,878.78 " " 16,662.10 " " 16,418.93 " " 42,303.03 " " 34,087.40 " " 16,583.12 " " 35,198.31 " " 16,418.93 " " 30,472.01 " " 16,418.93 " " 38,320.96 " " 17,568.26 " " 37,538.65 " " 16,418.93 " " 24,539.57 " " 30,674.47 " " 16,583.12 " " 16,747.31 " " 16,418.93 " " 42,303.03 " " 39,659.09 " " 39,659.09 " " 41,774.24 " " 40,234.78 " " 39,659.09 " " 16,747.31 " " 41,774.24 " Inpatient "ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC" 897 " 27,919.64 " " 8,797.48 " " 7,884.32 " " 22,335.71 " " 15,834.57 " " 7,963.16 " " 16,350.62 " " 7,884.32 " " 14,711.58 " " 7,884.32 " " 17,801.18 " " 8,436.22 " " 19,820.15 " " 7,884.32 " " 11,406.69 " " 14,258.36 " " 7,963.16 " " 8,042.01 " " 7,884.32 " " 22,335.71 " " 20,939.73 " " 20,939.73 " " 22,056.51 " " 18,690.20 " " 20,939.73 " " 8,042.01 " " 22,056.51 " Inpatient WOUND DEBRIDEMENTS FOR INJURIES WITH CC 902 " 160,889.35 " " 50,696.23 " " 18,066.23 " " 128,711.48 " " 37,610.45 " " 18,246.89 " " 38,836.18 " " 18,066.23 " " 37,208.37 " " 18,066.23 " " 42,281.56 " " 19,330.87 " " 114,215.35 " " 18,066.23 " " 27,094.34 " " 33,867.93 " " 18,246.89 " " 18,427.55 " " 18,066.23 " " 128,711.48 " " 120,667.01 " " 120,667.01 " " 127,102.59 " " 44,393.18 " " 120,667.01 " " 18,427.55 " " 127,102.59 " Inpatient OTHER O.R. PROCEDURES FOR INJURIES WITH MCC 907 " 138,147.06 " " 43,530.14 " " 35,827.49 " " 110,517.65 " " 75,596.19 " " 36,185.76 " " 78,059.86 " " 35,827.49 " " 77,712.29 " " 35,827.49 " " 84,985.01 " " 38,335.41 " " 98,070.60 " " 35,827.49 " " 45,450.85 " " 56,813.58 " " 36,185.76 " " 36,544.04 " " 35,827.49 " " 110,517.65 " " 103,610.30 " " 103,610.30 " " 109,136.18 " " 89,229.32 " " 103,610.30 " " 36,544.04 " " 109,136.18 " Inpatient OTHER O.R. PROCEDURES FOR INJURIES WITH CC 908 " 84,505.19 " " 26,627.58 " " 18,837.05 " " 67,604.15 " " 39,259.01 " " 19,025.42 " " 40,538.46 " " 18,837.05 " " 37,720.68 " " 18,837.05 " " 44,134.86 " " 20,155.64 " " 59,990.23 " " 18,837.05 " " 28,171.48 " " 35,214.36 " " 19,025.42 " " 19,213.79 " " 18,837.05 " " 67,604.15 " " 63,378.89 " " 63,378.89 " " 66,759.10 " " 46,339.04 " " 63,378.89 " " 19,213.79 " " 66,759.10 " Inpatient OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC 909 " 63,939.00 " " 20,147.18 " " 12,754.59 " " 51,151.20 " " 26,250.54 " " 12,882.14 " " 27,106.04 " " 12,754.59 " " 26,204.03 " " 12,754.59 " " 29,510.78 " " 13,647.41 " " 45,390.30 " " 12,754.59 " " 18,988.13 " " 23,735.17 " " 12,882.14 " " 13,009.68 " " 12,754.59 " " 51,151.20 " " 47,954.25 " " 47,954.25 " " 50,511.81 " " 30,984.60 " " 47,954.25 " " 13,009.68 " " 50,511.81 " Inpatient ALLERGIC REACTIONS WITH MCC 915 " 75,382.35 " " 23,752.98 " " 15,695.55 " " 60,305.88 " " 32,540.33 " " 15,852.51 " " 33,600.81 " " 15,695.55 " " 30,140.40 " " 15,695.55 " " 36,581.74 " " 16,794.24 " " 53,513.93 " " 15,695.55 " " 23,448.62 " " 29,310.77 " " 15,852.51 " " 16,009.46 " " 15,695.55 " " 60,305.88 " " 56,536.77 " " 56,536.77 " " 59,552.06 " " 38,408.70 " " 56,536.77 " " 16,009.46 " " 59,552.06 " Inpatient POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC 917 " 49,823.60 " " 15,699.42 " " 13,717.01 " " 39,858.88 " " 29,924.05 " " 13,854.18 " " 30,900.59 " " 13,717.01 " " 28,788.07 " " 13,717.01 " " 33,805.31 " " 14,677.20 " " 35,369.77 " " 13,717.01 " " 28,289.84 " " 35,364.79 " " 13,854.18 " " 13,991.35 " " 13,717.01 " " 39,858.88 " " 37,367.70 " " 37,367.70 " " 39,360.64 " " 33,630.93 " " 37,367.70 " " 13,991.35 " " 39,360.64 " Inpatient POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC 918 " 34,207.02 " " 10,778.63 " " 7,567.40 " " 27,365.62 " " 20,544.74 " " 7,643.07 " " 21,215.20 " " 7,567.40 " " 13,975.73 " " 7,567.40 " " 23,209.46 " " 8,097.12 " " 24,283.57 " " 7,567.40 " " 10,923.35 " " 13,654.19 " " 7,643.07 " " 7,718.75 " " 7,567.40 " " 27,365.62 " " 25,655.27 " " 25,655.27 " " 27,023.55 " " 23,089.74 " " 25,655.27 " " 7,718.75 " " 27,023.55 " Inpatient COMPLICATIONS OF TREATMENT WITH MCC 919 " 77,285.11 " " 24,352.54 " " 16,990.11 " " 61,828.09 " " 35,308.98 " " 17,160.01 " " 36,459.70 " " 16,990.11 " " 32,606.94 " " 16,990.11 " " 39,694.25 " " 18,179.42 " " 54,864.70 " " 16,990.11 " " 25,326.71 " " 31,658.40 " " 17,160.01 " " 17,329.91 " " 16,990.11 " " 61,828.09 " " 57,963.83 " " 57,963.83 " " 61,055.24 " " 41,676.66 " " 57,963.83 " " 17,329.91 " " 61,055.24 " Inpatient COMPLICATIONS OF TREATMENT WITH CC 920 " 37,413.62 " " 11,789.03 " " 9,653.38 " " 29,930.89 " " 19,618.02 " " 9,749.91 " " 20,257.37 " " 9,653.38 " " 18,612.57 " " 9,653.38 " " 22,054.52 " " 10,329.12 " " 26,559.93 " " 9,653.38 " " 14,182.41 " " 17,728.01 " " 9,749.91 " " 9,846.45 " " 9,653.38 " " 29,930.89 " " 28,060.21 " " 28,060.21 " " 29,556.76 " " 23,155.96 " " 28,060.21 " " 9,846.45 " " 29,556.76 " Inpatient "OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC" 922 " 66,703.66 " " 21,018.32 " " 14,699.12 " " 53,362.92 " " 30,409.27 " " 14,846.11 " " 31,400.30 " " 14,699.12 " " 27,604.96 " " 14,699.12 " " 34,186.01 " " 15,728.06 " " 47,352.92 " " 14,699.12 " " 21,929.57 " " 27,411.96 " " 14,846.11 " " 14,993.10 " " 14,699.12 " " 53,362.92 " " 50,027.74 " " 50,027.74 " " 52,695.89 " " 35,893.32 " " 50,027.74 " " 14,993.10 " " 52,695.89 " Inpatient SIGNS AND SYMPTOMS WITH MCC 947 " 59,599.97 " " 18,779.95 " " 11,169.96 " " 47,679.98 " " 22,861.52 " " 11,281.66 " " 23,606.57 " " 11,169.96 " " 21,867.12 " " 11,169.96 " " 25,700.85 " " 11,951.86 " " 42,310.02 " " 11,169.96 " " 16,433.36 " " 20,541.71 " " 11,281.66 " " 11,393.36 " " 11,169.96 " " 47,679.98 " " 44,699.98 " " 44,699.98 " " 47,083.98 " " 26,984.40 " " 44,699.98 " " 11,393.36 " " 47,083.98 " Inpatient SIGNS AND SYMPTOMS WITHOUT MCC 948 " 31,426.68 " " 9,902.55 " " 7,527.11 " " 25,141.35 " " 15,070.60 " " 7,602.38 " " 15,561.75 " " 7,527.11 " " 14,393.03 " " 7,527.11 " " 16,942.33 " " 8,054.01 " " 22,309.80 " " 7,527.11 " " 10,854.31 " " 13,567.88 " " 7,602.38 " " 7,677.65 " " 7,527.11 " " 25,141.35 " " 23,570.01 " " 23,570.01 " " 24,827.08 " " 17,788.46 " " 23,570.01 " " 7,677.65 " " 24,827.08 " Inpatient CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA 955 " 304,482.89 " " 95,942.56 " " 56,786.65 " " 243,586.31 " " 120,421.23 " " 57,354.52 " " 124,345.75 " " 56,786.65 " " 112,005.17 " " 56,786.65 " " 135,377.18 " " 60,761.72 " " 216,152.40 " " 56,786.65 " " 72,225.16 " " 90,281.47 " " 57,354.52 " " 57,922.38 " " 56,786.65 " " 243,586.31 " " 228,362.17 " " 228,362.17 " " 240,541.48 " " 142,138.18 " " 228,362.17 " " 57,922.38 " " 240,541.48 " Inpatient "LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA" 956 " 218,266.85 " " 68,775.88 " " 34,948.33 " " 174,613.48 " " 73,715.95 " " 35,297.81 " " 76,118.35 " " 34,948.33 " " 72,777.38 " " 34,948.33 " " 82,871.25 " " 37,394.71 " " 154,947.63 " " 34,948.33 " " 44,210.35 " " 55,262.94 " " 35,297.81 " " 35,647.30 " " 34,948.33 " " 174,613.48 " " 163,700.13 " " 163,700.13 " " 172,430.81 " " 87,010.00 " " 163,700.13 " " 35,647.30 " " 172,430.81 " Inpatient OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC 957 " 339,387.46 " " 106,940.99 " " 66,917.52 " " 271,509.97 " " 142,087.97 " " 67,586.70 " " 146,718.61 " " 66,917.52 " " 136,059.38 " " 66,917.52 " " 159,734.87 " " 71,601.75 " " 240,931.16 " " 66,917.52 " " 85,239.02 " " 106,548.79 " " 67,586.70 " " 68,255.87 " " 66,917.52 " " 271,509.97 " " 254,540.59 " " 254,540.59 " " 268,116.09 " " 167,712.34 " " 254,540.59 " " 68,255.87 " " 268,116.09 " Inpatient OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC 958 " 215,331.06 " " 67,850.82 " " 38,132.81 " " 172,264.85 " " 80,526.54 " " 38,514.14 " " 83,150.89 " " 38,132.81 " " 79,329.32 " " 38,132.81 " " 90,527.69 " " 40,802.11 " " 152,863.52 " " 38,132.81 " " 48,299.43 " " 60,374.30 " " 38,514.14 " " 38,895.47 " " 38,132.81 " " 172,264.85 " " 161,498.29 " " 161,498.29 " " 170,111.54 " " 95,048.82 " " 161,498.29 " " 38,895.47 " " 170,111.54 " Inpatient OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC 963 " 162,185.31 " " 51,104.59 " " 24,920.41 " " 129,748.24 " " 52,269.40 " " 25,169.61 " " 53,972.85 " " 24,920.41 " " 50,001.14 " " 24,920.41 " " 58,761.10 " " 26,664.84 " " 115,135.35 " " 24,920.41 " " 31,288.38 " " 39,110.48 " " 25,169.61 " " 25,418.82 " " 24,920.41 " " 129,748.24 " " 121,638.98 " " 121,638.98 " " 128,126.39 " " 61,695.74 " " 121,638.98 " " 25,418.82 " " 128,126.39 " Inpatient OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC 964 " 68,410.11 " " 21,556.03 " " 13,836.08 " " 54,728.09 " " 28,563.49 " " 13,974.44 " " 29,494.38 " " 13,836.08 " " 26,615.74 " " 13,836.08 " " 32,111.00 " " 14,804.61 " " 48,564.34 " " 13,836.08 " " 20,548.61 " " 25,685.77 " " 13,974.44 " " 14,112.80 " " 13,836.08 " " 54,728.09 " " 51,307.58 " " 51,307.58 " " 54,043.99 " " 33,714.68 " " 51,307.58 " " 14,112.80 " " 54,043.99 " Inpatient EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC 981 " 195,148.89 " " 61,491.41 " " 41,792.67 " " 156,119.11 " " 88,353.83 " " 42,210.60 " " 91,233.28 " " 41,792.67 " " 80,303.62 " " 41,792.67 " " 99,327.11 " " 44,718.16 " " 138,536.20 " " 41,792.67 " " 52,928.36 " " 66,160.47 " " 42,210.60 " " 42,628.52 " " 41,792.67 " " 156,119.11 " " 146,361.67 " " 146,361.67 " " 154,167.62 " " 104,287.70 " " 146,361.67 " " 42,628.52 " " 154,167.62 " Inpatient EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC 982 " 122,662.11 " " 38,650.83 " " 23,189.86 " " 98,129.69 " " 48,568.28 " " 23,421.76 " " 50,151.12 " " 23,189.86 " " 46,267.83 " " 23,189.86 " " 54,600.32 " " 24,813.15 " " 87,077.83 " " 23,189.86 " " 29,186.41 " " 36,483.02 " " 23,421.76 " " 23,653.66 " " 23,189.86 " " 98,129.69 " " 91,996.58 " " 91,996.58 " " 96,903.07 " " 57,327.16 " " 91,996.58 " " 23,653.66 " " 96,903.07 " Inpatient EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC 983 " 88,449.73 " " 27,870.51 " " 15,272.98 " " 70,759.78 " " 31,636.59 " " 15,425.71 " " 32,667.62 " " 15,272.98 " " 30,650.85 " " 15,272.98 " " 35,565.76 " " 16,342.09 " " 62,790.46 " " 15,272.98 " " 22,854.81 " " 28,568.51 " " 15,425.71 " " 15,578.44 " " 15,272.98 " " 70,759.78 " " 66,337.30 " " 66,337.30 " " 69,875.29 " " 37,341.98 " " 66,337.30 " " 15,578.44 " " 69,875.29 " Inpatient NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC 987 " 140,921.90 " " 44,404.49 " " 29,808.59 " " 112,737.52 " " 84,637.70 " " 30,106.68 " " 87,399.76 " " 29,808.59 " " 81,424.68 " " 29,808.59 " " 95,615.51 " " 31,895.19 " " 100,040.46 " " 29,808.59 " " 37,467.95 " " 46,834.95 " " 30,106.68 " " 30,404.76 " " 29,808.59 " " 112,737.52 " " 105,691.43 " " 105,691.43 " " 111,328.30 " " 95,122.28 " " 105,691.43 " " 30,404.76 " " 111,328.30 " Inpatient NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC 988 " 75,996.96 " " 23,946.64 " " 15,757.33 " " 60,797.57 " " 32,672.44 " " 15,914.90 " " 33,737.23 " " 15,757.33 " " 31,861.77 " " 15,757.33 " " 36,730.26 " " 16,860.34 " " 53,950.24 " " 15,757.33 " " 23,213.85 " " 29,017.32 " " 15,914.90 " " 16,072.48 " " 15,757.33 " " 60,797.57 " " 56,997.72 " " 56,997.72 " " 60,037.60 " " 38,564.64 " " 56,997.72 " " 16,072.48 " " 60,037.60 " Inpatient TRACHEOSTOMY W MV 96+ HOURS W EXTENSIVE PROCEDURE 4.4 " 1,470,913.03 " " 463,484.69 " " 138,251.24 " " 248,700.16 " " 145,163.80 " " 138,251.24 " " 138,251.24 " " 138,251.24 " " 147,237.57 " " 138,251.24 " " 138,251.24 " " 207,376.86 " " 248,700.16 " " 246,280.76 " Inpatient TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE 5.3 " 986,995.68 " " 311,002.34 " " 72,430.47 " " 130,295.17 " " 76,051.99 " " 72,430.47 " " 72,430.47 " " 72,430.47 " " 77,138.45 " " 72,430.47 " " 72,430.47 " " 108,645.71 " " 130,295.17 " " 129,027.64 " Inpatient TRACHEOSTOMY W MV 96+ HOURS W/O EXTENSIVE PROCEDURE 5.4 " 944,981.65 " " 297,763.72 " " 92,902.83 " " 167,122.90 " " 97,547.97 " " 92,902.83 " " 92,902.83 " " 92,902.83 " " 98,941.51 " " 92,902.83 " " 92,902.83 " " 139,354.25 " " 167,122.90 " " 165,497.10 " Inpatient OPEN CRANIOTOMY FOR TRAUMA 20.1 " 96,182.94 " " 30,307.24 " " 21,083.98 " " 37,927.97 " " 22,138.18 " " 21,083.98 " " 21,083.98 " " 21,083.98 " " 22,454.44 " " 21,083.98 " " 21,083.98 " " 31,625.97 " " 37,927.97 " " 37,559.00 " Inpatient OPEN CRANIOTOMY FOR TRAUMA 20.2 " 92,232.92 " " 29,062.59 " " 25,866.30 " " 46,530.89 " " 27,159.62 " " 25,866.30 " " 25,866.30 " " 25,866.30 " " 27,547.61 " " 25,866.30 " " 25,866.30 " " 38,799.45 " " 46,530.89 " " 46,078.23 " Inpatient OPEN CRANIOTOMY FOR TRAUMA 20.3 " 74,041.66 " " 23,330.53 " " 33,382.21 " " 60,051.26 " " 35,051.32 " " 33,382.21 " " 33,382.21 " " 33,382.21 " " 35,552.05 " " 33,382.21 " " 33,382.21 " " 50,073.32 " " 60,051.26 " " 59,467.07 " Inpatient OPEN CRANIOTOMY FOR TRAUMA 20.4 " 976,594.97 " " 307,725.08 " " 55,721.89 " " 100,238.11 " " 58,507.98 " " 55,721.89 " " 55,721.89 " " 55,721.89 " " 59,343.81 " " 55,721.89 " " 55,721.89 " " 83,582.84 " " 100,238.11 " " 99,262.97 " Inpatient OPEN CRANIOTOMY EXCEPT TRAUMA 21.1 " 76,234.53 " " 24,021.50 " " 19,660.19 " " 35,366.72 " " 20,643.20 " " 19,660.19 " " 19,660.19 " " 19,660.19 " " 20,938.10 " " 19,660.19 " " 19,660.19 " " 29,490.29 " " 35,366.72 " " 35,022.66 " Inpatient OPEN CRANIOTOMY EXCEPT TRAUMA 21.2 " 89,528.00 " " 28,210.27 " " 27,002.18 " " 48,574.22 " " 28,352.29 " " 27,002.18 " " 27,002.18 " " 27,002.18 " " 28,757.32 " " 27,002.18 " " 27,002.18 " " 40,503.27 " " 48,574.22 " " 48,101.68 " Inpatient OPEN CRANIOTOMY EXCEPT TRAUMA 21.3 " 178,113.33 " " 56,123.51 " " 39,340.35 " " 70,769.36 " " 41,307.37 " " 39,340.35 " " 39,340.35 " " 39,340.35 " " 41,897.47 " " 39,340.35 " " 39,340.35 " " 59,010.53 " " 70,769.36 " " 70,080.90 " Inpatient OPEN CRANIOTOMY EXCEPT TRAUMA 21.4 " 390,822.80 " " 123,148.26 " " 65,586.10 " " 117,982.84 " " 68,865.41 " " 65,586.10 " " 65,586.10 " " 65,586.10 " " 69,849.20 " " 65,586.10 " " 65,586.10 " " 98,379.15 " " 117,982.84 " " 116,835.08 " Inpatient VENTRICULAR SHUNT PROCEDURES 22.1 " 72,942.44 " " 22,984.16 " " 12,205.86 " " 21,957.12 " " 12,816.15 " " 12,205.86 " " 12,205.86 " " 12,205.86 " " 12,999.24 " " 12,205.86 " " 12,205.86 " " 18,308.79 " " 21,957.12 " " 21,743.52 " Inpatient VENTRICULAR SHUNT PROCEDURES 22.2 " 72,922.88 " " 22,978.00 " " 14,981.05 " " 26,949.41 " " 15,730.10 " " 14,981.05 " " 14,981.05 " " 14,981.05 " " 15,954.82 " " 14,981.05 " " 14,981.05 " " 22,471.58 " " 26,949.41 " " 26,687.24 " Inpatient VENTRICULAR SHUNT PROCEDURES 22.3 " 103,075.11 " " 32,478.97 " " 23,133.55 " " 41,614.94 " " 24,290.23 " " 23,133.55 " " 23,133.55 " " 23,133.55 " " 24,637.23 " " 23,133.55 " " 23,133.55 " " 34,700.33 " " 41,614.94 " " 41,210.11 " Inpatient SPINAL PROCEDURES 23.1 " 88,123.40 " " 27,767.68 " " 14,424.35 " " 25,947.96 " " 15,145.57 " " 14,424.35 " " 14,424.35 " " 14,424.35 " " 15,361.93 " " 14,424.35 " " 14,424.35 " " 21,636.53 " " 25,947.96 " " 25,695.54 " Inpatient SPINAL PROCEDURES 23.2 " 88,996.32 " " 28,042.74 " " 19,311.52 " " 34,739.49 " " 20,277.10 " " 19,311.52 " " 19,311.52 " " 19,311.52 " " 20,566.77 " " 19,311.52 " " 19,311.52 " " 28,967.28 " " 34,739.49 " " 34,401.54 " Inpatient SPINAL PROCEDURES 23.3 " 161,397.81 " " 50,856.45 " " 33,672.63 " " 60,573.69 " " 35,356.26 " " 33,672.63 " " 33,672.63 " " 33,672.63 " " 35,861.35 " " 33,672.63 " " 33,672.63 " " 50,508.95 " " 60,573.69 " " 59,984.42 " Inpatient OPEN EXTRACRANIAL VASCULAR PROCEDURES 24.1 " 62,768.30 " " 19,778.29 " " 9,178.53 " " 16,511.26 " " 9,637.46 " " 9,178.53 " " 9,178.53 " " 9,178.53 " " 9,775.13 " " 9,178.53 " " 9,178.53 " " 13,767.80 " " 16,511.26 " " 16,350.63 " Inpatient OPEN EXTRACRANIAL VASCULAR PROCEDURES 24.2 " 36,194.06 " " 11,404.75 " " 11,894.64 " " 21,397.27 " " 12,489.37 " " 11,894.64 " " 11,894.64 " " 11,894.64 " " 12,667.79 " " 11,894.64 " " 11,894.64 " " 17,841.96 " " 21,397.27 " " 21,189.11 " Inpatient OPEN EXTRACRANIAL VASCULAR PROCEDURES 24.3 " 82,029.97 " " 25,847.64 " " 21,425.99 " " 38,543.21 " " 22,497.29 " " 21,425.99 " " 21,425.99 " " 21,425.99 " " 22,818.68 " " 21,425.99 " " 21,425.99 " " 32,138.99 " " 38,543.21 " " 38,168.26 " Inpatient OTHER NERVOUS SYSTEM & RELATED PROCEDURES 26.1 " 37,611.65 " " 11,851.43 " " 13,660.44 " " 24,573.77 " " 14,343.46 " " 13,660.44 " " 13,660.44 " " 13,660.44 " " 14,548.37 " " 13,660.44 " " 13,660.44 " " 20,490.66 " " 24,573.77 " " 24,334.71 " Inpatient OTHER NERVOUS SYSTEM & RELATED PROCEDURES 26.2 " 57,501.89 " " 18,118.84 " " 18,107.41 " " 32,573.42 " " 19,012.78 " " 18,107.41 " " 18,107.41 " " 18,107.41 " " 19,284.39 " " 18,107.41 " " 18,107.41 " " 27,161.12 " " 32,573.42 " " 32,256.54 " Inpatient OTHER NERVOUS SYSTEM & RELATED PROCEDURES 26.3 " 450,802.27 " " 142,047.80 " " 24,321.01 " " 43,751.06 " " 25,537.06 " " 24,321.01 " " 24,321.01 " " 24,321.01 " " 25,901.88 " " 24,321.01 " " 24,321.01 " " 36,481.52 " " 43,751.06 " " 43,325.45 " Inpatient OTHER NERVOUS SYSTEM & RELATED PROCEDURES 26.4 " 192,519.74 " " 60,662.97 " " 46,465.98 " " 83,587.65 " " 48,789.28 " " 46,465.98 " " 46,465.98 " " 46,465.98 " " 49,486.27 " " 46,465.98 " " 46,465.98 " " 69,698.97 " " 83,587.65 " " 82,774.50 " Inpatient OTHER OPEN CRANIOTOMY 27.1 " 200,785.74 " " 63,267.59 " " 15,427.91 " " 27,753.27 " " 16,199.31 " " 15,427.91 " " 15,427.91 " " 15,427.91 " " 16,430.72 " " 15,427.91 " " 15,427.91 " " 23,141.87 " " 27,753.27 " " 27,483.28 " Inpatient OTHER OPEN CRANIOTOMY 27.2 " 51,603.30 " " 16,260.20 " " 19,368.94 " " 34,842.79 " " 20,337.39 " " 19,368.94 " " 19,368.94 " " 19,368.94 " " 20,627.92 " " 19,368.94 " " 19,368.94 " " 29,053.41 " " 34,842.79 " " 34,503.83 " Inpatient OTHER OPEN CRANIOTOMY 27.4 " 205,813.56 " " 64,851.85 " " 57,475.22 " " 103,392.17 " " 60,348.98 " " 57,475.22 " " 57,475.22 " " 57,475.22 " " 61,211.11 " " 57,475.22 " " 57,475.22 " " 86,212.83 " " 103,392.17 " " 102,386.36 " Inpatient OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES 29.1 " 71,379.93 " " 22,491.82 " " 17,254.46 " " 31,039.05 " " 18,117.18 " " 17,254.46 " " 17,254.46 " " 17,254.46 " " 18,376.00 " " 17,254.46 " " 17,254.46 " " 25,881.69 " " 31,039.05 " " 30,737.10 " Inpatient OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES 29.2 " 59,260.63 " " 18,673.02 " " 19,171.72 " " 34,488.01 " " 20,130.31 " " 19,171.72 " " 19,171.72 " " 19,171.72 " " 20,417.88 " " 19,171.72 " " 19,171.72 " " 28,757.58 " " 34,488.01 " " 34,152.50 " Inpatient OTHER PERCUTANEOUS INTRACRANIAL PROCEDURES 29.4 " 273,196.62 " " 86,084.25 " " 45,754.50 " " 82,307.77 " " 48,042.23 " " 45,754.50 " " 45,754.50 " " 45,754.50 " " 48,728.54 " " 45,754.50 " " 45,754.50 " " 68,631.75 " " 82,307.77 " " 81,507.07 " Inpatient PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES 30.1 " 85,544.30 " " 26,955.01 " " 17,958.46 " " 32,305.47 " " 18,856.38 " " 17,958.46 " " 17,958.46 " " 17,958.46 " " 19,125.76 " " 17,958.46 " " 17,958.46 " " 26,937.69 " " 32,305.47 " " 31,991.20 " Inpatient PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES 30.2 " 81,704.96 " " 25,745.23 " " 25,039.15 " " 45,042.93 " " 26,291.11 " " 25,039.15 " " 25,039.15 " " 25,039.15 " " 26,666.69 " " 25,039.15 " " 25,039.15 " " 37,558.73 " " 45,042.93 " " 44,604.74 " Inpatient PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES 30.3 " 160,787.71 " " 50,664.21 " " 37,636.12 " " 67,703.62 " " 39,517.93 " " 37,636.12 " " 37,636.12 " " 37,636.12 " " 40,082.47 " " 37,636.12 " " 37,636.12 " " 56,454.18 " " 67,703.62 " " 67,044.98 " Inpatient PERCUTANEOUS INTRA & EXTRACRANIAL VASCULAR PROCEDURES 30.4 " 128,736.04 " " 40,564.73 " " 51,259.12 " " 92,210.03 " " 53,822.08 " " 51,259.12 " " 51,259.12 " " 51,259.12 " " 54,590.96 " " 51,259.12 " " 51,259.12 " " 76,888.68 " " 92,210.03 " " 91,313.00 " Inpatient NERVOUS SYSTEM MALIGNANCY 41.1 " 36,808.03 " " 11,598.21 " " 7,850.43 " " 14,122.14 " " 8,242.95 " " 7,850.43 " " 7,850.43 " " 7,850.43 " " 8,360.71 " " 7,850.43 " " 7,850.43 " " 11,775.65 " " 14,122.14 " " 13,984.76 " Inpatient NERVOUS SYSTEM MALIGNANCY 41.2 " 18,364.71 " " 5,786.72 " " 8,641.79 " " 15,545.72 " " 9,073.88 " " 8,641.79 " " 8,641.79 " " 8,641.79 " " 9,203.51 " " 8,641.79 " " 8,641.79 " " 12,962.69 " " 15,545.72 " " 15,394.48 " Inpatient NERVOUS SYSTEM MALIGNANCY 41.3 " 48,161.47 " " 15,175.68 " " 11,483.56 " " 20,657.78 " " 12,057.74 " " 11,483.56 " " 11,483.56 " " 11,483.56 " " 12,229.99 " " 11,483.56 " " 11,483.56 " " 17,225.34 " " 20,657.78 " " 20,456.81 " Inpatient NERVOUS SYSTEM MALIGNANCY 41.4 " 131,810.87 " " 41,533.61 " " 18,777.28 " " 33,778.45 " " 19,716.14 " " 18,777.28 " " 18,777.28 " " 18,777.28 " " 19,997.80 " " 18,777.28 " " 18,777.28 " " 28,165.92 " " 33,778.45 " " 33,449.85 " Inpatient DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS 42.1 " 167,057.98 " " 52,639.97 " " 6,281.01 " " 11,298.91 " " 6,595.06 " " 6,281.01 " " 6,281.01 " " 6,281.01 " " 6,689.28 " " 6,281.01 " " 6,281.01 " " 9,421.52 " " 11,298.91 " " 11,188.99 " Inpatient DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS 42.2 " 70,350.41 " " 22,167.41 " " 7,605.78 " " 13,682.04 " " 7,986.07 " " 7,605.78 " " 7,605.78 " " 7,605.78 " " 8,100.16 " " 7,605.78 " " 7,605.78 " " 11,408.67 " " 13,682.04 " " 13,548.94 " Inpatient DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS 42.3 " 72,397.20 " " 22,812.36 " " 11,515.18 " " 20,714.66 " " 12,090.94 " " 11,515.18 " " 11,515.18 " " 11,515.18 " " 12,263.67 " " 11,515.18 " " 11,515.18 " " 17,272.77 " " 20,714.66 " " 20,513.14 " Inpatient DEGENERATIVE NERVOUS SYSTEM DISORDERS EXC MULT SCLEROSIS 42.4 " 45,090.38 " " 14,207.98 " " 27,736.96 " " 49,896.02 " " 29,123.81 " " 27,736.96 " " 27,736.96 " " 27,736.96 " " 29,539.86 " " 27,736.96 " " 27,736.96 " " 41,605.44 " " 49,896.02 " " 49,410.62 " Inpatient MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES 43.1 " 13,229.38 " " 4,168.58 " " 7,706.47 " " 13,863.17 " " 8,091.79 " " 7,706.47 " " 7,706.47 " " 7,706.47 " " 8,207.39 " " 7,706.47 " " 7,706.47 " " 11,559.71 " " 13,863.17 " " 13,728.31 " Inpatient MULTIPLE SCLEROSIS & OTHER DEMYELINATING DISEASES 43.2 " 66,229.13 " " 20,868.80 " " 10,162.95 " " 18,282.13 " " 10,671.10 " " 10,162.95 " " 10,162.95 " " 10,162.95 " " 10,823.54 " " 10,162.95 " " 10,162.95 " " 15,244.43 " " 18,282.13 " " 18,104.28 " Inpatient INTRACRANIAL HEMORRHAGE 44.1 " 42,089.12 " " 13,262.28 " " 7,625.75 " " 13,717.96 " " 8,007.04 " " 7,625.75 " " 7,625.75 " " 7,625.75 " " 8,121.42 " " 7,625.75 " " 7,625.75 " " 11,438.63 " " 13,717.96 " " 13,584.51 " Inpatient INTRACRANIAL HEMORRHAGE 44.2 " 77,272.57 " " 24,348.59 " " 9,603.75 " " 17,276.19 " " 10,083.94 " " 9,603.75 " " 9,603.75 " " 9,603.75 " " 10,227.99 " " 9,603.75 " " 9,603.75 " " 14,405.63 " " 17,276.19 " " 17,108.12 " Inpatient INTRACRANIAL HEMORRHAGE 44.3 " 270,035.33 " " 85,088.13 " " 13,179.46 " " 23,708.53 " " 13,838.43 " " 13,179.46 " " 13,179.46 " " 13,179.46 " " 14,036.12 " " 13,179.46 " " 13,179.46 " " 19,769.19 " " 23,708.53 " " 23,477.89 " Inpatient INTRACRANIAL HEMORRHAGE 44.4 " 126,997.64 " " 40,016.95 " " 19,687.65 " " 35,416.11 " " 20,672.03 " " 19,687.65 " " 19,687.65 " " 19,687.65 " " 20,967.35 " " 19,687.65 " " 19,687.65 " " 29,531.48 " " 35,416.11 " " 35,071.58 " Inpatient CVA & PRECEREBRAL OCCLUSION W INFARCT 45.1 " 58,700.34 " " 18,496.48 " " 6,881.81 " " 12,379.69 " " 7,225.90 " " 6,881.81 " " 6,881.81 " " 6,881.81 " " 7,329.13 " " 6,881.81 " " 6,881.81 " " 10,322.72 " " 12,379.69 " " 12,259.26 " Inpatient CVA & PRECEREBRAL OCCLUSION W INFARCT 45.2 " 44,627.59 " " 14,062.15 " " 8,719.18 " " 15,684.93 " " 9,155.14 " " 8,719.18 " " 8,719.18 " " 8,719.18 " " 9,285.93 " " 8,719.18 " " 8,719.18 " " 13,078.77 " " 15,684.93 " " 15,532.35 " Inpatient CVA & PRECEREBRAL OCCLUSION W INFARCT 45.3 " 55,864.70 " " 17,602.97 " " 12,709.30 " " 22,862.76 " " 13,344.77 " " 12,709.30 " " 12,709.30 " " 12,709.30 " " 13,535.40 " " 12,709.30 " " 12,709.30 " " 19,063.95 " " 22,862.76 " " 22,640.35 " Inpatient CVA & PRECEREBRAL OCCLUSION W INFARCT 45.4 " 96,251.97 " " 30,328.99 " " 22,535.24 " " 40,538.64 " " 23,662.00 " " 22,535.24 " " 22,535.24 " " 22,535.24 " " 24,000.03 " " 22,535.24 " " 22,535.24 " " 33,802.86 " " 40,538.64 " " 40,144.28 " Inpatient NONSPECIFIC CVA & PRECEREBRAL OCCLUSION W/O INFARCT 46.3 " 17,082.73 " " 5,382.77 " " 10,733.80 " " 19,309.03 " " 11,270.49 " " 10,733.80 " " 10,733.80 " " 10,733.80 " " 11,431.50 " " 10,733.80 " " 10,733.80 " " 16,100.70 " " 19,309.03 " " 19,121.19 " Inpatient TRANSIENT ISCHEMIA 47.2 " 46,428.37 " " 14,629.58 " " 6,940.06 " " 12,484.47 " " 7,287.06 " " 6,940.06 " " 6,940.06 " " 6,940.06 " " 7,391.16 " " 6,940.06 " " 6,940.06 " " 10,410.09 " " 12,484.47 " " 12,363.02 " Inpatient "PERIPHERAL, CRANIAL & AUTONOMIC NERVE DISORDERS " 48.2 " 97,202.25 " " 30,628.43 " " 6,963.36 " " 12,526.39 " " 7,311.53 " " 6,963.36 " " 6,963.36 " " 6,963.36 " " 7,415.98 " " 6,963.36 " " 6,963.36 " " 10,445.04 " " 12,526.39 " " 12,404.53 " Inpatient BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM 49.1 " 56,071.21 " " 17,668.04 " " 11,220.60 " " 20,184.74 " " 11,781.63 " " 11,220.60 " " 11,220.60 " " 11,220.60 " " 11,949.94 " " 11,220.60 " " 11,220.60 " " 16,830.90 " " 20,184.74 " " 19,988.38 " Inpatient BACTERIAL & TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM 49.2 " 96,674.16 " " 30,462.03 " " 18,456.08 " " 33,200.64 " " 19,378.88 " " 18,456.08 " " 18,456.08 " " 18,456.08 " " 19,655.73 " " 18,456.08 " " 18,456.08 " " 27,684.12 " " 33,200.64 " " 32,877.66 " Inpatient NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITI 50.1 " 23,020.56 " " 7,253.78 " " 6,399.17 " " 11,511.47 " " 6,719.13 " " 6,399.17 " " 6,399.17 " " 6,399.17 " " 6,815.12 " " 6,399.17 " " 6,399.17 " " 9,598.76 " " 11,511.47 " " 11,399.48 " Inpatient NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXC VIRAL MENINGITI 50.4 " 520,286.86 " " 163,942.39 " " 45,256.87 " " 81,412.58 " " 47,519.71 " " 45,256.87 " " 45,256.87 " " 45,256.87 " " 48,198.57 " " 45,256.87 " " 45,256.87 " " 67,885.31 " " 81,412.58 " " 80,620.59 " Inpatient ALTERATION IN CONSCIOUSNESS 52.3 " 60,123.62 " " 18,944.95 " " 8,751.64 " " 15,743.33 " " 9,189.22 " " 8,751.64 " " 8,751.64 " " 8,751.64 " " 9,320.50 " " 8,751.64 " " 8,751.64 " " 13,127.46 " " 15,743.33 " " 15,590.17 " Inpatient ALTERATION IN CONSCIOUSNESS 52.4 " 120,953.00 " " 38,112.29 " " 20,191.93 " " 36,323.26 " " 21,201.53 " " 20,191.93 " " 20,191.93 " " 20,191.93 " " 21,504.41 " " 20,191.93 " " 20,191.93 " " 30,287.90 " " 36,323.26 " " 35,969.90 " Inpatient SEIZURE 53.1 " 23,008.84 " " 7,250.09 " " 5,175.09 " " 9,309.47 " " 5,433.84 " " 5,175.09 " " 5,175.09 " " 5,175.09 " " 5,511.47 " " 5,175.09 " " 5,175.09 " " 7,762.64 " " 9,309.47 " " 9,218.91 " Inpatient SEIZURE 53.2 " 28,558.64 " " 8,998.83 " " 6,500.69 " " 11,694.09 " " 6,825.72 " " 6,500.69 " " 6,500.69 " " 6,500.69 " " 6,923.23 " " 6,500.69 " " 6,500.69 " " 9,751.04 " " 11,694.09 " " 11,580.33 " Inpatient SEIZURE 53.3 " 46,375.40 " " 14,612.89 " " 8,779.93 " " 15,794.22 " " 9,218.93 " " 8,779.93 " " 8,779.93 " " 8,779.93 " " 9,350.63 " " 8,779.93 " " 8,779.93 " " 13,169.90 " " 15,794.22 " " 15,640.57 " Inpatient SEIZURE 53.4 " 175,794.29 " " 55,392.78 " " 22,904.71 " " 41,203.28 " " 24,049.95 " " 22,904.71 " " 22,904.71 " " 22,904.71 " " 24,393.52 " " 22,904.71 " " 22,904.71 " " 34,357.07 " " 41,203.28 " " 40,802.45 " Inpatient MIGRAINE & OTHER HEADACHES 54.1 " 21,120.50 " " 6,655.07 " " 5,145.13 " " 9,255.57 " " 5,402.39 " " 5,145.13 " " 5,145.13 " " 5,145.13 " " 5,479.56 " " 5,145.13 " " 5,145.13 " " 7,717.70 " " 9,255.57 " " 9,165.53 " Inpatient MIGRAINE & OTHER HEADACHES 54.2 " 38,246.49 " " 12,051.47 " " 6,249.39 " " 11,242.03 " " 6,561.86 " " 6,249.39 " " 6,249.39 " " 6,249.39 " " 6,655.60 " " 6,249.39 " " 6,249.39 " " 9,374.09 " " 11,242.03 " " 11,132.66 " Inpatient MIGRAINE & OTHER HEADACHES 54.3 " 36,949.17 " " 11,642.68 " " 8,176.63 " " 14,708.94 " " 8,585.46 " " 8,176.63 " " 8,176.63 " " 8,176.63 " " 8,708.11 " " 8,176.63 " " 8,176.63 " " 12,264.95 " " 14,708.94 " " 14,565.85 " Inpatient HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE 55.1 " 29,424.29 " " 9,271.59 " " 6,748.67 " " 12,140.18 " " 7,086.10 " " 6,748.67 " " 6,748.67 " " 6,748.67 " " 7,187.33 " " 6,748.67 " " 6,748.67 " " 10,123.01 " " 12,140.18 " " 12,022.08 " Inpatient HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE 55.2 " 32,642.20 " " 10,285.56 " " 9,251.75 " " 16,642.97 " " 9,714.34 " " 9,251.75 " " 9,251.75 " " 9,251.75 " " 9,853.11 " " 9,251.75 " " 9,251.75 " " 13,877.63 " " 16,642.97 " " 16,481.07 " Inpatient HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE 55.3 " 52,108.33 " " 16,419.33 " " 13,665.44 " " 24,582.76 " " 14,348.71 " " 13,665.44 " " 13,665.44 " " 13,665.44 " " 14,553.69 " " 13,665.44 " " 13,665.44 " " 20,498.16 " " 24,582.76 " " 24,343.61 " Inpatient HEAD TRAUMA W COMA >1 HR OR HEMORRHAGE 55.4 " 100,601.12 " " 31,699.41 " " 28,085.62 " " 50,523.22 " " 29,489.90 " " 28,085.62 " " 28,085.62 " " 28,085.62 " " 29,911.19 " " 28,085.62 " " 28,085.62 " " 42,128.43 " " 50,523.22 " " 50,031.72 " Inpatient "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL IN " 57.1 " 52,337.76 " " 16,491.63 " " 5,313.23 " " 9,557.97 " " 5,578.89 " " 5,313.23 " " 5,313.23 " " 5,313.23 " " 5,658.59 " " 5,313.23 " " 5,313.23 " " 7,969.85 " " 9,557.97 " " 9,464.99 " Inpatient "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL IN " 57.2 " 36,856.91 " " 11,613.61 " " 7,996.88 " " 14,385.59 " " 8,396.72 " " 7,996.88 " " 7,996.88 " " 7,996.88 " " 8,516.68 " " 7,996.88 " " 7,996.88 " " 11,995.32 " " 14,385.59 " " 14,245.64 " Inpatient "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL IN " 57.3 " 35,236.17 " " 11,102.92 " " 11,523.50 " " 20,729.62 " " 12,099.68 " " 11,523.50 " " 11,523.50 " " 11,523.50 " " 12,272.53 " " 11,523.50 " " 11,523.50 " " 17,285.25 " " 20,729.62 " " 20,527.96 " Inpatient "CONCUSSION, CLOSED SKULL FX NOS,UNCOMPLICATED INTRACRANIAL IN " 57.4 " 81,832.29 " " 25,785.35 " " 20,920.05 " " 37,633.08 " " 21,966.05 " " 20,920.05 " " 20,920.05 " " 20,920.05 " " 22,279.85 " " 20,920.05 " " 20,920.05 " " 31,380.08 " " 37,633.08 " " 37,266.98 " Inpatient OTHER DISORDERS OF NERVOUS SYSTEM 58.1 " 56,704.16 " " 17,867.48 " " 6,434.95 " " 11,575.83 " " 6,756.70 " " 6,434.95 " " 6,434.95 " " 6,434.95 " " 6,853.22 " " 6,434.95 " " 6,434.95 " " 9,652.43 " " 11,575.83 " " 11,463.22 " Inpatient OTHER DISORDERS OF NERVOUS SYSTEM 58.2 " 71,104.82 " " 22,405.13 " " 7,941.13 " " 14,285.30 " " 8,338.19 " " 7,941.13 " " 7,941.13 " " 7,941.13 " " 8,457.30 " " 7,941.13 " " 7,941.13 " " 11,911.70 " " 14,285.30 " " 14,146.33 " Inpatient OTHER DISORDERS OF NERVOUS SYSTEM 58.3 " 80,159.58 " " 25,258.28 " " 11,357.07 " " 20,430.23 " " 11,924.92 " " 11,357.07 " " 11,357.07 " " 11,357.07 " " 12,095.28 " " 11,357.07 " " 11,357.07 " " 17,035.61 " " 20,430.23 " " 20,231.48 " Inpatient OTHER DISORDERS OF NERVOUS SYSTEM 58.4 " 136,913.73 " " 43,141.52 " " 23,246.72 " " 41,818.52 " " 24,409.06 " " 23,246.72 " " 23,246.72 " " 23,246.72 " " 24,757.76 " " 23,246.72 " " 23,246.72 " " 34,870.08 " " 41,818.52 " " 41,411.71 " Inpatient ANOXIC & OTHER SEVERE BRAIN DAMAGE 59.3 " 120,264.99 " " 37,895.50 " " 13,290.97 " " 23,909.13 " " 13,955.52 " " 13,290.97 " " 13,290.97 " " 13,290.97 " " 14,154.88 " " 13,290.97 " " 13,290.97 " " 19,936.46 " " 23,909.13 " " 23,676.53 " Inpatient ANOXIC & OTHER SEVERE BRAIN DAMAGE 59.4 " 83,219.70 " " 26,222.53 " " 21,693.11 " " 39,023.74 " " 22,777.77 " " 21,693.11 " " 21,693.11 " " 21,693.11 " " 23,103.16 " " 21,693.11 " " 21,693.11 " " 32,539.67 " " 39,023.74 " " 38,644.11 " Inpatient ORBIT & EYE PROCEDURES 73.2 " 68,551.05 " " 21,600.44 " " 12,588.64 " " 22,645.70 " " 13,218.07 " " 12,588.64 " " 12,588.64 " " 12,588.64 " " 13,406.90 " " 12,588.64 " " 12,588.64 " " 18,882.96 " " 22,645.70 " " 22,425.40 " Inpatient ORBIT & EYE PROCEDURES 73.3 " 44,906.94 " " 14,150.18 " " 20,775.26 " " 37,372.62 " " 21,814.02 " " 20,775.26 " " 20,775.26 " " 20,775.26 " " 22,125.65 " " 20,775.26 " " 20,775.26 " " 31,162.89 " " 37,372.62 " " 37,009.05 " Inpatient ORBIT & EYE PROCEDURES 73.4 " 241,753.57 " " 76,176.55 " " 46,232.15 " " 83,167.01 " " 48,543.76 " " 46,232.15 " " 46,232.15 " " 46,232.15 " " 49,237.24 " " 46,232.15 " " 46,232.15 " " 69,348.23 " " 83,167.01 " " 82,357.95 " Inpatient EYE INFECTIONS & OTHER EYE DISORDERS 82.1 " 37,957.64 " " 11,960.45 " " 5,160.11 " " 9,282.52 " " 5,418.12 " " 5,160.11 " " 5,160.11 " " 5,160.11 " " 5,495.52 " " 5,160.11 " " 5,160.11 " " 7,740.17 " " 9,282.52 " " 9,192.22 " Inpatient EYE INFECTIONS & OTHER EYE DISORDERS 82.2 " 65,909.20 " " 20,767.99 " " 6,735.36 " " 12,116.24 " " 7,072.13 " " 6,735.36 " " 6,735.36 " " 6,735.36 " " 7,173.16 " " 6,735.36 " " 6,735.36 " " 10,103.04 " " 12,116.24 " " 11,998.37 " Inpatient EYE INFECTIONS & OTHER EYE DISORDERS 82.3 " 23,501.93 " " 7,405.46 " " 10,408.43 " " 18,723.72 " " 10,928.85 " " 10,408.43 " " 10,408.43 " " 10,408.43 " " 11,084.98 " " 10,408.43 " " 10,408.43 " " 15,612.65 " " 18,723.72 " " 18,541.58 " Inpatient EYE INFECTIONS & OTHER EYE DISORDERS 82.4 " 354,138.20 " " 111,588.95 " " 28,128.90 " " 50,601.08 " " 29,535.35 " " 28,128.90 " " 28,128.90 " " 28,128.90 " " 29,957.28 " " 28,128.90 " " 28,128.90 " " 42,193.35 " " 50,601.08 " " 50,108.82 " Inpatient MAJOR CRANIAL/FACIAL BONE PROCEDURES 89.1 " 51,603.80 " " 16,260.36 " " 17,132.97 " " 30,820.50 " " 17,989.62 " " 17,132.97 " " 17,132.97 " " 17,132.97 " " 18,246.61 " " 17,132.97 " " 17,132.97 " " 25,699.46 " " 30,820.50 " " 30,520.67 " Inpatient MAJOR CRANIAL/FACIAL BONE PROCEDURES 89.2 " 86,392.82 " " 27,222.38 " " 22,819.00 " " 41,049.10 " " 23,959.95 " " 22,819.00 " " 22,819.00 " " 22,819.00 " " 24,302.24 " " 22,819.00 " " 22,819.00 " " 34,228.50 " " 41,049.10 " " 40,649.77 " Inpatient MAJOR CRANIAL/FACIAL BONE PROCEDURES 89.3 " 130,465.00 " " 41,109.52 " " 36,661.68 " " 65,950.70 " " 38,494.76 " " 36,661.68 " " 36,661.68 " " 36,661.68 " " 39,044.69 " " 36,661.68 " " 36,661.68 " " 54,992.52 " " 65,950.70 " " 65,309.12 " Inpatient MAJOR CRANIAL/FACIAL BONE PROCEDURES 89.4 " 203,458.40 " " 64,109.74 " " 63,663.86 " " 114,524.92 " " 66,847.05 " " 63,663.86 " " 63,663.86 " " 63,663.86 " " 67,802.01 " " 63,663.86 " " 63,663.86 " " 95,495.79 " " 114,524.92 " " 113,410.80 " Inpatient OTHER MAJOR HEAD & NECK PROCEDURES 91.2 " 124,583.36 " " 39,256.22 " " 20,621.31 " " 37,095.67 " " 21,652.38 " " 20,621.31 " " 20,621.31 " " 20,621.31 " " 21,961.70 " " 20,621.31 " " 20,621.31 " " 30,931.97 " " 37,095.67 " " 36,734.80 " Inpatient OTHER MAJOR HEAD & NECK PROCEDURES 91.3 " 124,113.46 " " 39,108.15 " " 35,959.35 " " 64,687.27 " " 37,757.32 " " 35,959.35 " " 35,959.35 " " 35,959.35 " " 38,296.71 " " 35,959.35 " " 35,959.35 " " 53,939.03 " " 64,687.27 " " 64,057.99 " Inpatient TONSIL & ADENOID PROCEDURES 97.1 " 49,244.14 " " 15,516.83 " " 5,562.04 " " 10,005.55 " " 5,840.14 " " 5,562.04 " " 5,562.04 " " 5,562.04 " " 5,923.57 " " 5,562.04 " " 5,562.04 " " 8,343.06 " " 10,005.55 " " 9,908.22 " Inpatient TONSIL & ADENOID PROCEDURES 97.2 " 69,828.39 " " 22,002.93 " " 7,971.92 " " 14,340.69 " " 8,370.52 " " 7,971.92 " " 7,971.92 " " 7,971.92 " " 8,490.09 " " 7,971.92 " " 7,971.92 " " 11,957.88 " " 14,340.69 " " 14,201.18 " Inpatient TONSIL & ADENOID PROCEDURES 97.3 " 86,079.36 " " 27,123.61 " " 13,925.90 " " 25,051.30 " " 14,622.20 " " 13,925.90 " " 13,925.90 " " 13,925.90 " " 14,831.08 " " 13,925.90 " " 13,925.90 " " 20,888.85 " " 25,051.30 " " 24,807.60 " Inpatient TONSIL & ADENOID PROCEDURES 97.4 " 410,570.24 " " 129,370.68 " " 33,943.07 " " 61,060.19 " " 35,640.22 " " 33,943.07 " " 33,943.07 " " 33,943.07 " " 36,149.37 " " 33,943.07 " " 33,943.07 " " 50,914.61 " " 61,060.19 " " 60,466.18 " Inpatient "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES " 98.2 " 38,264.35 " " 12,057.10 " " 12,740.09 " " 22,918.15 " " 13,377.09 " " 12,740.09 " " 12,740.09 " " 12,740.09 " " 13,568.20 " " 12,740.09 " " 12,740.09 " " 19,110.14 " " 22,918.15 " " 22,695.20 " Inpatient "OTHER EAR, NOSE, MOUTH & THROAT PROCEDURES " 98.3 " 133,397.98 " " 42,033.70 " " 22,073.40 " " 39,707.84 " " 23,177.07 " " 22,073.40 " " 22,073.40 " " 22,073.40 " " 23,508.17 " " 22,073.40 " " 22,073.40 " " 33,110.10 " " 39,707.84 " " 39,321.55 " Inpatient INFECTIONS OF UPPER RESPIRATORY TRACT 113.1 " 44,113.15 " " 13,900.05 " " 3,366.85 " " 6,056.63 " " 3,535.19 " " 3,366.85 " " 3,366.85 " " 3,366.85 " " 3,585.70 " " 3,366.85 " " 3,366.85 " " 5,050.28 " " 6,056.63 " " 5,997.71 " Inpatient INFECTIONS OF UPPER RESPIRATORY TRACT 113.2 " 20,442.16 " " 6,441.33 " " 4,927.11 " " 8,863.38 " " 5,173.47 " " 4,927.11 " " 4,927.11 " " 4,927.11 " " 5,247.37 " " 4,927.11 " " 4,927.11 " " 7,390.67 " " 8,863.38 " " 8,777.15 " Inpatient INFECTIONS OF UPPER RESPIRATORY TRACT 113.3 " 31,991.41 " " 10,080.49 " " 7,931.98 " " 14,268.84 " " 8,328.58 " " 7,931.98 " " 7,931.98 " " 7,931.98 " " 8,447.56 " " 7,931.98 " " 7,931.98 " " 11,897.97 " " 14,268.84 " " 14,130.03 " Inpatient INFECTIONS OF UPPER RESPIRATORY TRACT 113.4 " 61,215.60 " " 19,289.04 " " 16,578.77 " " 29,823.55 " " 17,407.71 " " 16,578.77 " " 16,578.77 " " 16,578.77 " " 17,656.39 " " 16,578.77 " " 16,578.77 " " 24,868.16 " " 29,823.55 " " 29,533.42 " Inpatient DENTAL DISEASES & DISORDERS 114.1 " 17,114.15 " " 5,392.67 " " 4,259.73 " " 7,662.83 " " 4,472.72 " " 4,259.73 " " 4,259.73 " " 4,259.73 " " 4,536.61 " " 4,259.73 " " 4,259.73 " " 6,389.60 " " 7,662.83 " " 7,588.28 " Inpatient DENTAL DISEASES & DISORDERS 114.3 " 33,763.18 " " 10,638.78 " " 10,340.20 " " 18,600.99 " " 10,857.21 " " 10,340.20 " " 10,340.20 " " 10,340.20 " " 11,012.31 " " 10,340.20 " " 10,340.20 " " 15,510.30 " " 18,600.99 " " 18,420.03 " Inpatient DENTAL DISEASES & DISORDERS 114.4 " 377,190.76 " " 118,852.81 " " 24,144.60 " " 43,433.72 " " 25,351.83 " " 24,144.60 " " 24,144.60 " " 24,144.60 " " 25,714.00 " " 24,144.60 " " 24,144.60 " " 36,216.90 " " 43,433.72 " " 43,011.19 " Inpatient "OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES " 115.1 " 42,540.54 " " 13,404.52 " " 4,878.85 " " 8,776.56 " " 5,122.79 " " 4,878.85 " " 4,878.85 " " 4,878.85 " " 5,195.98 " " 4,878.85 " " 4,878.85 " " 7,318.28 " " 8,776.56 " " 8,691.18 " Inpatient "OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES " 115.2 " 25,609.08 " " 8,069.42 " " 6,763.65 " " 12,167.13 " " 7,101.83 " " 6,763.65 " " 6,763.65 " " 6,763.65 " " 7,203.29 " " 6,763.65 " " 6,763.65 " " 10,145.48 " " 12,167.13 " " 12,048.77 " Inpatient "OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES " 115.3 " 64,300.82 " " 20,261.19 " " 10,846.14 " " 19,511.12 " " 11,388.45 " " 10,846.14 " " 10,846.14 " " 10,846.14 " " 11,551.14 " " 10,846.14 " " 10,846.14 " " 16,269.21 " " 19,511.12 " " 19,321.31 " Inpatient "OTHER EAR, NOSE, MOUTH,THROAT & CRANIAL/FACIAL DIAGNOSES " 115.4 " 237,880.51 " " 74,956.15 " " 22,199.05 " " 39,933.87 " " 23,309.00 " " 22,199.05 " " 22,199.05 " " 22,199.05 " " 23,641.99 " " 22,199.05 " " 22,199.05 " " 33,298.58 " " 39,933.87 " " 39,545.39 " Inpatient MAJOR RESPIRATORY & CHEST PROCEDURES 120.1 " 91,291.01 " " 28,765.80 " " 17,323.53 " " 31,163.30 " " 18,189.71 " " 17,323.53 " " 17,323.53 " " 17,323.53 " " 18,449.56 " " 17,323.53 " " 17,323.53 " " 25,985.30 " " 31,163.30 " " 30,860.14 " Inpatient MAJOR RESPIRATORY & CHEST PROCEDURES 120.2 " 93,333.40 " " 29,409.35 " " 21,203.81 " " 38,143.53 " " 22,264.00 " " 21,203.81 " " 21,203.81 " " 21,203.81 " " 22,582.06 " " 21,203.81 " " 21,203.81 " " 31,805.72 " " 38,143.53 " " 37,772.47 " Inpatient MAJOR RESPIRATORY & CHEST PROCEDURES 120.3 " 78,334.21 " " 24,683.11 " " 32,318.73 " " 58,138.16 " " 33,934.67 " " 32,318.73 " " 32,318.73 " " 32,318.73 " " 34,419.45 " " 32,318.73 " " 32,318.73 " " 48,478.10 " " 58,138.16 " " 57,572.59 " Inpatient OTHER RESPIRATORY & CHEST PROCEDURES 121.1 " 88,167.82 " " 27,781.68 " " 12,943.14 " " 23,283.41 " " 13,590.30 " " 12,943.14 " " 12,943.14 " " 12,943.14 " " 13,784.44 " " 12,943.14 " " 12,943.14 " " 19,414.71 " " 23,283.41 " " 23,056.91 " Inpatient OTHER RESPIRATORY & CHEST PROCEDURES 121.2 " 69,665.06 " " 21,951.46 " " 16,526.34 " " 29,729.23 " " 17,352.66 " " 16,526.34 " " 16,526.34 " " 16,526.34 " " 17,600.55 " " 16,526.34 " " 16,526.34 " " 24,789.51 " " 29,729.23 " " 29,440.02 " Inpatient OTHER RESPIRATORY & CHEST PROCEDURES 121.3 " 117,743.95 " " 37,101.12 " " 26,244.09 " " 47,210.49 " " 27,556.29 " " 26,244.09 " " 26,244.09 " " 26,244.09 " " 27,949.96 " " 26,244.09 " " 26,244.09 " " 39,366.14 " " 47,210.49 " " 46,751.22 " Inpatient OTHER RESPIRATORY & CHEST PROCEDURES 121.4 " 274,058.17 " " 86,355.73 " " 48,279.21 " " 86,849.47 " " 50,693.17 " " 48,279.21 " " 48,279.21 " " 48,279.21 " " 51,417.36 " " 48,279.21 " " 48,279.21 " " 72,418.82 " " 86,849.47 " " 86,004.58 " Inpatient RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS 130.3 " 251,148.37 " " 79,136.85 " " 41,414.04 " " 74,499.72 " " 43,484.74 " " 41,414.04 " " 41,414.04 " " 41,414.04 " " 44,105.95 " " 41,414.04 " " 41,414.04 " " 62,121.06 " " 74,499.72 " " 73,774.97 " Inpatient RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS 130.4 " 394,878.39 " " 124,426.18 " " 54,702.52 " " 98,404.36 " " 57,437.65 " " 54,702.52 " " 54,702.52 " " 54,702.52 " " 58,258.18 " " 54,702.52 " " 54,702.52 " " 82,053.78 " " 98,404.36 " " 97,447.07 " Inpatient CYSTIC FIBROSIS - PULMONARY DISEASE 131.2 " 88,862.08 " " 28,000.44 " " 19,011.95 " " 34,200.60 " " 19,962.55 " " 19,011.95 " " 19,011.95 " " 19,011.95 " " 20,247.73 " " 19,011.95 " " 19,011.95 " " 28,517.93 " " 34,200.60 " " 33,867.89 " Inpatient CYSTIC FIBROSIS - PULMONARY DISEASE 131.3 " 98,100.37 " " 30,911.43 " " 25,532.61 " " 45,930.61 " " 26,809.24 " " 25,532.61 " " 25,532.61 " " 25,532.61 " " 27,192.23 " " 25,532.61 " " 25,532.61 " " 38,298.92 " " 45,930.61 " " 45,483.79 " Inpatient RESPIRATORY FAILURE 133.2 " 55,561.57 " " 17,507.45 " " 7,279.58 " " 13,095.24 " " 7,643.56 " " 7,279.58 " " 7,279.58 " " 7,279.58 " " 7,752.75 " " 7,279.58 " " 7,279.58 " " 10,919.37 " " 13,095.24 " " 12,967.84 " Inpatient RESPIRATORY FAILURE 133.3 " 92,859.26 " " 29,259.95 " " 10,765.42 " " 19,365.91 " " 11,303.69 " " 10,765.42 " " 10,765.42 " " 10,765.42 " " 11,465.17 " " 10,765.42 " " 10,765.42 " " 16,148.13 " " 19,365.91 " " 19,177.52 " Inpatient RESPIRATORY FAILURE 133.4 " 101,110.12 " " 31,859.80 " " 18,148.18 " " 32,646.76 " " 19,055.59 " " 18,148.18 " " 18,148.18 " " 18,148.18 " " 19,327.81 " " 18,148.18 " " 18,148.18 " " 27,222.27 " " 32,646.76 " " 32,329.17 " Inpatient PULMONARY EMBOLISM 134.1 " 26,243.31 " " 8,269.27 " " 5,909.04 " " 10,629.77 " " 6,204.49 " " 5,909.04 " " 5,909.04 " " 5,909.04 " " 6,293.13 " " 5,909.04 " " 5,909.04 " " 8,863.56 " " 10,629.77 " " 10,526.36 " Inpatient PULMONARY EMBOLISM 134.2 " 24,353.66 " " 7,673.84 " " 7,812.15 " " 14,053.28 " " 8,202.76 " " 7,812.15 " " 7,812.15 " " 7,812.15 " " 8,319.94 " " 7,812.15 " " 7,812.15 " " 11,718.23 " " 14,053.28 " " 13,916.56 " Inpatient PULMONARY EMBOLISM 134.3 " 79,042.59 " " 24,906.32 " " 11,130.73 " " 20,023.07 " " 11,687.27 " " 11,130.73 " " 11,130.73 " " 11,130.73 " " 11,854.23 " " 11,130.73 " " 11,130.73 " " 16,696.10 " " 20,023.07 " " 19,828.28 " Inpatient PULMONARY EMBOLISM 134.4 " 66,951.65 " " 21,096.46 " " 16,650.33 " " 29,952.28 " " 17,482.85 " " 16,650.33 " " 16,650.33 " " 16,650.33 " " 17,732.60 " " 16,650.33 " " 16,650.33 " " 24,975.50 " " 29,952.28 " " 29,660.90 " Inpatient MAJOR CHEST & RESPIRATORY TRAUMA 135.1 " 35,264.56 " " 11,111.86 " " 7,301.21 " " 13,134.15 " " 7,666.27 " " 7,301.21 " " 7,301.21 " " 7,301.21 " " 7,775.79 " " 7,301.21 " " 7,301.21 " " 10,951.82 " " 13,134.15 " " 13,006.38 " Inpatient MAJOR CHEST & RESPIRATORY TRAUMA 135.2 " 34,730.29 " " 10,943.51 " " 7,855.42 " " 14,131.12 " " 8,248.19 " " 7,855.42 " " 7,855.42 " " 7,855.42 " " 8,366.02 " " 7,855.42 " " 7,855.42 " " 11,783.13 " " 14,131.12 " " 13,993.65 " Inpatient MAJOR CHEST & RESPIRATORY TRAUMA 135.3 " 50,366.74 " " 15,870.56 " " 11,740.69 " " 21,120.33 " " 12,327.72 " " 11,740.69 " " 11,740.69 " " 11,740.69 " " 12,503.83 " " 11,740.69 " " 11,740.69 " " 17,611.04 " " 21,120.33 " " 20,914.87 " Inpatient MAJOR CHEST & RESPIRATORY TRAUMA 135.4 " 148,721.04 " " 46,862.00 " " 20,433.25 " " 36,757.37 " " 21,454.91 " " 20,433.25 " " 20,433.25 " " 20,433.25 " " 21,761.41 " " 20,433.25 " " 20,433.25 " " 30,649.88 " " 36,757.37 " " 36,399.79 " Inpatient RESPIRATORY MALIGNANCY 136.2 " 114,236.89 " " 35,996.04 " " 9,381.57 " " 16,876.51 " " 9,850.65 " " 9,381.57 " " 9,381.57 " " 9,381.57 " " 9,991.37 " " 9,381.57 " " 9,381.57 " " 14,072.36 " " 16,876.51 " " 16,712.33 " Inpatient RESPIRATORY MALIGNANCY 136.3 " 93,798.47 " " 29,555.90 " " 12,828.30 " " 23,076.83 " " 13,469.72 " " 12,828.30 " " 12,828.30 " " 12,828.30 " " 13,662.14 " " 12,828.30 " " 12,828.30 " " 19,242.45 " " 23,076.83 " " 22,852.33 " Inpatient RESPIRATORY MALIGNANCY 136.4 " 149,346.24 " " 47,059.00 " " 18,706.55 " " 33,651.21 " " 19,641.88 " " 18,706.55 " " 18,706.55 " " 18,706.55 " " 19,922.48 " " 18,706.55 " " 18,706.55 " " 28,059.83 " " 33,651.21 " " 33,323.85 " Inpatient MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS 137.1 " 23,227.26 " " 7,318.91 " " 6,315.13 " " 11,360.29 " " 6,630.89 " " 6,315.13 " " 6,315.13 " " 6,315.13 " " 6,725.61 " " 6,315.13 " " 6,315.13 " " 9,472.70 " " 11,360.29 " " 11,249.77 " Inpatient MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS 137.2 " 29,863.73 " " 9,410.06 " " 8,071.78 " " 14,520.33 " " 8,475.37 " " 8,071.78 " " 8,071.78 " " 8,071.78 " " 8,596.45 " " 8,071.78 " " 8,071.78 " " 12,107.67 " " 14,520.33 " " 14,379.07 " Inpatient MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS 137.3 " 44,080.43 " " 13,889.74 " " 11,576.76 " " 20,825.43 " " 12,155.60 " " 11,576.76 " " 11,576.76 " " 11,576.76 " " 12,329.25 " " 11,576.76 " " 11,576.76 " " 17,365.14 " " 20,825.43 " " 20,622.84 " Inpatient MAJOR RESPIRATORY INFECTIONS & INFLAMMATIONS 137.4 " 62,490.67 " " 19,690.81 " " 16,989.01 " " 30,561.53 " " 17,838.46 " " 16,989.01 " " 16,989.01 " " 16,989.01 " " 18,093.30 " " 16,989.01 " " 16,989.01 " " 25,483.52 " " 30,561.53 " " 30,264.22 " Inpatient OTHER PNEUMONIA 139.2 " 39,253.92 " " 12,368.91 " " 6,093.78 " " 10,962.10 " " 6,398.47 " " 6,093.78 " " 6,093.78 " " 6,093.78 " " 6,489.88 " " 6,093.78 " " 6,093.78 " " 9,140.67 " " 10,962.10 " " 10,855.46 " Inpatient OTHER PNEUMONIA 139.3 " 57,815.45 " " 18,217.65 " " 9,047.05 " " 16,274.74 " " 9,499.40 " " 9,047.05 " " 9,047.05 " " 9,047.05 " " 9,635.11 " " 9,047.05 " " 9,047.05 " " 13,570.58 " " 16,274.74 " " 16,116.41 " Inpatient OTHER PNEUMONIA 139.4 " 95,596.70 " " 30,122.52 " " 14,379.41 " " 25,867.12 " " 15,098.38 " " 14,379.41 " " 14,379.41 " " 14,379.41 " " 15,314.07 " " 14,379.41 " " 14,379.41 " " 21,569.12 " " 25,867.12 " " 25,615.48 " Inpatient CHRONIC OBSTRUCTIVE PULMONARY DISEASE 140.2 " 37,430.84 " " 11,794.46 " " 6,427.46 " " 11,562.36 " " 6,748.83 " " 6,427.46 " " 6,427.46 " " 6,427.46 " " 6,845.24 " " 6,427.46 " " 6,427.46 " " 9,641.19 " " 11,562.36 " " 11,449.88 " Inpatient CHRONIC OBSTRUCTIVE PULMONARY DISEASE 140.3 " 44,435.40 " " 14,001.59 " " 8,017.69 " " 14,423.02 " " 8,418.57 " " 8,017.69 " " 8,017.69 " " 8,017.69 " " 8,538.84 " " 8,017.69 " " 8,017.69 " " 12,026.54 " " 14,423.02 " " 14,282.71 " Inpatient CHRONIC OBSTRUCTIVE PULMONARY DISEASE 140.4 " 119,478.30 " " 37,647.61 " " 12,453.84 " " 22,403.21 " " 13,076.53 " " 12,453.84 " " 12,453.84 " " 12,453.84 " " 13,263.34 " " 12,453.84 " " 12,453.84 " " 18,680.76 " " 22,403.21 " " 22,185.27 " Inpatient ASTHMA 141.1 " 37,415.83 " " 11,789.73 " " 3,937.70 " " 7,083.53 " " 4,134.59 " " 3,937.70 " " 3,937.70 " " 3,937.70 " " 4,193.65 " " 3,937.70 " " 3,937.70 " " 5,906.55 " " 7,083.53 " " 7,014.62 " Inpatient ASTHMA 141.2 " 38,512.43 " " 12,135.27 " " 5,673.54 " " 10,206.13 " " 5,957.22 " " 5,673.54 " " 5,673.54 " " 5,673.54 " " 6,042.32 " " 5,673.54 " " 5,673.54 " " 8,510.31 " " 10,206.13 " " 10,106.84 " Inpatient ASTHMA 141.3 " 55,659.37 " " 17,538.27 " " 8,088.42 " " 14,550.26 " " 8,492.84 " " 8,088.42 " " 8,088.42 " " 8,088.42 " " 8,614.17 " " 8,088.42 " " 8,088.42 " " 12,132.63 " " 14,550.26 " " 14,408.71 " Inpatient INTERSTITIAL & ALVEOLAR LUNG DISEASES 142.4 " 27,491.85 " " 8,662.68 " " 16,062.84 " " 28,895.44 " " 16,865.98 " " 16,062.84 " " 16,062.84 " " 16,062.84 " " 17,106.92 " " 16,062.84 " " 16,062.84 " " 24,094.26 " " 28,895.44 " " 28,614.34 " Inpatient "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DI " 143.1 " 6,461.00 " " 2,035.86 " " 4,939.59 " " 8,885.83 " " 5,186.57 " " 4,939.59 " " 4,939.59 " " 4,939.59 " " 5,260.66 " " 4,939.59 " " 4,939.59 " " 7,409.39 " " 8,885.83 " " 8,799.39 " Inpatient "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DI " 143.2 " 44,361.63 " " 13,978.35 " " 7,040.75 " " 12,665.61 " " 7,392.79 " " 7,040.75 " " 7,040.75 " " 7,040.75 " " 7,498.40 " " 7,040.75 " " 7,040.75 " " 10,561.13 " " 12,665.61 " " 12,542.39 " Inpatient "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DI " 143.3 " 87,534.30 " " 27,582.06 " " 10,683.87 " " 19,219.21 " " 11,218.06 " " 10,683.87 " " 10,683.87 " " 10,683.87 " " 11,378.32 " " 10,683.87 " " 10,683.87 " " 16,025.81 " " 19,219.21 " " 19,032.25 " Inpatient "OTHER RESPIRATORY DIAGNOSES EXCEPT SIGNS, SYMPTOMS & MINOR DI " 143.4 " 113,740.02 " " 35,839.48 " " 16,766.83 " " 30,161.85 " " 17,605.17 " " 16,766.83 " " 16,766.83 " " 16,766.83 " " 17,856.67 " " 16,766.83 " " 16,766.83 " " 25,150.25 " " 30,161.85 " " 29,868.43 " Inpatient "RESPIRATORY SIGNS, SYMPTOMS & MINOR DIAGNOSES " 144.3 " 39,303.35 " " 12,384.49 " " 9,877.53 " " 17,768.69 " " 10,371.41 " " 9,877.53 " " 9,877.53 " " 9,877.53 " " 10,519.57 " " 9,877.53 " " 9,877.53 " " 14,816.30 " " 17,768.69 " " 17,595.83 " Inpatient ACUTE BRONCHITIS & RELATED SYMPTOMS 145.4 " 65,286.40 " " 20,571.74 " " 14,472.61 " " 26,034.78 " " 15,196.24 " " 14,472.61 " " 14,472.61 " " 14,472.61 " " 15,413.33 " " 14,472.61 " " 14,472.61 " " 21,708.92 " " 26,034.78 " " 25,781.51 " Inpatient MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY 160.1 " 145,457.67 " " 45,833.71 " " 35,282.82 " " 63,470.26 " " 37,046.96 " " 35,282.82 " " 35,282.82 " " 35,282.82 " " 37,576.20 " " 35,282.82 " " 35,282.82 " " 52,924.23 " " 63,470.26 " " 62,852.82 " Inpatient MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY 160.2 " 171,668.35 " " 54,092.70 " " 40,906.44 " " 73,586.59 " " 42,951.76 " " 40,906.44 " " 40,906.44 " " 40,906.44 " " 43,565.36 " " 40,906.44 " " 40,906.44 " " 61,359.66 " " 73,586.59 " " 72,870.73 " Inpatient MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY 160.3 " 175,989.48 " " 55,454.28 " " 58,423.86 " " 105,098.68 " " 61,345.05 " " 58,423.86 " " 58,423.86 " " 58,423.86 " " 62,221.41 " " 58,423.86 " " 58,423.86 " " 87,635.79 " " 105,098.68 " " 104,076.26 " Inpatient MAJOR CARDIOTHORACIC REPAIR OF HEART ANOMALY 160.4 " 255,203.46 " " 80,414.61 " " 114,841.42 " " 206,588.23 " " 120,583.49 " " 114,841.42 " " 114,841.42 " " 114,841.42 " " 122,306.11 " " 114,841.42 " " 114,841.42 " " 172,262.13 " " 206,588.23 " " 204,578.51 " Inpatient IMPLANTABLE HEART ASSIST SYSTEMS 161.4 " 2,019,256.73 " " 636,267.80 " " 213,977.83 " " 384,924.72 " " 224,676.72 " " 213,977.83 " " 213,977.83 " " 213,977.83 " " 227,886.39 " " 213,977.83 " " 213,977.83 " " 320,966.75 " " 384,924.72 " " 381,180.11 " Inpatient CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX 162.2 " 253,976.81 " " 80,028.09 " " 49,134.66 " " 88,388.34 " " 51,591.39 " " 49,134.66 " " 49,134.66 " " 49,134.66 " " 52,328.41 " " 49,134.66 " " 49,134.66 " " 73,701.99 " " 88,388.34 " " 87,528.48 " Inpatient CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX 162.3 " 227,359.59 " " 71,641.01 " " 65,892.33 " " 118,533.71 " " 69,186.95 " " 65,892.33 " " 65,892.33 " " 65,892.33 " " 70,175.33 " " 65,892.33 " " 65,892.33 " " 98,838.50 " " 118,533.71 " " 117,380.60 " Inpatient CARDIAC VALVE PROCEDURES W AMI OR COMPLEX PDX 162.4 " 473,069.45 " " 149,064.18 " " 99,553.31 " " 179,086.45 " " 104,530.98 " " 99,553.31 " " 99,553.31 " " 99,553.31 " " 106,024.28 " " 99,553.31 " " 99,553.31 " " 149,329.97 " " 179,086.45 " " 177,344.27 " Inpatient CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX 163.1 " 167,277.47 " " 52,709.13 " " 36,236.46 " " 65,185.77 " " 38,048.28 " " 36,236.46 " " 36,236.46 " " 36,236.46 " " 38,591.83 " " 36,236.46 " " 36,236.46 " " 54,354.69 " " 65,185.77 " " 64,551.63 " Inpatient CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX 163.2 " 170,663.42 " " 53,776.04 " " 40,094.27 " " 72,125.58 " " 42,098.98 " " 40,094.27 " " 40,094.27 " " 40,094.27 " " 42,700.40 " " 40,094.27 " " 40,094.27 " " 60,141.41 " " 72,125.58 " " 71,423.93 " Inpatient CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX 163.3 " 182,109.09 " " 57,382.57 " " 52,427.44 " " 94,311.72 " " 55,048.81 " " 52,427.44 " " 52,427.44 " " 52,427.44 " " 55,835.22 " " 52,427.44 " " 52,427.44 " " 78,641.16 " " 94,311.72 " " 93,394.24 " Inpatient CARDIAC VALVE PROCEDURES W/O AMI OR COMPLEX PDX 163.4 " 373,576.92 " " 117,714.09 " " 83,771.74 " " 150,696.98 " " 87,960.33 " " 83,771.74 " " 83,771.74 " " 83,771.74 " " 89,216.90 " " 83,771.74 " " 83,771.74 " " 125,657.61 " " 150,696.98 " " 149,230.98 " Inpatient CORONARY BYPASS W AMI OR COMPLEX PDX 165.1 " 210,276.25 " " 66,258.05 " " 33,780.80 " " 60,768.28 " " 35,469.84 " " 33,780.80 " " 33,780.80 " " 33,780.80 " " 35,976.55 " " 33,780.80 " " 33,780.80 " " 50,671.20 " " 60,768.28 " " 60,177.12 " Inpatient CORONARY BYPASS W AMI OR COMPLEX PDX 165.2 " 147,703.22 " " 46,541.28 " " 39,113.17 " " 70,360.68 " " 41,068.83 " " 39,113.17 " " 39,113.17 " " 39,113.17 " " 41,655.53 " " 39,113.17 " " 39,113.17 " " 58,669.76 " " 70,360.68 " " 69,676.20 " Inpatient CORONARY BYPASS W AMI OR COMPLEX PDX 165.3 " 175,749.18 " " 55,378.57 " " 50,550.13 " " 90,934.63 " " 53,077.64 " " 50,550.13 " " 50,550.13 " " 50,550.13 " " 53,835.89 " " 50,550.13 " " 50,550.13 " " 75,825.20 " " 90,934.63 " " 90,050.00 " Inpatient CORONARY BYPASS W AMI OR COMPLEX PDX 165.4 " 318,785.66 " " 100,449.36 " " 73,402.41 " " 132,043.60 " " 77,072.53 " " 73,402.41 " " 73,402.41 " " 73,402.41 " " 78,173.57 " " 73,402.41 " " 73,402.41 " " 110,103.62 " " 132,043.60 " " 130,759.05 " Inpatient CORONARY BYPASS W/O AMI OR COMPLEX PDX 166.2 " 200,951.08 " " 63,319.69 " " 33,376.38 " " 60,040.77 " " 35,045.20 " " 33,376.38 " " 33,376.38 " " 33,376.38 " " 35,545.84 " " 33,376.38 " " 33,376.38 " " 50,064.57 " " 60,040.77 " " 59,456.68 " Inpatient CORONARY BYPASS W/O AMI OR COMPLEX PDX 166.3 " 200,122.71 " " 63,058.67 " " 41,810.97 " " 75,213.75 " " 43,901.52 " " 41,810.97 " " 41,810.97 " " 41,810.97 " " 44,528.68 " " 41,810.97 " " 41,810.97 " " 62,716.46 " " 75,213.75 " " 74,482.06 " Inpatient CORONARY BYPASS W/O AMI OR COMPLEX PDX 166.4 " 669,272.49 " " 210,887.76 " " 66,730.30 " " 120,041.14 " " 70,066.82 " " 66,730.30 " " 66,730.30 " " 66,730.30 " " 71,067.77 " " 66,730.30 " " 66,730.30 " " 100,095.45 " " 120,041.14 " " 118,873.36 " Inpatient OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES 167.1 " 98,463.89 " " 31,025.97 " " 29,559.35 " " 53,174.31 " " 31,037.32 " " 29,559.35 " " 29,559.35 " " 29,559.35 " " 31,480.71 " " 29,559.35 " " 29,559.35 " " 44,339.03 " " 53,174.31 " " 52,657.03 " Inpatient OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES 167.2 " 111,641.78 " " 35,178.32 " " 33,388.87 " " 60,063.24 " " 35,058.31 " " 33,388.87 " " 33,388.87 " " 33,388.87 " " 35,559.15 " " 33,388.87 " " 33,388.87 " " 50,083.31 " " 60,063.24 " " 59,478.93 " Inpatient OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES 167.3 " 173,490.57 " " 54,666.88 " " 41,986.56 " " 75,529.62 " " 44,085.89 " " 41,986.56 " " 41,986.56 " " 41,986.56 " " 44,715.69 " " 41,986.56 " " 41,986.56 " " 62,979.84 " " 75,529.62 " " 74,794.86 " Inpatient OTHER CARDIOTHORACIC & THORACIC VASCULAR PROCEDURES 167.4 " 613,802.38 " " 193,409.13 " " 81,141.33 " " 145,965.14 " " 85,198.40 " " 81,141.33 " " 81,141.33 " " 81,141.33 " " 86,415.52 " " 81,141.33 " " 81,141.33 " " 121,712.00 " " 145,965.14 " " 144,545.17 " Inpatient MAJOR ABDOMINAL VASCULAR PROCEDURES 169.1 " 129,786.17 " " 40,895.62 " " 18,570.08 " " 33,405.72 " " 19,498.58 " " 18,570.08 " " 18,570.08 " " 18,570.08 " " 19,777.14 " " 18,570.08 " " 18,570.08 " " 27,855.12 " " 33,405.72 " " 33,080.74 " Inpatient MAJOR ABDOMINAL VASCULAR PROCEDURES 169.2 " 167,656.03 " " 52,828.41 " " 24,410.89 " " 43,912.75 " " 25,631.43 " " 24,410.89 " " 24,410.89 " " 24,410.89 " " 25,997.60 " " 24,410.89 " " 24,410.89 " " 36,616.34 " " 43,912.75 " " 43,485.56 " Inpatient MAJOR ABDOMINAL VASCULAR PROCEDURES 169.3 " 513,775.52 " " 161,890.67 " " 38,701.26 " " 69,619.70 " " 40,636.32 " " 38,701.26 " " 38,701.26 " " 38,701.26 " " 41,216.84 " " 38,701.26 " " 38,701.26 " " 58,051.89 " " 69,619.70 " " 68,942.42 " Inpatient MAJOR ABDOMINAL VASCULAR PROCEDURES 169.4 " 228,535.62 " " 72,011.57 " " 65,635.20 " " 118,071.16 " " 68,916.96 " " 65,635.20 " " 65,635.20 " " 65,635.20 " " 69,901.49 " " 65,635.20 " " 65,635.20 " " 98,452.80 " " 118,071.16 " " 116,922.55 " Inpatient "PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHO " 171.1 " 81,551.20 " " 25,696.78 " " 15,427.91 " " 27,753.27 " " 16,199.31 " " 15,427.91 " " 15,427.91 " " 15,427.91 " " 16,430.72 " " 15,427.91 " " 15,427.91 " " 23,141.87 " " 27,753.27 " " 27,483.28 " Inpatient "PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHO " 171.2 " 70,088.73 " " 22,084.96 " " 17,740.44 " " 31,913.28 " " 18,627.46 " " 17,740.44 " " 17,740.44 " " 17,740.44 " " 18,893.57 " " 17,740.44 " " 17,740.44 " " 26,610.66 " " 31,913.28 " " 31,602.82 " Inpatient "PERM CARDIAC PACEMAKER IMPLANT W/O AMI, HEART FAILURE OR SHO " 171.3 " 329,608.77 " " 103,859.72 " " 22,313.89 " " 40,140.46 " " 23,429.58 " " 22,313.89 " " 22,313.89 " " 22,313.89 " " 23,764.29 " " 22,313.89 " " 22,313.89 " " 33,470.84 " " 40,140.46 " " 39,749.96 " Inpatient PERCUTANEOUS CARDIAC INTERVENTION W AMI 174.1 " 136,201.48 " " 42,917.08 " " 17,836.96 " " 32,086.91 " " 18,728.81 " " 17,836.96 " " 17,836.96 " " 17,836.96 " " 18,996.36 " " 17,836.96 " " 17,836.96 " " 26,755.44 " " 32,086.91 " " 31,774.76 " Inpatient PERCUTANEOUS CARDIAC INTERVENTION W AMI 174.2 " 121,382.38 " " 38,247.59 " " 20,075.43 " " 36,113.69 " " 21,079.20 " " 20,075.43 " " 20,075.43 " " 20,075.43 " " 21,380.33 " " 20,075.43 " " 20,075.43 " " 30,113.15 " " 36,113.69 " " 35,762.37 " Inpatient PERCUTANEOUS CARDIAC INTERVENTION W AMI 174.3 " 121,439.08 " " 38,265.45 " " 25,864.64 " " 46,527.90 " " 27,157.87 " " 25,864.64 " " 25,864.64 " " 25,864.64 " " 27,545.84 " " 25,864.64 " " 25,864.64 " " 38,796.96 " " 46,527.90 " " 46,075.27 " Inpatient PERCUTANEOUS CARDIAC INTERVENTION W/O AMI 175.2 " 159,304.44 " " 50,196.83 " " 22,824.82 " " 41,059.57 " " 23,966.06 " " 22,824.82 " " 22,824.82 " " 22,824.82 " " 24,308.43 " " 22,824.82 " " 22,824.82 " " 34,237.23 " " 41,059.57 " " 40,660.13 " Inpatient EXTERNAL HEART ASSIST SYSTEMS 178.4 " 1,871,061.36 " " 589,571.43 " " 84,583.91 " " 152,158.00 " " 88,813.11 " " 84,583.91 " " 84,583.91 " " 84,583.91 " " 90,081.86 " " 84,583.91 " " 84,583.91 " " 126,875.87 " " 152,158.00 " " 150,677.78 " Inpatient DEFIBRILLATOR IMPLANTS 179.2 " 270,146.12 " " 85,123.04 " " 41,032.09 " " 73,812.63 " " 43,083.69 " " 41,032.09 " " 41,032.09 " " 41,032.09 " " 43,699.18 " " 41,032.09 " " 41,032.09 " " 61,548.14 " " 73,812.63 " " 73,094.57 " Inpatient DEFIBRILLATOR IMPLANTS 179.3 " 910,317.17 " " 286,840.94 " " 48,746.05 " " 87,689.27 " " 51,183.35 " " 48,746.05 " " 48,746.05 " " 48,746.05 " " 51,914.54 " " 48,746.05 " " 48,746.05 " " 73,119.08 " " 87,689.27 " " 86,836.21 " Inpatient OTHER CIRCULATORY SYSTEM PROCEDURES 180.1 " 169,181.82 " " 53,309.19 " " 12,026.95 " " 21,635.28 " " 12,628.30 " " 12,026.95 " " 12,026.95 " " 12,026.95 " " 12,808.70 " " 12,026.95 " " 12,026.95 " " 18,040.43 " " 21,635.28 " " 21,424.81 " Inpatient OTHER CIRCULATORY SYSTEM PROCEDURES 180.3 " 172,151.74 " " 54,245.01 " " 21,717.24 " " 39,067.14 " " 22,803.10 " " 21,717.24 " " 21,717.24 " " 21,717.24 " " 23,128.86 " " 21,717.24 " " 21,717.24 " " 32,575.86 " " 39,067.14 " " 38,687.09 " Inpatient OTHER CIRCULATORY SYSTEM PROCEDURES 180.4 " 269,175.73 " " 84,817.27 " " 39,618.28 " " 71,269.32 " " 41,599.19 " " 39,618.28 " " 39,618.28 " " 39,618.28 " " 42,193.47 " " 39,618.28 " " 39,618.28 " " 59,427.42 " " 71,269.32 " " 70,576.00 " Inpatient LOWER EXTREMITY ARTERIAL PROCEDURES 181.1 " 50,590.80 " " 15,941.16 " " 14,188.85 " " 25,524.32 " " 14,898.29 " " 14,188.85 " " 14,188.85 " " 14,188.85 " " 15,111.13 " " 14,188.85 " " 14,188.85 " " 21,283.28 " " 25,524.32 " " 25,276.02 " Inpatient LOWER EXTREMITY ARTERIAL PROCEDURES 181.2 " 193,204.92 " " 60,878.87 " " 19,968.08 " " 35,920.58 " " 20,966.48 " " 19,968.08 " " 19,968.08 " " 19,968.08 " " 21,266.01 " " 19,968.08 " " 19,968.08 " " 29,952.12 " " 35,920.58 " " 35,571.14 " Inpatient LOWER EXTREMITY ARTERIAL PROCEDURES 181.3 " 193,684.06 " " 61,029.85 " " 32,213.05 " " 57,948.06 " " 33,823.70 " " 32,213.05 " " 32,213.05 " " 32,213.05 " " 34,306.90 " " 32,213.05 " " 32,213.05 " " 48,319.58 " " 57,948.06 " " 57,384.33 " Inpatient OTHER PERIPHERAL VASCULAR PROCEDURES 182.2 " 109,650.37 " " 34,550.83 " " 23,795.93 " " 42,806.50 " " 24,985.73 " " 23,795.93 " " 23,795.93 " " 23,795.93 " " 25,342.67 " " 23,795.93 " " 23,795.93 " " 35,693.90 " " 42,806.50 " " 42,390.07 " Inpatient OTHER PERIPHERAL VASCULAR PROCEDURES 182.3 " 280,812.21 " " 88,483.93 " " 26,954.74 " " 48,488.88 " " 28,302.48 " " 26,954.74 " " 26,954.74 " " 26,954.74 " " 28,706.80 " " 26,954.74 " " 26,954.74 " " 40,432.11 " " 48,488.88 " " 48,017.17 " Inpatient OTHER PERIPHERAL VASCULAR PROCEDURES 182.4 " 246,752.81 " " 77,751.81 " " 50,403.67 " " 90,671.16 " " 52,923.85 " " 50,403.67 " " 50,403.67 " " 50,403.67 " " 53,679.91 " " 50,403.67 " " 50,403.67 " " 75,605.51 " " 90,671.16 " " 89,789.10 " Inpatient ACUTE MYOCARDIAL INFARCTION 190.1 " 56,660.52 " " 17,853.73 " " 6,548.13 " " 11,779.43 " " 6,875.54 " " 6,548.13 " " 6,548.13 " " 6,548.13 " " 6,973.76 " " 6,548.13 " " 6,548.13 " " 9,822.20 " " 11,779.43 " " 11,664.84 " Inpatient ACUTE MYOCARDIAL INFARCTION 190.2 " 32,853.42 " " 10,352.11 " " 7,957.77 " " 14,315.23 " " 8,355.66 " " 7,957.77 " " 7,957.77 " " 7,957.77 " " 8,475.03 " " 7,957.77 " " 7,957.77 " " 11,936.66 " " 14,315.23 " " 14,175.97 " Inpatient ACUTE MYOCARDIAL INFARCTION 190.4 " 147,184.46 " " 46,377.82 " " 16,513.86 " " 29,706.78 " " 17,339.55 " " 16,513.86 " " 16,513.86 " " 16,513.86 " " 17,587.26 " " 16,513.86 " " 16,513.86 " " 24,770.79 " " 29,706.78 " " 29,417.79 " Inpatient CARDIAC CATHETERIZATION FOR CORONARY ARTERY DISEASE 191.1 " 32,812.00 " " 10,339.06 " " 9,125.27 " " 16,415.45 " " 9,581.53 " " 9,125.27 " " 9,125.27 " " 9,125.27 " " 9,718.41 " " 9,125.27 " " 9,125.27 " " 13,687.91 " " 16,415.45 " " 16,255.76 " Inpatient CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS 192.1 " 62,971.98 " " 19,842.47 " " 9,867.54 " " 17,750.72 " " 10,360.92 " " 9,867.54 " " 9,867.54 " " 9,867.54 " " 10,508.93 " " 9,867.54 " " 9,867.54 " " 14,801.31 " " 17,750.72 " " 17,578.04 " Inpatient CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS 192.2 " 39,729.62 " " 12,518.80 " " 12,140.95 " " 21,840.35 " " 12,748.00 " " 12,140.95 " " 12,140.95 " " 12,140.95 " " 12,930.11 " " 12,140.95 " " 12,140.95 " " 18,211.43 " " 21,840.35 " " 21,627.89 " Inpatient CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS 192.3 " 113,266.89 " " 35,690.40 " " 17,745.43 " " 31,922.25 " " 18,632.70 " " 17,745.43 " " 17,745.43 " " 17,745.43 " " 18,898.88 " " 17,745.43 " " 17,745.43 " " 26,618.15 " " 31,922.25 " " 31,611.71 " Inpatient CARDIAC CATHETERIZATION FOR OTHER NON-CORONARY CONDITIONS 192.4 " 120,006.29 " " 37,813.98 " " 29,064.22 " " 52,283.63 " " 30,517.43 " " 29,064.22 " " 29,064.22 " " 29,064.22 " " 30,953.39 " " 29,064.22 " " 29,064.22 " " 43,596.33 " " 52,283.63 " " 51,775.00 " Inpatient ACUTE & SUBACUTE ENDOCARDITIS 193.2 " 17,196.72 " " 5,418.69 " " 10,127.17 " " 18,217.77 " " 10,633.53 " " 10,127.17 " " 10,127.17 " " 10,127.17 " " 10,785.44 " " 10,127.17 " " 10,127.17 " " 15,190.76 " " 18,217.77 " " 18,040.54 " Inpatient ACUTE & SUBACUTE ENDOCARDITIS 193.3 " 51,670.03 " " 16,281.23 " " 15,436.23 " " 27,768.23 " " 16,208.04 " " 15,436.23 " " 15,436.23 " " 15,436.23 " " 16,439.58 " " 15,436.23 " " 15,436.23 " " 23,154.35 " " 27,768.23 " " 27,498.10 " Inpatient ACUTE & SUBACUTE ENDOCARDITIS 193.4 " 110,206.05 " " 34,725.93 " " 24,489.11 " " 44,053.46 " " 25,713.57 " " 24,489.11 " " 24,489.11 " " 24,489.11 " " 26,080.90 " " 24,489.11 " " 24,489.11 " " 36,733.67 " " 44,053.46 " " 43,624.90 " Inpatient HEART FAILURE 194.1 " 25,918.80 " " 8,167.01 " " 4,950.41 " " 8,905.29 " " 5,197.93 " " 4,950.41 " " 4,950.41 " " 4,950.41 " " 5,272.19 " " 4,950.41 " " 4,950.41 " " 7,425.62 " " 8,905.29 " " 8,818.66 " Inpatient HEART FAILURE 194.2 " 32,342.73 " " 10,191.19 " " 6,543.13 " " 11,770.44 " " 6,870.29 " " 6,543.13 " " 6,543.13 " " 6,543.13 " " 6,968.43 " " 6,543.13 " " 6,543.13 " " 9,814.70 " " 11,770.44 " " 11,655.93 " Inpatient HEART FAILURE 194.3 " 57,094.69 " " 17,990.54 " " 9,464.78 " " 17,026.19 " " 9,938.02 " " 9,464.78 " " 9,464.78 " " 9,464.78 " " 10,079.99 " " 9,464.78 " " 9,464.78 " " 14,197.17 " " 17,026.19 " " 16,860.56 " Inpatient HEART FAILURE 194.4 " 204,270.52 " " 64,365.64 " " 15,482.00 " " 27,850.57 " " 16,256.10 " " 15,482.00 " " 15,482.00 " " 15,482.00 " " 16,488.33 " " 15,482.00 " " 15,482.00 " " 23,223.00 " " 27,850.57 " " 27,579.63 " Inpatient CARDIAC ARREST & SHOCK 196.3 " 33,003.30 " " 10,399.34 " " 8,427.93 " " 15,161.00 " " 8,849.33 " " 8,427.93 " " 8,427.93 " " 8,427.93 " " 8,975.75 " " 8,427.93 " " 8,427.93 " " 12,641.90 " " 15,161.00 " " 15,013.51 " Inpatient CARDIAC ARREST & SHOCK 196.4 " 153,565.44 " " 48,388.47 " " 16,566.28 " " 29,801.08 " " 17,394.59 " " 16,566.28 " " 16,566.28 " " 16,566.28 " " 17,643.09 " " 16,566.28 " " 16,566.28 " " 24,849.42 " " 29,801.08 " " 29,511.17 " Inpatient PERIPHERAL & OTHER VASCULAR DISORDERS 197.1 " 40,596.52 " " 12,791.96 " " 5,314.06 " " 9,559.46 " " 5,579.76 " " 5,314.06 " " 5,314.06 " " 5,314.06 " " 5,659.47 " " 5,314.06 " " 5,314.06 " " 7,971.09 " " 9,559.46 " " 9,466.47 " Inpatient PERIPHERAL & OTHER VASCULAR DISORDERS 197.2 " 63,802.70 " " 20,104.23 " " 6,937.57 " " 12,479.99 " " 7,284.45 " " 6,937.57 " " 6,937.57 " " 6,937.57 " " 7,388.51 " " 6,937.57 " " 6,937.57 " " 10,406.36 " " 12,479.99 " " 12,358.59 " Inpatient PERIPHERAL & OTHER VASCULAR DISORDERS 197.3 " 37,594.37 " " 11,845.98 " " 9,629.55 " " 17,322.60 " " 10,111.03 " " 9,629.55 " " 9,629.55 " " 9,629.55 " " 10,255.47 " " 9,629.55 " " 9,629.55 " " 14,444.33 " " 17,322.60 " " 17,154.08 " Inpatient PERIPHERAL & OTHER VASCULAR DISORDERS 197.4 " 575,400.58 " " 181,308.72 " " 18,867.99 " " 33,941.63 " " 19,811.39 " " 18,867.99 " " 18,867.99 " " 18,867.99 " " 20,094.41 " " 18,867.99 " " 18,867.99 " " 28,301.99 " " 33,941.63 " " 33,611.44 " Inpatient HYPERTENSION 199.1 " 16,988.00 " " 5,352.92 " " 5,053.60 " " 9,090.92 " " 5,306.28 " " 5,053.60 " " 5,053.60 " " 5,053.60 " " 5,382.08 " " 5,053.60 " " 5,053.60 " " 7,580.40 " " 9,090.92 " " 9,002.48 " Inpatient HYPERTENSION 199.2 " 31,657.99 " " 9,975.43 " " 5,848.29 " " 10,520.49 " " 6,140.70 " " 5,848.29 " " 5,848.29 " " 5,848.29 " " 6,228.43 " " 5,848.29 " " 5,848.29 " " 8,772.44 " " 10,520.49 " " 10,418.14 " Inpatient HYPERTENSION 199.3 " 56,107.39 " " 17,679.44 " " 7,760.56 " " 13,960.47 " " 8,148.59 " " 7,760.56 " " 7,760.56 " " 7,760.56 " " 8,265.00 " " 7,760.56 " " 7,760.56 " " 11,640.84 " " 13,960.47 " " 13,824.66 " Inpatient HYPERTENSION 199.4 " 78,047.28 " " 24,592.70 " " 13,914.25 " " 25,030.34 " " 14,609.96 " " 13,914.25 " " 13,914.25 " " 13,914.25 " " 14,818.68 " " 13,914.25 " " 13,914.25 " " 20,871.38 " " 25,030.34 " " 24,786.84 " Inpatient CARDIAC STRUCTURAL & VALVULAR DISORDERS 200.2 " 55,501.52 " " 17,488.53 " " 6,927.58 " " 12,462.02 " " 7,273.96 " " 6,927.58 " " 6,927.58 " " 6,927.58 " " 7,377.87 " " 6,927.58 " " 6,927.58 " " 10,391.37 " " 12,462.02 " " 12,340.79 " Inpatient CARDIAC STRUCTURAL & VALVULAR DISORDERS 200.3 " 27,526.28 " " 8,673.53 " " 10,395.95 " " 18,701.27 " " 10,915.75 " " 10,395.95 " " 10,395.95 " " 10,395.95 " " 11,071.69 " " 10,395.95 " " 10,395.95 " " 15,593.93 " " 18,701.27 " " 18,519.35 " Inpatient CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS 201.1 " 25,055.94 " " 7,895.13 " " 4,463.61 " " 8,029.59 " " 4,686.79 " " 4,463.61 " " 4,463.61 " " 4,463.61 " " 4,753.74 " " 4,463.61 " " 4,463.61 " " 6,695.42 " " 8,029.59 " " 7,951.47 " Inpatient CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS 201.2 " 33,514.09 " " 10,560.29 " " 5,845.80 " " 10,516.01 " " 6,138.09 " " 5,845.80 " " 5,845.80 " " 5,845.80 " " 6,225.78 " " 5,845.80 " " 5,845.80 " " 8,768.70 " " 10,516.01 " " 10,413.71 " Inpatient CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS 201.3 " 39,907.98 " " 12,575.00 " " 8,625.15 " " 15,515.78 " " 9,056.41 " " 8,625.15 " " 8,625.15 " " 8,625.15 " " 9,185.78 " " 8,625.15 " " 8,625.15 " " 12,937.73 " " 15,515.78 " " 15,364.84 " Inpatient CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS 201.4 " 20,692.73 " " 6,520.28 " " 15,456.21 " " 27,804.18 " " 16,229.02 " " 15,456.21 " " 15,456.21 " " 15,456.21 " " 16,460.86 " " 15,456.21 " " 15,456.21 " " 23,184.32 " " 27,804.18 " " 27,533.69 " Inpatient "MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR P " 206.2 " 32,164.09 " " 10,134.90 " " 7,626.58 " " 13,719.45 " " 8,007.91 " " 7,626.58 " " 7,626.58 " " 7,626.58 " " 8,122.31 " " 7,626.58 " " 7,626.58 " " 11,439.87 " " 13,719.45 " " 13,585.99 " Inpatient "MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR P " 206.3 " 52,103.41 " " 16,417.78 " " 11,446.95 " " 20,591.92 " " 12,019.30 " " 11,446.95 " " 11,446.95 " " 11,446.95 " " 12,191.00 " " 11,446.95 " " 11,446.95 " " 17,170.43 " " 20,591.92 " " 20,391.60 " Inpatient "MALFUNCTION,REACTION,COMPLICATION OF CARDIAC/VASC DEVICE OR P " 206.4 " 249,846.38 " " 78,726.59 " " 22,795.70 " " 41,007.18 " " 23,935.49 " " 22,795.70 " " 22,795.70 " " 22,795.70 " " 24,277.42 " " 22,795.70 " " 22,795.70 " " 34,193.55 " " 41,007.18 " " 40,608.26 " Inpatient OTHER CIRCULATORY SYSTEM DIAGNOSES 207.1 " 27,747.53 " " 8,743.25 " " 5,602.81 " " 10,078.89 " " 5,882.95 " " 5,602.81 " " 5,602.81 " " 5,602.81 " " 5,966.99 " " 5,602.81 " " 5,602.81 " " 8,404.22 " " 10,078.89 " " 9,980.85 " Inpatient OTHER CIRCULATORY SYSTEM DIAGNOSES 207.2 " 106,245.10 " " 33,477.83 " " 7,005.80 " " 12,602.73 " " 7,356.09 " " 7,005.80 " " 7,005.80 " " 7,005.80 " " 7,461.18 " " 7,005.80 " " 7,005.80 " " 10,508.70 " " 12,602.73 " " 12,480.13 " Inpatient OTHER CIRCULATORY SYSTEM DIAGNOSES 207.3 " 74,941.16 " " 23,613.96 " " 9,626.22 " " 17,316.61 " " 10,107.53 " " 9,626.22 " " 9,626.22 " " 9,626.22 " " 10,251.92 " " 9,626.22 " " 9,626.22 " " 14,439.33 " " 17,316.61 " " 17,148.15 " Inpatient OTHER CIRCULATORY SYSTEM DIAGNOSES 207.4 " 82,010.62 " " 25,841.54 " " 19,485.44 " " 35,052.36 " " 20,459.71 " " 19,485.44 " " 19,485.44 " " 19,485.44 " " 20,751.99 " " 19,485.44 " " 19,485.44 " " 29,228.16 " " 35,052.36 " " 34,711.36 " Inpatient "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES " 220.1 " 67,391.16 " " 21,234.95 " " 13,481.53 " " 24,251.92 " " 14,155.61 " " 13,481.53 " " 13,481.53 " " 13,481.53 " " 14,357.83 " " 13,481.53 " " 13,481.53 " " 20,222.30 " " 24,251.92 " " 24,016.00 " Inpatient "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES " 220.2 " 56,132.59 " " 17,687.38 " " 20,012.18 " " 35,999.91 " " 21,012.79 " " 20,012.18 " " 20,012.18 " " 20,012.18 " " 21,312.97 " " 20,012.18 " " 20,012.18 " " 30,018.27 " " 35,999.91 " " 35,649.70 " Inpatient "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES " 220.3 " 130,648.54 " " 41,167.35 " " 32,195.57 " " 57,916.61 " " 33,805.35 " " 32,195.57 " " 32,195.57 " " 32,195.57 " " 34,288.28 " " 32,195.57 " " 32,195.57 " " 48,293.36 " " 57,916.61 " " 57,353.19 " Inpatient "MAJOR STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES " 220.4 " 314,813.48 " " 99,197.73 " " 59,003.86 " " 106,142.04 " " 61,954.05 " " 59,003.86 " " 59,003.86 " " 59,003.86 " " 62,839.11 " " 59,003.86 " " 59,003.86 " " 88,505.79 " " 106,142.04 " " 105,109.48 " Inpatient "OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES " 222.1 " 41,068.03 " " 12,940.54 " " 6,950.88 " " 12,503.94 " " 7,298.42 " " 6,950.88 " " 6,950.88 " " 6,950.88 " " 7,402.69 " " 6,950.88 " " 6,950.88 " " 10,426.32 " " 12,503.94 " " 12,382.30 " Inpatient "OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES " 222.2 " 122,224.18 " " 38,512.84 " " 12,113.49 " " 21,790.96 " " 12,719.16 " " 12,113.49 " " 12,113.49 " " 12,113.49 " " 12,900.87 " " 12,113.49 " " 12,113.49 " " 18,170.24 " " 21,790.96 " " 21,578.97 " Inpatient "OTHER STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES " 222.3 " 92,793.70 " " 29,239.29 " " 19,245.78 " " 34,621.23 " " 20,208.07 " " 19,245.78 " " 19,245.78 " " 19,245.78 " " 20,496.76 " " 19,245.78 " " 19,245.78 " " 28,868.67 " " 34,621.23 " " 34,284.43 " Inpatient OTHER SMALL & LARGE BOWEL PROCEDURES 223.1 " 81,355.45 " " 25,635.10 " " 9,999.02 " " 17,987.24 " " 10,498.97 " " 9,999.02 " " 9,999.02 " " 9,999.02 " " 10,648.96 " " 9,999.02 " " 9,999.02 " " 14,998.53 " " 17,987.24 " " 17,812.25 " Inpatient OTHER SMALL & LARGE BOWEL PROCEDURES 223.2 " 75,996.37 " " 23,946.45 " " 14,429.34 " " 25,956.94 " " 15,150.81 " " 14,429.34 " " 14,429.34 " " 14,429.34 " " 15,367.25 " " 14,429.34 " " 14,429.34 " " 21,644.01 " " 25,956.94 " " 25,704.43 " Inpatient OTHER SMALL & LARGE BOWEL PROCEDURES 223.3 " 351,911.83 " " 110,887.42 " " 22,958.80 " " 41,300.59 " " 24,106.74 " " 22,958.80 " " 22,958.80 " " 22,958.80 " " 24,451.12 " " 22,958.80 " " 22,958.80 " " 34,438.20 " " 41,300.59 " " 40,898.81 " Inpatient OTHER SMALL & LARGE BOWEL PROCEDURES 223.4 " 618,821.70 " " 194,990.72 " " 40,214.93 " " 72,342.64 " " 42,225.68 " " 40,214.93 " " 40,214.93 " " 40,214.93 " " 42,828.90 " " 40,214.93 " " 40,214.93 " " 60,322.40 " " 72,342.64 " " 71,638.88 " Inpatient PERITONEAL ADHESIOLYSIS 224.1 " 46,719.76 " " 14,721.40 " " 12,210.85 " " 21,966.10 " " 12,821.39 " " 12,210.85 " " 12,210.85 " " 12,210.85 " " 13,004.56 " " 12,210.85 " " 12,210.85 " " 18,316.28 " " 21,966.10 " " 21,752.41 " Inpatient PERITONEAL ADHESIOLYSIS 224.2 " 45,960.63 " " 14,482.19 " " 15,591.01 " " 28,046.67 " " 16,370.56 " " 15,591.01 " " 15,591.01 " " 15,591.01 " " 16,604.43 " " 15,591.01 " " 15,591.01 " " 23,386.52 " " 28,046.67 " " 27,773.83 " Inpatient PERITONEAL ADHESIOLYSIS 224.3 " 109,428.98 " " 34,481.07 " " 23,418.97 " " 42,128.39 " " 24,589.92 " " 23,418.97 " " 23,418.97 " " 23,418.97 " " 24,941.20 " " 23,418.97 " " 23,418.97 " " 35,128.46 " " 42,128.39 " " 41,718.55 " Inpatient "HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL " 227.1 " 85,204.87 " " 26,848.05 " " 10,976.79 " " 19,746.15 " " 11,525.63 " " 10,976.79 " " 10,976.79 " " 10,976.79 " " 11,690.28 " " 10,976.79 " " 10,976.79 " " 16,465.19 " " 19,746.15 " " 19,554.05 " Inpatient "HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL " 227.2 " 89,640.68 " " 28,245.78 " " 14,167.22 " " 25,485.41 " " 14,875.58 " " 14,167.22 " " 14,167.22 " " 14,167.22 " " 15,088.09 " " 14,167.22 " " 14,167.22 " " 21,250.83 " " 25,485.41 " " 25,237.49 " Inpatient "HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL & UMBILICAL " 227.3 " 51,152.48 " " 16,118.15 " " 22,060.08 " " 39,683.88 " " 23,163.08 " " 22,060.08 " " 22,060.08 " " 22,060.08 " " 23,493.99 " " 22,060.08 " " 22,060.08 " " 33,090.12 " " 39,683.88 " " 39,297.83 " Inpatient "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES " 228.1 " 66,060.22 " " 20,815.58 " " 8,209.91 " " 14,768.81 " " 8,620.41 " " 8,209.91 " " 8,209.91 " " 8,209.91 " " 8,743.55 " " 8,209.91 " " 8,209.91 " " 12,314.87 " " 14,768.81 " " 14,625.13 " Inpatient "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES " 228.2 " 113,628.45 " " 35,804.32 " " 11,099.11 " " 19,966.19 " " 11,654.07 " " 11,099.11 " " 11,099.11 " " 11,099.11 " " 11,820.55 " " 11,099.11 " " 11,099.11 " " 16,648.67 " " 19,966.19 " " 19,771.95 " Inpatient "INGUINAL, FEMORAL & UMBILICAL HERNIA PROCEDURES " 228.3 " 43,042.85 " " 13,562.80 " " 16,081.98 " " 28,929.87 " " 16,886.08 " " 16,081.98 " " 16,081.98 " " 16,081.98 " " 17,127.31 " " 16,081.98 " " 16,081.98 " " 24,122.97 " " 28,929.87 " " 28,648.44 " Inpatient OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES 229.1 " 35,548.55 " " 11,201.35 " " 10,828.66 " " 19,479.68 " " 11,370.09 " " 10,828.66 " " 10,828.66 " " 10,828.66 " " 11,532.52 " " 10,828.66 " " 10,828.66 " " 16,242.99 " " 19,479.68 " " 19,290.17 " Inpatient OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES 229.2 " 61,286.75 " " 19,311.45 " " 14,388.57 " " 25,883.60 " " 15,108.00 " " 14,388.57 " " 14,388.57 " " 14,388.57 " " 15,323.83 " " 14,388.57 " " 14,388.57 " " 21,582.86 " " 25,883.60 " " 25,631.80 " Inpatient OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES 229.3 " 76,424.78 " " 24,081.45 " " 21,127.25 " " 38,005.81 " " 22,183.61 " " 21,127.25 " " 21,127.25 " " 21,127.25 " " 22,500.52 " " 21,127.25 " " 21,127.25 " " 31,690.88 " " 38,005.81 " " 37,636.08 " Inpatient OTHER DIGESTIVE SYSTEM & ABDOMINAL PROCEDURES 229.4 " 181,205.71 " " 57,097.92 " " 39,454.35 " " 70,974.43 " " 41,427.07 " " 39,454.35 " " 39,454.35 " " 39,454.35 " " 42,018.88 " " 39,454.35 " " 39,454.35 " " 59,181.53 " " 70,974.43 " " 70,283.98 " Inpatient MAJOR SMALL BOWEL PROCEDURES 230.1 " 49,834.65 " " 15,702.90 " " 12,954.79 " " 23,304.37 " " 13,602.53 " " 12,954.79 " " 12,954.79 " " 12,954.79 " " 13,796.85 " " 12,954.79 " " 12,954.79 " " 19,432.19 " " 23,304.37 " " 23,077.66 " Inpatient MAJOR SMALL BOWEL PROCEDURES 230.2 " 76,249.75 " " 24,026.30 " " 18,143.19 " " 32,637.78 " " 19,050.35 " " 18,143.19 " " 18,143.19 " " 18,143.19 " " 19,322.50 " " 18,143.19 " " 18,143.19 " " 27,214.79 " " 32,637.78 " " 32,320.28 " Inpatient MAJOR SMALL BOWEL PROCEDURES 230.3 " 119,819.50 " " 37,755.13 " " 27,963.30 " " 50,303.18 " " 29,361.47 " " 27,963.30 " " 27,963.30 " " 27,963.30 " " 29,780.91 " " 27,963.30 " " 27,963.30 " " 41,944.95 " " 50,303.18 " " 49,813.82 " Inpatient MAJOR SMALL BOWEL PROCEDURES 230.4 " 723,480.62 " " 227,968.74 " " 53,521.71 " " 96,280.20 " " 56,197.80 " " 53,521.71 " " 53,521.71 " " 53,521.71 " " 57,000.62 " " 53,521.71 " " 53,521.71 " " 80,282.57 " " 96,280.20 " " 95,343.57 " Inpatient MAJOR LARGE BOWEL PROCEDURES 231.1 " 59,689.98 " " 18,808.31 " " 13,139.52 " " 23,636.68 " " 13,796.50 " " 13,139.52 " " 13,139.52 " " 13,139.52 " " 13,993.59 " " 13,139.52 " " 13,139.52 " " 19,709.28 " " 23,636.68 " " 23,406.74 " Inpatient MAJOR LARGE BOWEL PROCEDURES 231.2 " 66,870.44 " " 21,070.88 " " 17,165.43 " " 30,878.89 " " 18,023.70 " " 17,165.43 " " 17,165.43 " " 17,165.43 " " 18,281.18 " " 17,165.43 " " 17,165.43 " " 25,748.15 " " 30,878.89 " " 30,578.50 " Inpatient MAJOR LARGE BOWEL PROCEDURES 231.3 " 112,658.86 " " 35,498.81 " " 26,838.24 " " 48,279.31 " " 28,180.15 " " 26,838.24 " " 26,838.24 " " 26,838.24 " " 28,582.73 " " 26,838.24 " " 26,838.24 " " 40,257.36 " " 48,279.31 " " 47,809.64 " Inpatient MAJOR LARGE BOWEL PROCEDURES 231.4 " 114,823.16 " " 36,180.78 " " 45,946.72 " " 82,653.55 " " 48,244.06 " " 45,946.72 " " 45,946.72 " " 45,946.72 " " 48,933.26 " " 45,946.72 " " 45,946.72 " " 68,920.08 " " 82,653.55 " " 81,849.49 " Inpatient APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS 233.1 " 57,185.57 " " 18,019.17 " " 10,051.44 " " 18,081.54 " " 10,554.01 " " 10,051.44 " " 10,051.44 " " 10,051.44 " " 10,704.78 " " 10,051.44 " " 10,051.44 " " 15,077.16 " " 18,081.54 " " 17,905.64 " Inpatient APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS 233.2 " 59,449.44 " " 18,732.52 " " 13,172.81 " " 23,696.57 " " 13,831.45 " " 13,172.81 " " 13,172.81 " " 13,172.81 " " 14,029.04 " " 13,172.81 " " 13,172.81 " " 19,759.22 " " 23,696.57 " " 23,466.04 " Inpatient APPENDECTOMY WITH COMPLEX PRINCIPAL DIAGNOSIS 233.3 " 89,669.28 " " 28,254.79 " " 20,581.37 " " 37,023.83 " " 21,610.44 " " 20,581.37 " " 20,581.37 " " 20,581.37 " " 21,919.16 " " 20,581.37 " " 20,581.37 " " 30,872.06 " " 37,023.83 " " 36,663.65 " Inpatient DIGESTIVE MALIGNANCY 240.2 " 28,618.31 " " 9,017.63 " " 8,713.36 " " 15,674.46 " " 9,149.03 " " 8,713.36 " " 8,713.36 " " 8,713.36 " " 9,279.73 " " 8,713.36 " " 8,713.36 " " 13,070.04 " " 15,674.46 " " 15,521.98 " Inpatient DIGESTIVE MALIGNANCY 240.3 " 59,989.25 " " 18,902.61 " " 12,383.11 " " 22,275.98 " " 13,002.27 " " 12,383.11 " " 12,383.11 " " 12,383.11 " " 13,188.01 " " 12,383.11 " " 12,383.11 " " 18,574.67 " " 22,275.98 " " 22,059.27 " Inpatient PEPTIC ULCER & GASTRITIS 241.1 " 18,398.78 " " 5,797.45 " " 6,135.38 " " 11,036.94 " " 6,442.15 " " 6,135.38 " " 6,135.38 " " 6,135.38 " " 6,534.18 " " 6,135.38 " " 6,135.38 " " 9,203.07 " " 11,036.94 " " 10,929.57 " Inpatient PEPTIC ULCER & GASTRITIS 241.2 " 24,325.64 " " 7,665.01 " " 7,640.73 " " 13,744.91 " " 8,022.77 " " 7,640.73 " " 7,640.73 " " 7,640.73 " " 8,137.38 " " 7,640.73 " " 7,640.73 " " 11,461.10 " " 13,744.91 " " 13,611.20 " Inpatient PEPTIC ULCER & GASTRITIS 241.3 " 64,682.91 " " 20,381.58 " " 11,330.45 " " 20,382.35 " " 11,896.97 " " 11,330.45 " " 11,330.45 " " 11,330.45 " " 12,066.93 " " 11,330.45 " " 11,330.45 " " 16,995.68 " " 20,382.35 " " 20,184.06 " Inpatient PEPTIC ULCER & GASTRITIS 241.4 " 103,490.79 " " 32,609.95 " " 24,076.36 " " 43,310.96 " " 25,280.18 " " 24,076.36 " " 24,076.36 " " 24,076.36 " " 25,641.32 " " 24,076.36 " " 24,076.36 " " 36,114.54 " " 43,310.96 " " 42,889.63 " Inpatient MAJOR ESOPHAGEAL DISORDERS 242.2 " 16,390.26 " " 5,164.57 " " 7,291.23 " " 13,116.19 " " 7,655.79 " " 7,291.23 " " 7,291.23 " " 7,291.23 " " 7,765.16 " " 7,291.23 " " 7,291.23 " " 10,936.85 " " 13,116.19 " " 12,988.60 " Inpatient MAJOR ESOPHAGEAL DISORDERS 242.3 " 63,879.39 " " 20,128.40 " " 10,630.61 " " 19,123.40 " " 11,162.14 " " 10,630.61 " " 10,630.61 " " 10,630.61 " " 11,321.60 " " 10,630.61 " " 10,630.61 " " 15,945.92 " " 19,123.40 " " 18,937.37 " Inpatient OTHER ESOPHAGEAL DISORDERS 243.1 " 11,067.00 " " 3,487.21 " " 5,334.86 " " 9,596.88 " " 5,601.60 " " 5,334.86 " " 5,334.86 " " 5,334.86 " " 5,681.63 " " 5,334.86 " " 5,334.86 " " 8,002.29 " " 9,596.88 " " 9,503.52 " Inpatient OTHER ESOPHAGEAL DISORDERS 243.2 " 44,899.34 " " 14,147.78 " " 6,819.40 " " 12,267.42 " " 7,160.37 " " 6,819.40 " " 6,819.40 " " 6,819.40 " " 7,262.66 " " 6,819.40 " " 6,819.40 " " 10,229.10 " " 12,267.42 " " 12,148.08 " Inpatient OTHER ESOPHAGEAL DISORDERS 243.3 " 51,139.88 " " 16,114.18 " " 10,205.39 " " 18,358.48 " " 10,715.66 " " 10,205.39 " " 10,205.39 " " 10,205.39 " " 10,868.74 " " 10,205.39 " " 10,205.39 " " 15,308.09 " " 18,358.48 " " 18,179.88 " Inpatient OTHER ESOPHAGEAL DISORDERS 243.4 " 43,103.10 " " 13,581.79 " " 22,123.33 " " 39,797.66 " " 23,229.50 " " 22,123.33 " " 22,123.33 " " 22,123.33 " " 23,561.35 " " 22,123.33 " " 22,123.33 " " 33,185.00 " " 39,797.66 " " 39,410.50 " Inpatient DIVERTICULITIS & DIVERTICULOSIS 244.1 " 20,801.11 " " 6,554.43 " " 4,926.28 " " 8,861.89 " " 5,172.59 " " 4,926.28 " " 4,926.28 " " 4,926.28 " " 5,246.49 " " 4,926.28 " " 4,926.28 " " 7,389.42 " " 8,861.89 " " 8,775.68 " Inpatient DIVERTICULITIS & DIVERTICULOSIS 244.2 " 29,474.04 " " 9,287.27 " " 6,652.14 " " 11,966.53 " " 6,984.75 " " 6,652.14 " " 6,652.14 " " 6,652.14 " " 7,084.53 " " 6,652.14 " " 6,652.14 " " 9,978.21 " " 11,966.53 " " 11,850.12 " Inpatient DIVERTICULITIS & DIVERTICULOSIS 244.3 " 31,504.28 " " 9,927.00 " " 10,369.32 " " 18,653.37 " " 10,887.79 " " 10,369.32 " " 10,369.32 " " 10,369.32 " " 11,043.33 " " 10,369.32 " " 10,369.32 " " 15,553.98 " " 18,653.37 " " 18,471.91 " Inpatient INFLAMMATORY BOWEL DISEASE 245.1 " 43,349.05 " " 13,659.29 " " 5,930.68 " " 10,668.70 " " 6,227.21 " " 5,930.68 " " 5,930.68 " " 5,930.68 " " 6,316.17 " " 5,930.68 " " 5,930.68 " " 8,896.02 " " 10,668.70 " " 10,564.91 " Inpatient INFLAMMATORY BOWEL DISEASE 245.2 " 43,681.60 " " 13,764.07 " " 7,729.77 " " 13,905.08 " " 8,116.26 " " 7,729.77 " " 7,729.77 " " 7,729.77 " " 8,232.21 " " 7,729.77 " " 7,729.77 " " 11,594.66 " " 13,905.08 " " 13,769.81 " Inpatient INFLAMMATORY BOWEL DISEASE 245.3 " 39,908.37 " " 12,575.13 " " 11,809.76 " " 21,244.58 " " 12,400.25 " " 11,809.76 " " 11,809.76 " " 11,809.76 " " 12,577.39 " " 11,809.76 " " 11,809.76 " " 17,714.64 " " 21,244.58 " " 21,037.91 " Inpatient GASTROINTESTINAL VASCULAR INSUFFICIENCY 246.2 " 41,494.13 " " 13,074.80 " " 7,317.02 " " 13,162.59 " " 7,682.87 " " 7,317.02 " " 7,317.02 " " 7,317.02 " " 7,792.63 " " 7,317.02 " " 7,317.02 " " 10,975.53 " " 13,162.59 " " 13,034.54 " Inpatient GASTROINTESTINAL VASCULAR INSUFFICIENCY 246.4 " 430,199.64 " " 135,555.91 " " 19,908.17 " " 35,812.81 " " 20,903.58 " " 19,908.17 " " 19,908.17 " " 19,908.17 " " 21,202.20 " " 19,908.17 " " 19,908.17 " " 29,862.26 " " 35,812.81 " " 35,464.41 " Inpatient INTESTINAL OBSTRUCTION 247.1 " 33,357.39 " " 10,510.91 " " 4,628.37 " " 8,325.97 " " 4,859.79 " " 4,628.37 " " 4,628.37 " " 4,628.37 " " 4,929.21 " " 4,628.37 " " 4,628.37 " " 6,942.56 " " 8,325.97 " " 8,244.98 " Inpatient INTESTINAL OBSTRUCTION 247.2 " 39,830.79 " " 12,550.68 " " 6,236.90 " " 11,219.56 " " 6,548.75 " " 6,236.90 " " 6,236.90 " " 6,236.90 " " 6,642.30 " " 6,236.90 " " 6,236.90 " " 9,355.35 " " 11,219.56 " " 11,110.41 " Inpatient INTESTINAL OBSTRUCTION 247.3 " 39,708.29 " " 12,512.08 " " 10,062.26 " " 18,101.00 " " 10,565.37 " " 10,062.26 " " 10,062.26 " " 10,062.26 " " 10,716.31 " " 10,062.26 " " 10,062.26 " " 15,093.39 " " 18,101.00 " " 17,924.91 " Inpatient INTESTINAL OBSTRUCTION 247.4 " 15,791.23 " " 4,975.82 " " 19,429.68 " " 34,952.05 " " 20,401.16 " " 19,429.68 " " 19,429.68 " " 19,429.68 " " 20,692.61 " " 19,429.68 " " 19,429.68 " " 29,144.52 " " 34,952.05 " " 34,612.03 " Inpatient MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS 248.1 " 20,774.84 " " 6,546.15 " " 5,182.58 " " 9,322.94 " " 5,441.71 " " 5,182.58 " " 5,182.58 " " 5,182.58 " " 5,519.45 " " 5,182.58 " " 5,182.58 " " 7,773.87 " " 9,322.94 " " 9,232.25 " Inpatient MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS 248.2 " 31,660.01 " " 9,976.07 " " 7,200.52 " " 12,953.02 " " 7,560.55 " " 7,200.52 " " 7,200.52 " " 7,200.52 " " 7,668.55 " " 7,200.52 " " 7,200.52 " " 10,800.78 " " 12,953.02 " " 12,827.01 " Inpatient MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS 248.3 " 66,504.96 " " 20,955.71 " " 10,665.56 " " 19,186.28 " " 11,198.84 " " 10,665.56 " " 10,665.56 " " 10,665.56 " " 11,358.82 " " 10,665.56 " " 10,665.56 " " 15,998.34 " " 19,186.28 " " 18,999.63 " Inpatient MAJOR GASTROINTESTINAL & PERITONEAL INFECTIONS 248.4 " 65,584.00 " " 20,665.52 " " 22,442.04 " " 40,370.99 " " 23,564.14 " " 22,442.04 " " 22,442.04 " " 22,442.04 " " 23,900.77 " " 22,442.04 " " 22,442.04 " " 33,663.06 " " 40,370.99 " " 39,978.25 " Inpatient "OTHER GASTROENTERITIS, NAUSEA & VOMITING " 249.1 " 53,962.92 " " 17,003.72 " " 4,484.41 " " 8,067.01 " " 4,708.63 " " 4,484.41 " " 4,484.41 " " 4,484.41 " " 4,775.90 " " 4,484.41 " " 4,484.41 " " 6,726.62 " " 8,067.01 " " 7,988.53 " Inpatient "OTHER GASTROENTERITIS, NAUSEA & VOMITING " 249.2 " 26,364.29 " " 8,307.39 " " 5,522.09 " " 9,933.69 " " 5,798.19 " " 5,522.09 " " 5,522.09 " " 5,522.09 " " 5,881.03 " " 5,522.09 " " 5,522.09 " " 8,283.14 " " 9,933.69 " " 9,837.05 " Inpatient "OTHER GASTROENTERITIS, NAUSEA & VOMITING " 249.3 " 30,447.81 " " 9,594.11 " " 8,397.14 " " 15,105.62 " " 8,817.00 " " 8,397.14 " " 8,397.14 " " 8,397.14 " " 8,942.95 " " 8,397.14 " " 8,397.14 " " 12,595.71 " " 15,105.62 " " 14,958.67 " Inpatient "OTHER GASTROENTERITIS, NAUSEA & VOMITING " 249.4 " 37,105.30 " " 11,691.88 " " 18,612.52 " " 33,482.06 " " 19,543.15 " " 18,612.52 " " 18,612.52 " " 18,612.52 " " 19,822.33 " " 18,612.52 " " 18,612.52 " " 27,918.78 " " 33,482.06 " " 33,156.34 " Inpatient ABDOMINAL PAIN 251.2 " 37,522.56 " " 11,823.36 " " 6,344.25 " " 11,412.67 " " 6,661.46 " " 6,344.25 " " 6,344.25 " " 6,344.25 " " 6,756.63 " " 6,344.25 " " 6,344.25 " " 9,516.38 " " 11,412.67 " " 11,301.65 " Inpatient ABDOMINAL PAIN 251.3 " 21,259.00 " " 6,698.71 " " 8,501.16 " " 15,292.74 " " 8,926.22 " " 8,501.16 " " 8,501.16 " " 8,501.16 " " 9,053.74 " " 8,501.16 " " 8,501.16 " " 12,751.74 " " 15,292.74 " " 15,143.97 " Inpatient "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDUR " 252.2 " 38,550.17 " " 12,147.16 " " 7,256.28 " " 13,053.32 " " 7,619.09 " " 7,256.28 " " 7,256.28 " " 7,256.28 " " 7,727.94 " " 7,256.28 " " 7,256.28 " " 10,884.42 " " 13,053.32 " " 12,926.34 " Inpatient "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDUR " 252.3 " 58,678.33 " " 18,489.54 " " 11,181.49 " " 20,114.38 " " 11,740.56 " " 11,181.49 " " 11,181.49 " " 11,181.49 " " 11,908.29 " " 11,181.49 " " 11,181.49 " " 16,772.24 " " 20,114.38 " " 19,918.71 " Inpatient "MALFUNCTION, REACTION & COMPLICATION OF GI DEVICE OR PROCEDUR " 252.4 " 192,828.27 " " 60,760.19 " " 24,445.00 " " 43,974.11 " " 25,667.25 " " 24,445.00 " " 24,445.00 " " 24,445.00 " " 26,033.93 " " 24,445.00 " " 24,445.00 " " 36,667.50 " " 43,974.11 " " 43,546.32 " Inpatient OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE 253.1 " 11,740.00 " " 3,699.27 " " 5,667.72 " " 10,195.66 " " 5,951.11 " " 5,667.72 " " 5,667.72 " " 5,667.72 " " 6,036.12 " " 5,667.72 " " 5,667.72 " " 8,501.58 " " 10,195.66 " " 10,096.48 " Inpatient OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE 253.2 " 45,991.30 " " 14,491.86 " " 7,314.53 " " 13,158.11 " " 7,680.26 " " 7,314.53 " " 7,314.53 " " 7,314.53 " " 7,789.97 " " 7,314.53 " " 7,314.53 " " 10,971.80 " " 13,158.11 " " 13,030.10 " Inpatient OTHER & UNSPECIFIED GASTROINTESTINAL HEMORRHAGE 253.3 " 77,822.44 " " 24,521.85 " " 10,787.89 " " 19,406.34 " " 11,327.28 " " 10,787.89 " " 10,787.89 " " 10,787.89 " " 11,489.10 " " 10,787.89 " " 10,787.89 " " 16,181.84 " " 19,406.34 " " 19,217.55 " Inpatient OTHER DIGESTIVE SYSTEM DIAGNOSES 254.1 " 24,473.01 " " 7,711.44 " " 5,116.01 " " 9,203.19 " " 5,371.81 " " 5,116.01 " " 5,116.01 " " 5,116.01 " " 5,448.55 " " 5,116.01 " " 5,116.01 " " 7,674.02 " " 9,203.19 " " 9,113.66 " Inpatient OTHER DIGESTIVE SYSTEM DIAGNOSES 254.2 " 42,766.84 " " 13,475.83 " " 6,841.87 " " 12,307.84 " " 7,183.96 " " 6,841.87 " " 6,841.87 " " 6,841.87 " " 7,286.59 " " 6,841.87 " " 6,841.87 " " 10,262.81 " " 12,307.84 " " 12,188.11 " Inpatient OTHER DIGESTIVE SYSTEM DIAGNOSES 254.3 " 56,188.71 " " 17,705.06 " " 10,380.97 " " 18,674.33 " " 10,900.02 " " 10,380.97 " " 10,380.97 " " 10,380.97 " " 11,055.73 " " 10,380.97 " " 10,380.97 " " 15,571.46 " " 18,674.33 " " 18,492.66 " Inpatient OTHER DIGESTIVE SYSTEM DIAGNOSES 254.4 " 95,055.05 " " 29,951.85 " " 20,681.23 " " 37,203.46 " " 21,715.29 " " 20,681.23 " " 20,681.23 " " 20,681.23 " " 22,025.51 " " 20,681.23 " " 20,681.23 " " 31,021.85 " " 37,203.46 " " 36,841.54 " Inpatient "MAJOR PANCREAS, LIVER & SHUNT PROCEDURES " 260.1 " 74,012.77 " " 23,321.42 " " 18,203.94 " " 32,747.07 " " 19,114.14 " " 18,203.94 " " 18,203.94 " " 18,203.94 " " 19,387.20 " " 18,203.94 " " 18,203.94 " " 27,305.91 " " 32,747.07 " " 32,428.50 " Inpatient "MAJOR PANCREAS, LIVER & SHUNT PROCEDURES " 260.2 " 98,327.54 " " 30,983.01 " " 22,584.33 " " 40,626.95 " " 23,713.55 " " 22,584.33 " " 22,584.33 " " 22,584.33 " " 24,052.31 " " 22,584.33 " " 22,584.33 " " 33,876.50 " " 40,626.95 " " 40,231.73 " Inpatient "MAJOR PANCREAS, LIVER & SHUNT PROCEDURES " 260.3 " 137,489.49 " " 43,322.94 " " 34,181.06 " " 61,488.31 " " 35,890.11 " " 34,181.06 " " 34,181.06 " " 34,181.06 " " 36,402.83 " " 34,181.06 " " 34,181.06 " " 51,271.59 " " 61,488.31 " " 60,890.14 " Inpatient MAJOR BILIARY TRACT PROCEDURES 261.2 " 62,397.04 " " 19,661.31 " " 19,951.44 " " 35,890.65 " " 20,949.01 " " 19,951.44 " " 19,951.44 " " 19,951.44 " " 21,248.28 " " 19,951.44 " " 19,951.44 " " 29,927.16 " " 35,890.65 " " 35,541.50 " Inpatient MAJOR BILIARY TRACT PROCEDURES 261.3 " 119,749.13 " " 37,732.95 " " 29,422.88 " " 52,928.82 " " 30,894.02 " " 29,422.88 " " 29,422.88 " " 29,422.88 " " 31,335.37 " " 29,422.88 " " 29,422.88 " " 44,134.32 " " 52,928.82 " " 52,413.92 " Inpatient CHOLECYSTECTOMY 263.1 " 35,967.28 " " 11,333.29 " " 10,101.37 " " 18,171.35 " " 10,606.44 " " 10,101.37 " " 10,101.37 " " 10,101.37 " " 10,757.96 " " 10,101.37 " " 10,101.37 " " 15,152.06 " " 18,171.35 " " 17,994.58 " Inpatient CHOLECYSTECTOMY 263.2 " 93,203.33 " " 29,368.37 " " 13,216.08 " " 23,774.41 " " 13,876.88 " " 13,216.08 " " 13,216.08 " " 13,216.08 " " 14,075.13 " " 13,216.08 " " 13,216.08 " " 19,824.12 " " 23,774.41 " " 23,543.12 " Inpatient CHOLECYSTECTOMY 263.3 " 91,367.12 " " 28,789.78 " " 17,781.21 " " 31,986.62 " " 18,670.27 " " 17,781.21 " " 17,781.21 " " 17,781.21 " " 18,936.99 " " 17,781.21 " " 17,781.21 " " 26,671.82 " " 31,986.62 " " 31,675.45 " Inpatient "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES " 264.1 " 57,504.25 " " 18,119.59 " " 14,145.58 " " 25,446.48 " " 14,852.86 " " 14,145.58 " " 14,145.58 " " 14,145.58 " " 15,065.04 " " 14,145.58 " " 14,145.58 " " 21,218.37 " " 25,446.48 " " 25,198.94 " Inpatient "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES " 264.2 " 86,202.98 " " 27,162.56 " " 15,416.26 " " 27,732.31 " " 16,187.07 " " 15,416.26 " " 15,416.26 " " 15,416.26 " " 16,418.32 " " 15,416.26 " " 15,416.26 " " 23,124.39 " " 27,732.31 " " 27,462.53 " Inpatient "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES " 264.3 " 116,530.27 " " 36,718.69 " " 24,463.31 " " 44,007.05 " " 25,686.48 " " 24,463.31 " " 24,463.31 " " 24,463.31 " " 26,053.43 " " 24,463.31 " " 24,463.31 " " 36,694.97 " " 44,007.05 " " 43,578.94 " Inpatient "OTHER HEPATOBILIARY, PANCREAS & ABDOMINAL PROCEDURES " 264.4 " 131,472.29 " " 41,426.92 " " 60,975.21 " " 109,688.31 " " 64,023.97 " " 60,975.21 " " 60,975.21 " " 60,975.21 " " 64,938.60 " " 60,975.21 " " 60,975.21 " " 91,462.82 " " 109,688.31 " " 108,621.24 " Inpatient HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS 279.2 " 54,982.73 " " 17,325.06 " " 6,519.83 " " 11,728.52 " " 6,845.82 " " 6,519.83 " " 6,519.83 " " 6,519.83 " " 6,943.62 " " 6,519.83 " " 6,519.83 " " 9,779.75 " " 11,728.52 " " 11,614.43 " Inpatient HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS 279.3 " 50,717.64 " " 15,981.13 " " 9,988.20 " " 17,967.77 " " 10,487.61 " " 9,988.20 " " 9,988.20 " " 9,988.20 " " 10,637.43 " " 9,988.20 " " 9,988.20 " " 14,982.30 " " 17,967.77 " " 17,792.98 " Inpatient HEPATIC COMA & OTHER MAJOR ACUTE LIVER DISORDERS 279.4 " 132,950.23 " " 41,892.62 " " 23,744.34 " " 42,713.69 " " 24,931.56 " " 23,744.34 " " 23,744.34 " " 23,744.34 " " 25,287.72 " " 23,744.34 " " 23,744.34 " " 35,616.51 " " 42,713.69 " " 42,298.17 " Inpatient ALCOHOLIC LIVER DISEASE 280.2 " 15,209.38 " " 4,792.47 " " 6,221.93 " " 11,192.63 " " 6,533.03 " " 6,221.93 " " 6,221.93 " " 6,221.93 " " 6,626.36 " " 6,221.93 " " 6,221.93 " " 9,332.90 " " 11,192.63 " " 11,083.75 " Inpatient ALCOHOLIC LIVER DISEASE 280.3 " 54,855.39 " " 17,284.93 " " 9,582.95 " " 17,238.77 " " 10,062.10 " " 9,582.95 " " 9,582.95 " " 9,582.95 " " 10,205.84 " " 9,582.95 " " 9,582.95 " " 14,374.43 " " 17,238.77 " " 17,071.07 " Inpatient ALCOHOLIC LIVER DISEASE 280.4 " 98,390.33 " " 31,002.79 " " 21,588.26 " " 38,835.12 " " 22,667.67 " " 21,588.26 " " 21,588.26 " " 21,588.26 " " 22,991.50 " " 21,588.26 " " 21,588.26 " " 32,382.39 " " 38,835.12 " " 38,457.33 " Inpatient MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS 281.2 " 20,587.08 " " 6,486.99 " " 8,931.38 " " 16,066.66 " " 9,377.95 " " 8,931.38 " " 8,931.38 " " 8,931.38 " " 9,511.92 " " 8,931.38 " " 8,931.38 " " 13,397.07 " " 16,066.66 " " 15,910.36 " Inpatient MALIGNANCY OF HEPATOBILIARY SYSTEM & PANCREAS 281.3 " 68,505.26 " " 21,586.01 " " 11,692.43 " " 21,033.51 " " 12,277.05 " " 11,692.43 " " 11,692.43 " " 11,692.43 " " 12,452.44 " " 11,692.43 " " 11,692.43 " " 17,538.65 " " 21,033.51 " " 20,828.89 " Inpatient DISORDERS OF PANCREAS EXCEPT MALIGNANCY 282.1 " 29,435.17 " " 9,275.02 " " 4,815.61 " " 8,662.80 " " 5,056.39 " " 4,815.61 " " 4,815.61 " " 4,815.61 " " 5,128.62 " " 4,815.61 " " 4,815.61 " " 7,223.42 " " 8,662.80 " " 8,578.53 " Inpatient DISORDERS OF PANCREAS EXCEPT MALIGNANCY 282.2 " 43,654.50 " " 13,755.53 " " 6,492.37 " " 11,679.12 " " 6,816.99 " " 6,492.37 " " 6,492.37 " " 6,492.37 " " 6,914.37 " " 6,492.37 " " 6,492.37 " " 9,738.56 " " 11,679.12 " " 11,565.51 " Inpatient DISORDERS OF PANCREAS EXCEPT MALIGNANCY 282.3 " 58,735.80 " " 18,507.65 " " 10,843.64 " " 19,506.62 " " 11,385.82 " " 10,843.64 " " 10,843.64 " " 10,843.64 " " 11,548.48 " " 10,843.64 " " 10,843.64 " " 16,265.46 " " 19,506.62 " " 19,316.86 " Inpatient DISORDERS OF PANCREAS EXCEPT MALIGNANCY 282.4 " 100,830.26 " " 31,771.62 " " 26,675.98 " " 47,987.42 " " 28,009.78 " " 26,675.98 " " 26,675.98 " " 26,675.98 " " 28,409.92 " " 26,675.98 " " 26,675.98 " " 40,013.97 " " 47,987.42 " " 47,520.59 " Inpatient OTHER DISORDERS OF THE LIVER 283.1 " 34,693.55 " " 10,931.94 " " 5,249.98 " " 9,444.19 " " 5,512.48 " " 5,249.98 " " 5,249.98 " " 5,249.98 " " 5,591.23 " " 5,249.98 " " 5,249.98 " " 7,874.97 " " 9,444.19 " " 9,352.31 " Inpatient OTHER DISORDERS OF THE LIVER 283.2 " 30,346.30 " " 9,562.12 " " 6,632.17 " " 11,930.61 " " 6,963.78 " " 6,632.17 " " 6,632.17 " " 6,632.17 " " 7,063.26 " " 6,632.17 " " 6,632.17 " " 9,948.26 " " 11,930.61 " " 11,814.55 " Inpatient OTHER DISORDERS OF THE LIVER 283.3 " 35,996.44 " " 11,342.48 " " 9,984.87 " " 17,961.78 " " 10,484.11 " " 9,984.87 " " 9,984.87 " " 9,984.87 " " 10,633.89 " " 9,984.87 " " 9,984.87 " " 14,977.31 " " 17,961.78 " " 17,787.05 " Inpatient OTHER DISORDERS OF THE LIVER 283.4 " 33,403.61 " " 10,525.48 " " 21,331.13 " " 38,372.57 " " 22,397.69 " " 21,331.13 " " 21,331.13 " " 21,331.13 " " 22,717.65 " " 21,331.13 " " 21,331.13 " " 31,996.70 " " 38,372.57 " " 37,999.27 " Inpatient DISORDERS OF GALLBLADDER & BILIARY TRACT 284.2 " 41,743.63 " " 13,153.42 " " 8,278.15 " " 14,891.56 " " 8,692.06 " " 8,278.15 " " 8,278.15 " " 8,278.15 " " 8,816.23 " " 8,278.15 " " 8,278.15 " " 12,417.23 " " 14,891.56 " " 14,746.70 " Inpatient DISORDERS OF GALLBLADDER & BILIARY TRACT 284.3 " 74,450.31 " " 23,459.29 " " 11,819.74 " " 21,262.53 " " 12,410.73 " " 11,819.74 " " 11,819.74 " " 11,819.74 " " 12,588.02 " " 11,819.74 " " 11,819.74 " " 17,729.61 " " 21,262.53 " " 21,055.68 " Inpatient DISORDERS OF GALLBLADDER & BILIARY TRACT 284.4 " 127,870.18 " " 40,291.89 " " 22,097.53 " " 39,751.25 " " 23,202.41 " " 22,097.53 " " 22,097.53 " " 22,097.53 " " 23,533.87 " " 22,097.53 " " 22,097.53 " " 33,146.30 " " 39,751.25 " " 39,364.54 " Inpatient HIP JOINT REPLACEMENT 301.1 " 83,969.71 " " 26,458.85 " " 14,594.11 " " 26,253.34 " " 15,323.82 " " 14,594.11 " " 14,594.11 " " 14,594.11 " " 15,542.73 " " 14,594.11 " " 14,594.11 " " 21,891.17 " " 26,253.34 " " 25,997.95 " Inpatient HIP JOINT REPLACEMENT 301.2 " 100,226.83 " " 31,581.47 " " 15,464.53 " " 27,819.14 " " 16,237.76 " " 15,464.53 " " 15,464.53 " " 15,464.53 " " 16,469.72 " " 15,464.53 " " 15,464.53 " " 23,196.80 " " 27,819.14 " " 27,548.51 " Inpatient HIP JOINT REPLACEMENT 301.3 " 75,354.32 " " 23,744.15 " " 22,154.12 " " 39,853.05 " " 23,261.83 " " 22,154.12 " " 22,154.12 " " 22,154.12 " " 23,594.14 " " 22,154.12 " " 22,154.12 " " 33,231.18 " " 39,853.05 " " 39,465.35 " Inpatient HIP JOINT REPLACEMENT 301.4 " 142,137.98 " " 44,787.68 " " 32,781.40 " " 58,970.46 " " 34,420.47 " " 32,781.40 " " 32,781.40 " " 32,781.40 " " 34,912.19 " " 32,781.40 " " 32,781.40 " " 49,172.10 " " 58,970.46 " " 58,396.79 " Inpatient KNEE JOINT REPLACEMENT 302.2 " 116,510.38 " " 36,712.42 " " 15,106.71 " " 27,175.46 " " 15,862.05 " " 15,106.71 " " 15,106.71 " " 15,106.71 " " 16,088.65 " " 15,106.71 " " 15,106.71 " " 22,660.07 " " 27,175.46 " " 26,911.09 " Inpatient KNEE JOINT REPLACEMENT 302.3 " 407,973.66 " " 128,552.50 " " 21,504.21 " " 38,683.92 " " 22,579.42 " " 21,504.21 " " 21,504.21 " " 21,504.21 " " 22,901.98 " " 21,504.21 " " 21,504.21 " " 32,256.32 " " 38,683.92 " " 38,307.60 " Inpatient DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK 303.1 " 209,141.68 " " 65,900.54 " " 41,913.33 " " 75,397.89 " " 44,009.00 " " 41,913.33 " " 41,913.33 " " 41,913.33 " " 44,637.70 " " 41,913.33 " " 41,913.33 " " 62,870.00 " " 75,397.89 " " 74,664.41 " Inpatient DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK 303.2 " 295,703.73 " " 93,176.25 " " 51,979.75 " " 93,506.37 " " 54,578.74 " " 51,979.75 " " 51,979.75 " " 51,979.75 " " 55,358.43 " " 51,979.75 " " 51,979.75 " " 77,969.63 " " 93,506.37 " " 92,596.73 " Inpatient DORSAL & LUMBAR FUSION PROC FOR CURVATURE OF BACK 303.3 " 423,282.73 " " 133,376.39 " " 75,380.42 " " 135,601.84 " " 79,149.44 " " 75,380.42 " " 75,380.42 " " 75,380.42 " " 80,280.15 " " 75,380.42 " " 75,380.42 " " 113,070.63 " " 135,601.84 " " 134,282.68 " Inpatient DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK 304.1 " 162,169.41 " " 51,099.58 " " 25,500.99 " " 45,873.73 " " 26,776.04 " " 25,500.99 " " 25,500.99 " " 25,500.99 " " 27,158.55 " " 25,500.99 " " 25,500.99 " " 38,251.49 " " 45,873.73 " " 45,427.46 " Inpatient DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK 304.2 " 179,656.50 " " 56,609.76 " " 31,089.66 " " 55,927.19 " " 32,644.14 " " 31,089.66 " " 31,089.66 " " 31,089.66 " " 33,110.49 " " 31,089.66 " " 31,089.66 " " 46,634.49 " " 55,927.19 " " 55,383.12 " Inpatient DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK 304.3 " 207,311.96 " " 65,324.00 " " 48,423.18 " " 87,108.46 " " 50,844.34 " " 48,423.18 " " 48,423.18 " " 48,423.18 " " 51,570.69 " " 48,423.18 " " 48,423.18 " " 72,634.77 " " 87,108.46 " " 86,261.05 " Inpatient DORSAL & LUMBAR FUSION PROC EXCEPT FOR CURVATURE OF BACK 304.4 " 346,768.04 " " 109,266.61 " " 73,880.90 " " 132,904.35 " " 77,574.95 " " 73,880.90 " " 73,880.90 " " 73,880.90 " " 78,683.16 " " 73,880.90 " " 73,880.90 " " 110,821.35 " " 132,904.35 " " 131,611.44 " Inpatient AMPUTATION OF LOWER LIMB EXCEPT TOES 305.2 " 73,339.31 " " 23,109.22 " " 13,226.06 " " 23,792.36 " " 13,887.36 " " 13,226.06 " " 13,226.06 " " 13,226.06 " " 14,085.75 " " 13,226.06 " " 13,226.06 " " 19,839.09 " " 23,792.36 " " 23,560.90 " Inpatient AMPUTATION OF LOWER LIMB EXCEPT TOES 305.3 " 143,894.38 " " 45,341.12 " " 21,425.16 " " 38,541.72 " " 22,496.42 " " 21,425.16 " " 21,425.16 " " 21,425.16 " " 22,817.80 " " 21,425.16 " " 21,425.16 " " 32,137.74 " " 38,541.72 " " 38,166.78 " Inpatient HIP & FEMUR FRACTURE REPAIR 308.1 " 71,883.28 " " 22,650.42 " " 12,398.92 " " 22,304.42 " " 13,018.87 " " 12,398.92 " " 12,398.92 " " 12,398.92 " " 13,204.85 " " 12,398.92 " " 12,398.92 " " 18,598.38 " " 22,304.42 " " 22,087.44 " Inpatient HIP & FEMUR FRACTURE REPAIR 308.2 " 95,667.53 " " 30,144.84 " " 14,656.52 " " 26,365.61 " " 15,389.35 " " 14,656.52 " " 14,656.52 " " 14,656.52 " " 15,609.19 " " 14,656.52 " " 14,656.52 " " 21,984.78 " " 26,365.61 " " 26,109.12 " Inpatient HIP & FEMUR FRACTURE REPAIR 308.3 " 103,846.73 " " 32,722.11 " " 19,227.47 " " 34,588.30 " " 20,188.84 " " 19,227.47 " " 19,227.47 " " 19,227.47 " " 20,477.26 " " 19,227.47 " " 19,227.47 " " 28,841.21 " " 34,588.30 " " 34,251.82 " Inpatient HIP & FEMUR FRACTURE REPAIR 308.4 " 218,972.62 " " 68,998.27 " " 29,726.61 " " 53,475.20 " " 31,212.94 " " 29,726.61 " " 29,726.61 " " 29,726.61 " " 31,658.84 " " 29,726.61 " " 29,726.61 " " 44,589.92 " " 53,475.20 " " 52,954.98 " Inpatient OTHER SIGNIFICANT HIP & FEMUR SURGERY 309.1 " 72,590.24 " " 22,873.18 " " 13,385.00 " " 24,078.28 " " 14,054.25 " " 13,385.00 " " 13,385.00 " " 13,385.00 " " 14,255.03 " " 13,385.00 " " 13,385.00 " " 20,077.50 " " 24,078.28 " " 23,844.04 " Inpatient OTHER SIGNIFICANT HIP & FEMUR SURGERY 309.2 " 100,895.76 " " 31,792.25 " " 17,484.97 " " 31,453.71 " " 18,359.22 " " 17,484.97 " " 17,484.97 " " 17,484.97 " " 18,621.49 " " 17,484.97 " " 17,484.97 " " 26,227.46 " " 31,453.71 " " 31,147.73 " Inpatient OTHER SIGNIFICANT HIP & FEMUR SURGERY 309.3 " 147,712.02 " " 46,544.06 " " 24,207.01 " " 43,545.99 " " 25,417.36 " " 24,207.01 " " 24,207.01 " " 24,207.01 " " 25,780.47 " " 24,207.01 " " 24,207.01 " " 36,310.52 " " 43,545.99 " " 43,122.37 " Inpatient OTHER SIGNIFICANT HIP & FEMUR SURGERY 309.4 " 109,737.04 " " 34,578.14 " " 41,832.61 " " 75,252.68 " " 43,924.24 " " 41,832.61 " " 41,832.61 " " 41,832.61 " " 44,551.73 " " 41,832.61 " " 41,832.61 " " 62,748.92 " " 75,252.68 " " 74,520.61 " Inpatient INTERVERTEBRAL DISC EXCISION & DECOMPRESSION 310.1 " 126,981.71 " " 40,011.94 " " 10,638.10 " " 19,136.88 " " 11,170.01 " " 10,638.10 " " 10,638.10 " " 10,638.10 " " 11,329.58 " " 10,638.10 " " 10,638.10 " " 15,957.15 " " 19,136.88 " " 18,950.71 " Inpatient INTERVERTEBRAL DISC EXCISION & DECOMPRESSION 310.2 " 76,920.50 " " 24,237.65 " " 13,595.54 " " 24,457.02 " " 14,275.32 " " 13,595.54 " " 13,595.54 " " 13,595.54 " " 14,479.25 " " 13,595.54 " " 13,595.54 " " 20,393.31 " " 24,457.02 " " 24,219.09 " Inpatient "SKIN GRAFT, EXCEPT HAND, FOR MUSCULOSKELETAL & CONNECTIVE TISSU " 312.4 " 558,250.45 " " 175,904.72 " " 61,581.00 " " 110,778.06 " " 64,660.05 " " 61,581.00 " " 61,581.00 " " 61,581.00 " " 65,583.77 " " 61,581.00 " " 61,581.00 " " 92,371.50 " " 110,778.06 " " 109,700.39 " Inpatient KNEE & LOWER LEG PROCEDURES EXCEPT FOOT 313.1 " 167,021.32 " " 52,628.42 " " 11,209.78 " " 20,165.27 " " 11,770.27 " " 11,209.78 " " 11,209.78 " " 11,209.78 " " 11,938.42 " " 11,209.78 " " 11,209.78 " " 16,814.67 " " 20,165.27 " " 19,969.10 " Inpatient KNEE & LOWER LEG PROCEDURES EXCEPT FOOT 313.2 " 132,090.82 " " 41,621.82 " " 15,107.54 " " 27,176.95 " " 15,862.92 " " 15,107.54 " " 15,107.54 " " 15,107.54 " " 16,089.53 " " 15,107.54 " " 15,107.54 " " 22,661.31 " " 27,176.95 " " 26,912.57 " Inpatient KNEE & LOWER LEG PROCEDURES EXCEPT FOOT 313.3 " 231,214.08 " " 72,855.56 " " 22,158.28 " " 39,860.53 " " 23,266.19 " " 22,158.28 " " 22,158.28 " " 22,158.28 " " 23,598.57 " " 22,158.28 " " 22,158.28 " " 33,237.42 " " 39,860.53 " " 39,472.76 " Inpatient KNEE & LOWER LEG PROCEDURES EXCEPT FOOT 313.4 " 220,883.55 " " 69,600.41 " " 37,863.29 " " 68,112.27 " " 39,756.45 " " 37,863.29 " " 37,863.29 " " 37,863.29 " " 40,324.40 " " 37,863.29 " " 37,863.29 " " 56,794.94 " " 68,112.27 " " 67,449.66 " Inpatient FOOT & TOE PROCEDURES 314.2 " 122,861.65 " " 38,713.71 " " 10,923.53 " " 19,650.34 " " 11,469.71 " " 10,923.53 " " 10,923.53 " " 10,923.53 " " 11,633.56 " " 10,923.53 " " 10,923.53 " " 16,385.30 " " 19,650.34 " " 19,459.18 " Inpatient FOOT & TOE PROCEDURES 314.3 " 128,718.96 " " 40,559.35 " " 15,628.46 " " 28,114.04 " " 16,409.88 " " 15,628.46 " " 15,628.46 " " 15,628.46 " " 16,644.31 " " 15,628.46 " " 15,628.46 " " 23,442.69 " " 28,114.04 " " 27,840.54 " Inpatient "SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLAC " 315.1 " 157,588.96 " " 49,656.28 " " 8,487.85 " " 15,268.79 " " 8,912.24 " " 8,487.85 " " 8,487.85 " " 8,487.85 " " 9,039.56 " " 8,487.85 " " 8,487.85 " " 12,731.78 " " 15,268.79 " " 15,120.26 " Inpatient "SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLAC " 315.2 " 85,068.34 " " 26,805.03 " " 13,723.69 " " 24,687.55 " " 14,409.87 " " 13,723.69 " " 13,723.69 " " 13,723.69 " " 14,615.73 " " 13,723.69 " " 13,723.69 " " 20,585.54 " " 24,687.55 " " 24,447.38 " Inpatient "SHOULDER, UPPER ARM & FOREARM PROCEDURES EXCEPT JOINT REPLAC " 315.3 " 105,559.48 " " 33,261.79 " " 20,023.83 " " 36,020.87 " " 21,025.02 " " 20,023.83 " " 20,023.83 " " 20,023.83 " " 21,325.38 " " 20,023.83 " " 20,023.83 " " 30,035.75 " " 36,020.87 " " 35,670.45 " Inpatient HAND & WRIST PROCEDURES 316.3 " 218,650.00 " " 68,896.62 " " 17,375.96 " " 31,257.61 " " 18,244.76 " " 17,375.96 " " 17,375.96 " " 17,375.96 " " 18,505.40 " " 17,375.96 " " 17,375.96 " " 26,063.94 " " 31,257.61 " " 30,953.54 " Inpatient "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES " 317.1 " 44,153.84 " " 13,912.87 " " 9,230.12 " " 16,604.06 " " 9,691.63 " " 9,230.12 " " 9,230.12 " " 9,230.12 " " 9,830.08 " " 9,230.12 " " 9,230.12 " " 13,845.18 " " 16,604.06 " " 16,442.54 " Inpatient "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES " 317.2 " 77,631.65 " " 24,461.73 " " 12,477.14 " " 22,445.13 " " 13,101.00 " " 12,477.14 " " 12,477.14 " " 12,477.14 " " 13,288.15 " " 12,477.14 " " 12,477.14 " " 18,715.71 " " 22,445.13 " " 22,226.78 " Inpatient "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES " 317.3 " 192,844.17 " " 60,765.20 " " 19,930.63 " " 35,853.21 " " 20,927.16 " " 19,930.63 " " 19,930.63 " " 19,930.63 " " 21,226.12 " " 19,930.63 " " 19,930.63 " " 29,895.95 " " 35,853.21 " " 35,504.42 " Inpatient "TENDON, MUSCLE & OTHER SOFT TISSUE PROCEDURES " 317.4 " 269,786.37 " " 85,009.69 " " 39,664.05 " " 71,351.66 " " 41,647.25 " " 39,664.05 " " 39,664.05 " " 39,664.05 " " 42,242.21 " " 39,664.05 " " 39,664.05 " " 59,496.08 " " 71,351.66 " " 70,657.54 " Inpatient OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES 320.1 " 75,676.62 " " 23,845.70 " " 10,125.50 " " 18,214.76 " " 10,631.78 " " 10,125.50 " " 10,125.50 " " 10,125.50 " " 10,783.66 " " 10,125.50 " " 10,125.50 " " 15,188.25 " " 18,214.76 " " 18,037.57 " Inpatient OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES 320.2 " 64,437.26 " " 20,304.18 " " 14,242.11 " " 25,620.13 " " 14,954.22 " " 14,242.11 " " 14,242.11 " " 14,242.11 " " 15,167.85 " " 14,242.11 " " 14,242.11 " " 21,363.17 " " 25,620.13 " " 25,370.89 " Inpatient OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES 320.3 " 103,320.93 " " 32,556.42 " " 21,853.71 " " 39,312.64 " " 22,946.40 " " 21,853.71 " " 21,853.71 " " 21,853.71 " " 23,274.20 " " 21,853.71 " " 21,853.71 " " 32,780.57 " " 39,312.64 " " 38,930.20 " Inpatient OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE PROCEDURES 320.4 " 92,991.04 " " 29,301.48 " " 38,283.52 " " 68,868.22 " " 40,197.70 " " 38,283.52 " " 38,283.52 " " 38,283.52 " " 40,771.95 " " 38,283.52 " " 38,283.52 " " 57,425.28 " " 68,868.22 " " 68,198.26 " Inpatient CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DEC 321.1 " 116,796.81 " " 36,802.67 " " 15,853.97 " " 28,519.71 " " 16,646.67 " " 15,853.97 " " 15,853.97 " " 15,853.97 " " 16,884.48 " " 15,853.97 " " 15,853.97 " " 23,780.96 " " 28,519.71 " " 28,242.26 " Inpatient CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DEC 321.2 " 111,706.93 " " 35,198.85 " " 19,923.14 " " 35,839.74 " " 20,919.30 " " 19,923.14 " " 19,923.14 " " 19,923.14 " " 21,218.14 " " 19,923.14 " " 19,923.14 " " 29,884.71 " " 35,839.74 " " 35,491.08 " Inpatient CERVICAL SPINAL FUSION & OTHER BACK/NECK PROC EXC DISC EXCIS/DEC 321.3 " 323,233.72 " " 101,850.95 " " 29,896.37 " " 53,780.58 " " 31,391.19 " " 29,896.37 " " 29,896.37 " " 29,896.37 " " 31,839.63 " " 29,896.37 " " 29,896.37 " " 44,844.56 " " 53,780.58 " " 53,257.39 " Inpatient SHOULDER & ELBOW JOINT REPLACEMENT 322.2 " 97,508.91 " " 30,725.06 " " 17,683.02 " " 31,809.98 " " 18,567.17 " " 17,683.02 " " 17,683.02 " " 17,683.02 " " 18,832.42 " " 17,683.02 " " 17,683.02 " " 26,524.53 " " 31,809.98 " " 31,500.53 " Inpatient FRACTURE OF FEMUR 340.2 " 8,244.12 " " 2,597.72 " " 5,207.54 " " 9,367.84 " " 5,467.92 " " 5,207.54 " " 5,207.54 " " 5,207.54 " " 5,546.03 " " 5,207.54 " " 5,207.54 " " 7,811.31 " " 9,367.84 " " 9,276.71 " Inpatient FRACTURE OF FEMUR 340.3 " 10,897.76 " " 3,433.88 " " 7,857.92 " " 14,135.61 " " 8,250.82 " " 7,857.92 " " 7,857.92 " " 7,857.92 " " 8,368.68 " " 7,857.92 " " 7,857.92 " " 11,786.88 " " 14,135.61 " " 13,998.10 " Inpatient "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK " 342.1 " 8,096.00 " " 2,551.05 " " 5,225.02 " " 9,399.29 " " 5,486.27 " " 5,225.02 " " 5,225.02 " " 5,225.02 " " 5,564.65 " " 5,225.02 " " 5,225.02 " " 7,837.53 " " 9,399.29 " " 9,307.85 " Inpatient "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK " 342.2 " 22,036.00 " " 6,943.54 " " 6,386.69 " " 11,489.02 " " 6,706.02 " " 6,386.69 " " 6,386.69 " " 6,386.69 " " 6,801.82 " " 6,386.69 " " 6,386.69 " " 9,580.04 " " 11,489.02 " " 11,377.25 " Inpatient "FRACTURES & DISLOCATIONS EXCEPT FEMUR, PELVIS & BACK " 342.3 " 33,883.27 " " 10,676.62 " " 9,098.64 " " 16,367.54 " " 9,553.57 " " 9,098.64 " " 9,098.64 " " 9,098.64 " " 9,690.05 " " 9,098.64 " " 9,098.64 " " 13,647.96 " " 16,367.54 " " 16,208.32 " Inpatient MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALI 343.2 " 47,055.43 " " 14,827.17 " " 9,582.95 " " 17,238.77 " " 10,062.10 " " 9,582.95 " " 9,582.95 " " 9,582.95 " " 10,205.84 " " 9,582.95 " " 9,582.95 " " 14,374.43 " " 17,238.77 " " 17,071.07 " Inpatient MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALI 343.3 " 54,664.38 " " 17,224.74 " " 14,269.57 " " 25,669.53 " " 14,983.05 " " 14,269.57 " " 14,269.57 " " 14,269.57 " " 15,197.09 " " 14,269.57 " " 14,269.57 " " 21,404.36 " " 25,669.53 " " 25,419.81 " Inpatient MUSCULOSKELETAL MALIGNANCY & PATHOL FRACTURE D/T MUSCSKEL MALI 343.4 " 48,378.13 " " 15,243.95 " " 25,418.61 " " 45,725.54 " " 26,689.54 " " 25,418.61 " " 25,418.61 " " 25,418.61 " " 27,070.82 " " 25,418.61 " " 25,418.61 " " 38,127.92 " " 45,725.54 " " 45,280.71 " Inpatient "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIO " 344.1 " 65,207.63 " " 20,546.92 " " 6,648.81 " " 11,960.54 " " 6,981.25 " " 6,648.81 " " 6,648.81 " " 6,648.81 " " 7,080.98 " " 6,648.81 " " 6,648.81 " " 9,973.22 " " 11,960.54 " " 11,844.19 " Inpatient "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIO " 344.2 " 47,425.94 " " 14,943.91 " " 8,353.87 " " 15,027.78 " " 8,771.56 " " 8,353.87 " " 8,353.87 " " 8,353.87 " " 8,896.87 " " 8,353.87 " " 8,353.87 " " 12,530.81 " " 15,027.78 " " 14,881.58 " Inpatient "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIO " 344.3 " 51,599.09 " " 16,258.87 " " 12,050.25 " " 21,677.19 " " 12,652.76 " " 12,050.25 " " 12,050.25 " " 12,050.25 " " 12,833.52 " " 12,050.25 " " 12,050.25 " " 18,075.38 " " 21,677.19 " " 21,466.32 " Inpatient "OSTEOMYELITIS, SEPTIC ARTHRITIS & OTHER MUSCULOSKELETAL INFECTIO " 344.4 " 216,369.90 " " 68,178.15 " " 22,799.03 " " 41,013.18 " " 23,938.98 " " 22,799.03 " " 22,799.03 " " 22,799.03 " " 24,280.97 " " 22,799.03 " " 22,799.03 " " 34,198.55 " " 41,013.18 " " 40,614.19 " Inpatient CONNECTIVE TISSUE DISORDERS 346.1 " 47,492.12 " " 14,964.77 " " 6,916.76 " " 12,442.56 " " 7,262.60 " " 6,916.76 " " 6,916.76 " " 6,916.76 " " 7,366.35 " " 6,916.76 " " 6,916.76 " " 10,375.14 " " 12,442.56 " " 12,321.52 " Inpatient CONNECTIVE TISSUE DISORDERS 346.2 " 44,928.08 " " 14,156.84 " " 9,009.60 " " 16,207.37 " " 9,460.08 " " 9,009.60 " " 9,009.60 " " 9,009.60 " " 9,595.22 " " 9,009.60 " " 9,009.60 " " 13,514.40 " " 16,207.37 " " 16,049.70 " Inpatient CONNECTIVE TISSUE DISORDERS 346.3 " 48,981.47 " " 15,434.06 " " 14,338.64 " " 25,793.78 " " 15,055.57 " " 14,338.64 " " 14,338.64 " " 14,338.64 " " 15,270.65 " " 14,338.64 " " 14,338.64 " " 21,507.96 " " 25,793.78 " " 25,542.85 " Inpatient CONNECTIVE TISSUE DISORDERS 346.4 " 302,597.62 " " 95,348.51 " " 32,728.98 " " 58,876.16 " " 34,365.43 " " 32,728.98 " " 32,728.98 " " 32,728.98 " " 34,856.36 " " 32,728.98 " " 32,728.98 " " 49,093.47 " " 58,876.16 " " 58,303.40 " Inpatient "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES " 347.1 " 16,064.30 " " 5,061.86 " " 6,249.39 " " 11,242.03 " " 6,561.86 " " 6,249.39 " " 6,249.39 " " 6,249.39 " " 6,655.60 " " 6,249.39 " " 6,249.39 " " 9,374.09 " " 11,242.03 " " 11,132.66 " Inpatient "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES " 347.2 " 22,476.59 " " 7,082.37 " " 7,451.83 " " 13,405.10 " " 7,824.42 " " 7,451.83 " " 7,451.83 " " 7,451.83 " " 7,936.20 " " 7,451.83 " " 7,451.83 " " 11,177.75 " " 13,405.10 " " 13,274.69 " Inpatient "OTHER BACK & NECK DISORDERS, FRACTURES & INJURIES " 347.3 " 41,209.15 " " 12,985.00 " " 10,011.50 " " 18,009.69 " " 10,512.08 " " 10,011.50 " " 10,011.50 " " 10,011.50 " " 10,662.25 " " 10,011.50 " " 10,011.50 " " 15,017.25 " " 18,009.69 " " 17,834.49 " Inpatient "MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCED " 349.2 " 24,281.51 " " 7,651.10 " " 7,025.77 " " 12,638.66 " " 7,377.06 " " 7,025.77 " " 7,025.77 " " 7,025.77 " " 7,482.45 " " 7,025.77 " " 7,025.77 " " 10,538.66 " " 12,638.66 " " 12,515.71 " Inpatient "MALFUNCTION, REACTION, COMPLIC OF ORTHOPEDIC DEVICE OR PROCED " 349.3 " 89,102.79 " " 28,076.29 " " 10,587.34 " " 19,045.57 " " 11,116.71 " " 10,587.34 " " 10,587.34 " " 10,587.34 " " 11,275.52 " " 10,587.34 " " 10,587.34 " " 15,881.01 " " 19,045.57 " " 18,860.29 " Inpatient OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 351.1 " 18,999.23 " " 5,986.66 " " 5,172.59 " " 9,304.97 " " 5,431.22 " " 5,172.59 " " 5,172.59 " " 5,172.59 " " 5,508.81 " " 5,172.59 " " 5,172.59 " " 7,758.89 " " 9,304.97 " " 9,214.45 " Inpatient OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 351.2 " 59,029.30 " " 18,600.13 " " 6,092.94 " " 10,960.59 " " 6,397.59 " " 6,092.94 " " 6,092.94 " " 6,092.94 " " 6,488.98 " " 6,092.94 " " 6,092.94 " " 9,139.41 " " 10,960.59 " " 10,853.96 " Inpatient OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 351.3 " 79,060.82 " " 24,912.06 " " 10,182.92 " " 18,318.05 " " 10,692.07 " " 10,182.92 " " 10,182.92 " " 10,182.92 " " 10,844.81 " " 10,182.92 " " 10,182.92 " " 15,274.38 " " 18,318.05 " " 18,139.85 " Inpatient OTHER MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE DIAGNOSES 351.4 " 113,028.96 " " 35,615.42 " " 19,571.98 " " 35,208.03 " " 20,550.58 " " 19,571.98 " " 19,571.98 " " 19,571.98 " " 20,844.16 " " 19,571.98 " " 19,571.98 " " 29,357.97 " " 35,208.03 " " 34,865.53 " Inpatient SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES 361.2 " 80,067.12 " " 25,229.15 " " 13,447.41 " " 24,190.55 " " 14,119.78 " " 13,447.41 " " 13,447.41 " " 13,447.41 " " 14,321.49 " " 13,447.41 " " 13,447.41 " " 20,171.12 " " 24,190.55 " " 23,955.22 " Inpatient SKIN GRAFT FOR SKIN & SUBCUTANEOUS TISSUE DIAGNOSES 361.3 " 200,582.79 " " 63,203.64 " " 22,035.95 " " 39,640.47 " " 23,137.75 " " 22,035.95 " " 22,035.95 " " 22,035.95 " " 23,468.29 " " 22,035.95 " " 22,035.95 " " 33,053.93 " " 39,640.47 " " 39,254.84 " Inpatient MASTECTOMY PROCEDURES 362.1 " 141,973.27 " " 44,735.78 " " 10,330.21 " " 18,583.01 " " 10,846.72 " " 10,330.21 " " 10,330.21 " " 10,330.21 " " 11,001.67 " " 10,330.21 " " 10,330.21 " " 15,495.32 " " 18,583.01 " " 18,402.24 " Inpatient MASTECTOMY PROCEDURES 362.2 " 112,379.04 " " 35,410.64 " " 13,107.07 " " 23,578.31 " " 13,762.42 " " 13,107.07 " " 13,107.07 " " 13,107.07 " " 13,959.03 " " 13,107.07 " " 13,107.07 " " 19,660.61 " " 23,578.31 " " 23,348.93 " Inpatient "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES " 364.2 " 59,887.21 " " 18,870.46 " " 10,661.40 " " 19,178.79 " " 11,194.47 " " 10,661.40 " " 10,661.40 " " 10,661.40 " " 11,354.39 " " 10,661.40 " " 10,661.40 " " 15,992.10 " " 19,178.79 " " 18,992.22 " Inpatient "OTHER SKIN, SUBCUTANEOUS TISSUE & RELATED PROCEDURES " 364.3 " 93,659.68 " " 29,512.17 " " 17,396.76 " " 31,295.03 " " 18,266.60 " " 17,396.76 " " 17,396.76 " " 17,396.76 " " 18,527.55 " " 17,396.76 " " 17,396.76 " " 26,095.14 " " 31,295.03 " " 30,990.59 " Inpatient SKIN ULCERS 380.2 " 21,662.99 " " 6,826.01 " " 6,851.03 " " 12,324.32 " " 7,193.58 " " 6,851.03 " " 6,851.03 " " 6,851.03 " " 7,296.35 " " 6,851.03 " " 6,851.03 " " 10,276.55 " " 12,324.32 " " 12,204.42 " Inpatient SKIN ULCERS 380.3 " 74,524.65 " " 23,482.72 " " 9,935.78 " " 17,873.47 " " 10,432.57 " " 9,935.78 " " 9,935.78 " " 9,935.78 " " 10,581.61 " " 9,935.78 " " 9,935.78 " " 14,903.67 " " 17,873.47 " " 17,699.60 " Inpatient SKIN ULCERS 380.4 " 202,510.32 " " 63,811.00 " " 20,673.74 " " 37,189.99 " " 21,707.43 " " 20,673.74 " " 20,673.74 " " 20,673.74 " " 22,017.53 " " 20,673.74 " " 20,673.74 " " 31,010.61 " " 37,189.99 " " 36,828.20 " Inpatient MAJOR SKIN DISORDERS 381.1 " 16,549.36 " " 5,214.70 " " 4,144.90 " " 7,456.26 " " 4,352.15 " " 4,144.90 " " 4,144.90 " " 4,144.90 " " 4,414.32 " " 4,144.90 " " 4,144.90 " " 6,217.35 " " 7,456.26 " " 7,383.72 " Inpatient MAJOR SKIN DISORDERS 381.2 " 29,794.31 " " 9,388.19 " " 7,076.54 " " 12,729.99 " " 7,430.37 " " 7,076.54 " " 7,076.54 " " 7,076.54 " " 7,536.52 " " 7,076.54 " " 7,076.54 " " 10,614.81 " " 12,729.99 " " 12,606.15 " Inpatient CELLULITIS & OTHER SKIN INFECTIONS 383.1 " 15,426.67 " " 4,860.94 " " 4,203.15 " " 7,561.05 " " 4,413.31 " " 4,203.15 " " 4,203.15 " " 4,203.15 " " 4,476.35 " " 4,203.15 " " 4,203.15 " " 6,304.73 " " 7,561.05 " " 7,487.49 " Inpatient CELLULITIS & OTHER SKIN INFECTIONS 383.2 " 28,828.27 " " 9,083.79 " " 5,834.98 " " 10,496.55 " " 6,126.73 " " 5,834.98 " " 5,834.98 " " 5,834.98 " " 6,214.25 " " 5,834.98 " " 5,834.98 " " 8,752.47 " " 10,496.55 " " 10,394.43 " Inpatient CELLULITIS & OTHER SKIN INFECTIONS 383.3 " 61,802.70 " " 19,474.03 " " 8,943.03 " " 16,087.62 " " 9,390.18 " " 8,943.03 " " 8,943.03 " " 8,943.03 " " 9,524.33 " " 8,943.03 " " 8,943.03 " " 13,414.55 " " 16,087.62 " " 15,931.11 " Inpatient CELLULITIS & OTHER SKIN INFECTIONS 383.4 " 106,319.92 " " 33,501.41 " " 18,201.44 " " 32,742.57 " " 19,111.51 " " 18,201.44 " " 18,201.44 " " 18,201.44 " " 19,384.53 " " 18,201.44 " " 18,201.44 " " 27,302.16 " " 32,742.57 " " 32,424.05 " Inpatient "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOU " 384.2 " 45,689.13 " " 14,396.64 " " 6,808.59 " " 12,247.97 " " 7,149.02 " " 6,808.59 " " 6,808.59 " " 6,808.59 " " 7,251.15 " " 6,808.59 " " 6,808.59 " " 10,212.89 " " 12,247.97 " " 12,128.82 " Inpatient "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOU " 384.3 " 168,022.47 " " 52,943.88 " " 10,412.59 " " 18,731.21 " " 10,933.22 " " 10,412.59 " " 10,412.59 " " 10,412.59 " " 11,089.41 " " 10,412.59 " " 10,412.59 " " 15,618.89 " " 18,731.21 " " 18,548.99 " Inpatient "CONTUSION, OPEN WOUND & OTHER TRAUMA TO SKIN & SUBCUTANEOU " 384.4 " 43,253.76 " " 13,629.26 " " 19,288.22 " " 34,697.58 " " 20,252.63 " " 19,288.22 " " 19,288.22 " " 19,288.22 " " 20,541.95 " " 19,288.22 " " 19,288.22 " " 28,932.33 " " 34,697.58 " " 34,360.04 " Inpatient "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS " 385.1 " 26,195.47 " " 8,254.19 " " 4,198.16 " " 7,552.07 " " 4,408.07 " " 4,198.16 " " 4,198.16 " " 4,198.16 " " 4,471.04 " " 4,198.16 " " 4,198.16 " " 6,297.24 " " 7,552.07 " " 7,478.60 " Inpatient "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS " 385.2 " 13,532.83 " " 4,264.19 " " 5,839.97 " " 10,505.52 " " 6,131.97 " " 5,839.97 " " 5,839.97 " " 5,839.97 " " 6,219.57 " " 5,839.97 " " 5,839.97 " " 8,759.96 " " 10,505.52 " " 10,403.32 " Inpatient "OTHER SKIN, SUBCUTANEOUS TISSUE & BREAST DISORDERS " 385.3 " 22,115.17 " " 6,968.49 " " 9,227.62 " " 16,599.57 " " 9,689.00 " " 9,227.62 " " 9,227.62 " " 9,227.62 " " 9,827.42 " " 9,227.62 " " 9,227.62 " " 13,841.43 " " 16,599.57 " " 16,438.08 " Inpatient PROCEDURES FOR OBESITY 403.1 " 45,533.61 " " 14,347.64 " " 9,771.01 " " 17,577.07 " " 10,259.56 " " 9,771.01 " " 9,771.01 " " 9,771.01 " " 10,406.13 " " 9,771.01 " " 9,771.01 " " 14,656.52 " " 17,577.07 " " 17,406.08 " Inpatient PROCEDURES FOR OBESITY 403.2 " 51,560.80 " " 16,246.81 " " 11,923.76 " " 21,449.65 " " 12,519.95 " " 11,923.76 " " 11,923.76 " " 11,923.76 " " 12,698.80 " " 11,923.76 " " 11,923.76 " " 17,885.64 " " 21,449.65 " " 21,240.99 " Inpatient DIABETES 420.1 " 58,790.57 " " 18,524.91 " " 4,421.17 " " 7,953.24 " " 4,642.23 " " 4,421.17 " " 4,421.17 " " 4,421.17 " " 4,708.55 " " 4,421.17 " " 4,421.17 " " 6,631.76 " " 7,953.24 " " 7,875.87 " Inpatient DIABETES 420.2 " 27,791.09 " " 8,756.97 " " 5,331.53 " " 9,590.89 " " 5,598.11 " " 5,331.53 " " 5,331.53 " " 5,331.53 " " 5,678.08 " " 5,331.53 " " 5,331.53 " " 7,997.30 " " 9,590.89 " " 9,497.59 " Inpatient DIABETES 420.3 " 53,452.49 " " 16,842.88 " " 8,075.94 " " 14,527.81 " " 8,479.74 " " 8,075.94 " " 8,075.94 " " 8,075.94 " " 8,600.88 " " 8,075.94 " " 8,075.94 " " 12,113.91 " " 14,527.81 " " 14,386.48 " Inpatient DIABETES 420.4 " 108,905.02 " " 34,315.97 " " 17,455.01 " " 31,399.82 " " 18,327.76 " " 17,455.01 " " 17,455.01 " " 17,455.01 " " 18,589.59 " " 17,455.01 " " 17,455.01 " " 26,182.52 " " 31,399.82 " " 31,094.35 " Inpatient "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS " 421.1 " 23,659.91 " " 7,455.24 " " 4,651.67 " " 8,367.89 " " 4,884.25 " " 4,651.67 " " 4,651.67 " " 4,651.67 " " 4,954.03 " " 4,651.67 " " 4,651.67 " " 6,977.51 " " 8,367.89 " " 8,286.48 " Inpatient "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS " 421.2 " 37,282.66 " " 11,747.77 " " 6,638.83 " " 11,942.59 " " 6,970.77 " " 6,638.83 " " 6,638.83 " " 6,638.83 " " 7,070.35 " " 6,638.83 " " 6,638.83 " " 9,958.25 " " 11,942.59 " " 11,826.41 " Inpatient "MALNUTRITION, FAILURE TO THRIVE & OTHER NUTRITIONAL DISORDERS " 421.3 " 74,359.38 " " 23,430.64 " " 10,746.28 " " 19,331.48 " " 11,283.59 " " 10,746.28 " " 10,746.28 " " 10,746.28 " " 11,444.79 " " 10,746.28 " " 10,746.28 " " 16,119.42 " " 19,331.48 " " 19,143.42 " Inpatient HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS 422.1 " 34,667.13 " " 10,923.61 " " 3,817.04 " " 6,866.47 " " 4,007.89 " " 3,817.04 " " 3,817.04 " " 3,817.04 " " 4,065.15 " " 3,817.04 " " 3,817.04 " " 5,725.56 " " 6,866.47 " " 6,799.68 " Inpatient HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS 422.2 " 25,667.76 " " 8,087.91 " " 5,064.42 " " 9,110.39 " " 5,317.64 " " 5,064.42 " " 5,064.42 " " 5,064.42 " " 5,393.61 " " 5,064.42 " " 5,064.42 " " 7,596.63 " " 9,110.39 " " 9,021.76 " Inpatient HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS 422.3 " 59,163.44 " " 18,642.40 " " 7,600.79 " " 13,673.06 " " 7,980.83 " " 7,600.79 " " 7,600.79 " " 7,600.79 " " 8,094.84 " " 7,600.79 " " 7,600.79 " " 11,401.19 " " 13,673.06 " " 13,540.05 " Inpatient HYPOVOLEMIA & RELATED ELECTROLYTE DISORDERS 422.4 " 71,736.62 " " 22,604.21 " " 15,211.56 " " 27,364.08 " " 15,972.14 " " 15,211.56 " " 15,211.56 " " 15,211.56 " " 16,200.31 " " 15,211.56 " " 15,211.56 " " 22,817.34 " " 27,364.08 " " 27,097.87 " Inpatient INBORN ERRORS OF METABOLISM 423.2 " 24,983.00 " " 7,872.14 " " 12,155.93 " " 21,867.30 " " 12,763.73 " " 12,155.93 " " 12,155.93 " " 12,155.93 " " 12,946.07 " " 12,155.93 " " 12,155.93 " " 18,233.90 " " 21,867.30 " " 21,654.57 " Inpatient OTHER ENDOCRINE DISORDERS 424.1 " 30,407.42 " " 9,581.38 " " 5,444.71 " " 9,794.49 " " 5,716.95 " " 5,444.71 " " 5,444.71 " " 5,444.71 " " 5,798.62 " " 5,444.71 " " 5,444.71 " " 8,167.07 " " 9,794.49 " " 9,699.21 " Inpatient OTHER ENDOCRINE DISORDERS 424.2 " 44,137.99 " " 13,907.88 " " 7,278.75 " " 13,093.74 " " 7,642.69 " " 7,278.75 " " 7,278.75 " " 7,278.75 " " 7,751.87 " " 7,278.75 " " 7,278.75 " " 10,918.13 " " 13,093.74 " " 12,966.37 " Inpatient OTHER ENDOCRINE DISORDERS 424.3 " 46,542.60 " " 14,665.57 " " 11,498.54 " " 20,684.72 " " 12,073.47 " " 11,498.54 " " 11,498.54 " " 11,498.54 " " 12,245.95 " " 11,498.54 " " 11,498.54 " " 17,247.81 " " 20,684.72 " " 20,483.50 " Inpatient OTHER ENDOCRINE DISORDERS 424.4 " 58,144.71 " " 18,321.40 " " 24,561.50 " " 44,183.68 " " 25,789.58 " " 24,561.50 " " 24,561.50 " " 24,561.50 " " 26,158.00 " " 24,561.50 " " 24,561.50 " " 36,842.25 " " 44,183.68 " " 43,753.86 " Inpatient OTHER NON-HYPOVOLEMIC ELECTROLYTE DISORDERS 425.3 " 57,714.16 " " 18,185.73 " " 7,884.55 " " 14,183.52 " " 8,278.78 " " 7,884.55 " " 7,884.55 " " 7,884.55 " " 8,397.05 " " 7,884.55 " " 7,884.55 " " 11,826.83 " " 14,183.52 " " 14,045.54 " Inpatient NON-HYPOVOLEMIC SODIUM DISORDERS 426.2 " 26,631.44 " " 8,391.57 " " 6,141.21 " " 11,047.42 " " 6,448.27 " " 6,141.21 " " 6,141.21 " " 6,141.21 " " 6,540.39 " " 6,141.21 " " 6,141.21 " " 9,211.82 " " 11,047.42 " " 10,939.95 " Inpatient NON-HYPOVOLEMIC SODIUM DISORDERS 426.3 " 81,609.52 " " 25,715.16 " " 9,153.56 " " 16,466.34 " " 9,611.24 " " 9,153.56 " " 9,153.56 " " 9,153.56 " " 9,748.54 " " 9,153.56 " " 9,153.56 " " 13,730.34 " " 16,466.34 " " 16,306.15 " Inpatient NON-HYPOVOLEMIC SODIUM DISORDERS 426.4 " 45,401.86 " " 14,306.13 " " 18,423.62 " " 33,142.25 " " 19,344.80 " " 18,423.62 " " 18,423.62 " " 18,423.62 " " 19,621.16 " " 18,423.62 " " 18,423.62 " " 27,635.43 " " 33,142.25 " " 32,819.84 " Inpatient THYROID DISORDERS 427.2 " 22,838.75 " " 7,196.49 " " 6,608.87 " " 11,888.70 " " 6,939.31 " " 6,608.87 " " 6,608.87 " " 6,608.87 " " 7,038.45 " " 6,608.87 " " 6,608.87 " " 9,913.31 " " 11,888.70 " " 11,773.04 " Inpatient MAJOR BLADDER PROCEDURES 441.2 " 44,000.60 " " 13,864.59 " " 21,966.05 " " 39,514.73 " " 23,064.35 " " 21,966.05 " " 21,966.05 " " 21,966.05 " " 23,393.84 " " 21,966.05 " " 21,966.05 " " 32,949.08 " " 39,514.73 " " 39,130.32 " Inpatient MAJOR BLADDER PROCEDURES 441.3 " 163,490.21 " " 51,515.77 " " 29,807.33 " " 53,620.41 " " 31,297.70 " " 29,807.33 " " 29,807.33 " " 29,807.33 " " 31,744.81 " " 29,807.33 " " 29,807.33 " " 44,711.00 " " 53,620.41 " " 53,098.78 " Inpatient KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY 442.1 " 65,341.39 " " 20,589.07 " " 13,305.95 " " 23,936.07 " " 13,971.25 " " 13,305.95 " " 13,305.95 " " 13,305.95 " " 14,170.84 " " 13,305.95 " " 13,305.95 " " 19,958.93 " " 23,936.07 " " 23,703.22 " Inpatient KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY 442.2 " 53,944.86 " " 16,998.03 " " 15,620.97 " " 28,100.56 " " 16,402.02 " " 15,620.97 " " 15,620.97 " " 15,620.97 " " 16,636.33 " " 15,620.97 " " 15,620.97 " " 23,431.46 " " 28,100.56 " " 27,827.20 " Inpatient KIDNEY & URINARY TRACT PROCEDURES FOR MALIGNANCY 442.3 " 330,525.03 " " 104,148.44 " " 24,420.87 " " 43,930.70 " " 25,641.91 " " 24,420.87 " " 24,420.87 " " 24,420.87 " " 26,008.23 " " 24,420.87 " " 24,420.87 " " 36,631.31 " " 43,930.70 " " 43,503.34 " Inpatient KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY 443.1 " 48,971.72 " " 15,430.99 " " 10,887.75 " " 19,585.97 " " 11,432.14 " " 10,887.75 " " 10,887.75 " " 10,887.75 " " 11,595.45 " " 10,887.75 " " 10,887.75 " " 16,331.63 " " 19,585.97 " " 19,395.44 " Inpatient KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY 443.2 " 54,684.39 " " 17,231.05 " " 13,470.71 " " 24,232.46 " " 14,144.25 " " 13,470.71 " " 13,470.71 " " 13,470.71 " " 14,346.31 " " 13,470.71 " " 13,470.71 " " 20,206.07 " " 24,232.46 " " 23,996.72 " Inpatient KIDNEY & URINARY TRACT PROCEDURES FOR NONMALIGNANCY 443.3 " 80,984.77 " " 25,518.30 " " 21,425.16 " " 38,541.72 " " 22,496.42 " " 21,425.16 " " 21,425.16 " " 21,425.16 " " 22,817.80 " " 21,425.16 " " 21,425.16 " " 32,137.74 " " 38,541.72 " " 38,166.78 " Inpatient OTHER BLADDER PROCEDURES 445.1 " 52,495.09 " " 16,541.20 " " 9,378.24 " " 16,870.52 " " 9,847.15 " " 9,378.24 " " 9,378.24 " " 9,378.24 " " 9,987.83 " " 9,378.24 " " 9,378.24 " " 14,067.36 " " 16,870.52 " " 16,706.40 " Inpatient OTHER BLADDER PROCEDURES 445.2 " 138,808.32 " " 43,738.50 " " 12,977.25 " " 23,344.78 " " 13,626.11 " " 12,977.25 " " 12,977.25 " " 12,977.25 " " 13,820.77 " " 12,977.25 " " 12,977.25 " " 19,465.88 " " 23,344.78 " " 23,117.67 " Inpatient OTHER BLADDER PROCEDURES 445.4 " 165,101.43 " " 52,023.46 " " 36,784.00 " " 66,170.74 " " 38,623.20 " " 36,784.00 " " 36,784.00 " " 36,784.00 " " 39,174.96 " " 36,784.00 " " 36,784.00 " " 55,176.00 " " 66,170.74 " " 65,527.02 " Inpatient URETHRAL & TRANSURETHRAL PROCEDURES 446.2 " 141,305.82 " " 44,525.46 " " 10,337.70 " " 18,596.49 " " 10,854.59 " " 10,337.70 " " 10,337.70 " " 10,337.70 " " 11,009.65 " " 10,337.70 " " 10,337.70 " " 15,506.55 " " 18,596.49 " " 18,415.58 " Inpatient "OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES " 447.1 " 13,855.89 " " 4,365.99 " " 13,018.86 " " 23,419.63 " " 13,669.80 " " 13,018.86 " " 13,018.86 " " 13,018.86 " " 13,865.09 " " 13,018.86 " " 13,018.86 " " 19,528.29 " " 23,419.63 " " 23,191.80 " Inpatient "OTHER KIDNEY, URINARY TRACT & RELATED PROCEDURES " 447.4 " 540,868.42 " " 170,427.64 " " 49,634.77 " " 89,287.99 " " 52,116.51 " " 49,634.77 " " 49,634.77 " " 49,634.77 " " 52,861.03 " " 49,634.77 " " 49,634.77 " " 74,452.16 " " 89,287.99 " " 88,419.38 " Inpatient KIDNEY & URINARY TRACT MALIGNANCY 461.3 " 34,017.90 " " 10,719.04 " " 12,656.05 " " 22,766.97 " " 13,288.85 " " 12,656.05 " " 12,656.05 " " 12,656.05 " " 13,478.69 " " 12,656.05 " " 12,656.05 " " 18,984.08 " " 22,766.97 " " 22,545.49 " Inpatient NEPHRITIS & NEPHROSIS 462.1 " 19,691.17 " " 6,204.69 " " 4,792.31 " " 8,620.89 " " 5,031.93 " " 4,792.31 " " 4,792.31 " " 4,792.31 " " 5,103.81 " " 4,792.31 " " 4,792.31 " " 7,188.47 " " 8,620.89 " " 8,537.02 " Inpatient NEPHRITIS & NEPHROSIS 462.2 " 35,653.03 " " 11,234.27 " " 6,616.36 " " 11,902.17 " " 6,947.18 " " 6,616.36 " " 6,616.36 " " 6,616.36 " " 7,046.42 " " 6,616.36 " " 6,616.36 " " 9,924.54 " " 11,902.17 " " 11,786.38 " Inpatient NEPHRITIS & NEPHROSIS 462.3 " 66,493.09 " " 20,951.97 " " 13,366.70 " " 24,045.36 " " 14,035.04 " " 13,366.70 " " 13,366.70 " " 13,366.70 " " 14,235.54 " " 13,366.70 " " 13,366.70 " " 20,050.05 " " 24,045.36 " " 23,811.44 " Inpatient KIDNEY & URINARY TRACT INFECTIONS 463.1 " 28,469.13 " " 8,970.62 " " 4,747.37 " " 8,540.04 " " 4,984.74 " " 4,747.37 " " 4,747.37 " " 4,747.37 " " 5,055.95 " " 4,747.37 " " 4,747.37 " " 7,121.06 " " 8,540.04 " " 8,456.96 " Inpatient KIDNEY & URINARY TRACT INFECTIONS 463.2 " 27,659.59 " " 8,715.54 " " 5,802.53 " " 10,438.17 " " 6,092.66 " " 5,802.53 " " 5,802.53 " " 5,802.53 " " 6,179.69 " " 5,802.53 " " 5,802.53 " " 8,703.80 " " 10,438.17 " " 10,336.63 " Inpatient KIDNEY & URINARY TRACT INFECTIONS 463.3 " 67,807.67 " " 21,366.20 " " 7,979.41 " " 14,354.16 " " 8,378.38 " " 7,979.41 " " 7,979.41 " " 7,979.41 " " 8,498.07 " " 7,979.41 " " 7,979.41 " " 11,969.12 " " 14,354.16 " " 14,214.52 " Inpatient KIDNEY & URINARY TRACT INFECTIONS 463.4 " 87,196.41 " " 27,475.59 " " 15,009.35 " " 27,000.32 " " 15,759.82 " " 15,009.35 " " 15,009.35 " " 15,009.35 " " 15,984.96 " " 15,009.35 " " 15,009.35 " " 22,514.03 " " 27,000.32 " " 26,737.66 " Inpatient URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION 465.1 " 106,014.81 " " 33,405.27 " " 5,300.74 " " 9,535.50 " " 5,565.78 " " 5,300.74 " " 5,300.74 " " 5,300.74 " " 5,645.29 " " 5,300.74 " " 5,300.74 " " 7,951.11 " " 9,535.50 " " 9,442.74 " Inpatient URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION 465.2 " 74,909.63 " " 23,604.02 " " 6,403.33 " " 11,518.95 " " 6,723.50 " " 6,403.33 " " 6,403.33 " " 6,403.33 " " 6,819.55 " " 6,403.33 " " 6,403.33 " " 9,605.00 " " 11,518.95 " " 11,406.89 " Inpatient URINARY STONES & ACQUIRED UPPER URINARY TRACT OBSTRUCTION 465.3 " 66,678.36 " " 21,010.35 " " 10,470.84 " " 18,835.99 " " 10,994.38 " " 10,470.84 " " 10,470.84 " " 10,470.84 " " 11,151.44 " " 10,470.84 " " 10,470.84 " " 15,706.26 " " 18,835.99 " " 18,652.75 " Inpatient "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PRO " 466.2 " 53,105.59 " " 16,733.57 " " 6,380.86 " " 11,478.53 " " 6,699.90 " " 6,380.86 " " 6,380.86 " " 6,380.86 " " 6,795.62 " " 6,380.86 " " 6,380.86 " " 9,571.29 " " 11,478.53 " " 11,366.86 " Inpatient "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PRO " 466.3 " 42,182.21 " " 13,291.61 " " 9,863.38 " " 17,743.23 " " 10,356.55 " " 9,863.38 " " 9,863.38 " " 9,863.38 " " 10,504.50 " " 9,863.38 " " 9,863.38 " " 14,795.07 " " 17,743.23 " " 17,570.63 " Inpatient "MALFUNCTION, REACTION, COMPLIC OF GENITOURINARY DEVICE OR PRO " 466.4 " 75,916.84 " " 23,921.40 " " 16,567.12 " " 29,802.59 " " 17,395.48 " " 16,567.12 " " 16,567.12 " " 16,567.12 " " 17,643.98 " " 16,567.12 " " 16,567.12 " " 24,850.68 " " 29,802.59 " " 29,512.67 " Inpatient "OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS " 468.1 " 81,513.87 " " 25,685.02 " " 5,079.39 " " 9,137.31 " " 5,333.36 " " 5,079.39 " " 5,079.39 " " 5,079.39 " " 5,409.55 " " 5,079.39 " " 5,079.39 " " 7,619.09 " " 9,137.31 " " 9,048.43 " Inpatient "OTHER KIDNEY & URINARY TRACT DIAGNOSES, SIGNS & SYMPTOMS " 468.2 " 54,067.00 " " 17,036.51 " " 6,575.59 " " 11,828.83 " " 6,904.37 " " 6,575.59 " " 6,575.59 " " 6,575.59 " " 7,003.00 " " 6,575.59 " " 6,575.59 " " 9,863.39 " " 11,828.83 " " 11,713.76 " Inpatient ACUTE KIDNEY INJURY 469.1 " 26,252.12 " " 8,272.04 " " 4,638.36 " " 8,343.95 " " 4,870.28 " " 4,638.36 " " 4,638.36 " " 4,638.36 " " 4,939.85 " " 4,638.36 " " 4,638.36 " " 6,957.54 " " 8,343.95 " " 8,262.77 " Inpatient ACUTE KIDNEY INJURY 469.2 " 22,106.38 " " 6,965.72 " " 6,158.68 " " 11,078.85 " " 6,466.61 " " 6,158.68 " " 6,158.68 " " 6,158.68 " " 6,558.99 " " 6,158.68 " " 6,158.68 " " 9,238.02 " " 11,078.85 " " 10,971.07 " Inpatient ACUTE KIDNEY INJURY 469.3 " 46,114.62 " " 14,530.72 " " 9,790.15 " " 17,611.50 " " 10,279.66 " " 9,790.15 " " 9,790.15 " " 9,790.15 " " 10,426.51 " " 9,790.15 " " 9,790.15 " " 14,685.23 " " 17,611.50 " " 17,440.17 " Inpatient ACUTE KIDNEY INJURY 469.4 " 120,468.12 " " 37,959.50 " " 19,305.69 " " 34,729.01 " " 20,270.97 " " 19,305.69 " " 19,305.69 " " 19,305.69 " " 20,560.56 " " 19,305.69 " " 19,305.69 " " 28,958.54 " " 34,729.01 " " 34,391.16 " Inpatient MAJOR MALE PELVIC PROCEDURES 480.1 " 106,280.73 " " 33,489.06 " " 11,497.71 " " 20,683.23 " " 12,072.60 " " 11,497.71 " " 11,497.71 " " 11,497.71 " " 12,245.06 " " 11,497.71 " " 11,497.71 " " 17,246.57 " " 20,683.23 " " 20,482.02 " Inpatient MAJOR MALE PELVIC PROCEDURES 480.2 " 107,415.21 " " 33,846.53 " " 12,671.03 " " 22,793.92 " " 13,304.58 " " 12,671.03 " " 12,671.03 " " 12,671.03 " " 13,494.65 " " 12,671.03 " " 12,671.03 " " 19,006.55 " " 22,793.92 " " 22,572.17 " Inpatient OTHER MALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 484.2 " 105,692.62 " " 33,303.74 " " 12,876.57 " " 23,163.66 " " 13,520.40 " " 12,876.57 " " 12,876.57 " " 12,876.57 " " 13,713.55 " " 12,876.57 " " 12,876.57 " " 19,314.86 " " 23,163.66 " " 22,938.32 " Inpatient MALE REPRODUCTIVE SYSTEM DIAGNOSES EXCEPT MALIGNANCY 501.2 " 41,143.09 " " 12,964.19 " " 5,977.28 " " 10,752.53 " " 6,276.14 " " 5,977.28 " " 5,977.28 " " 5,977.28 " " 6,365.80 " " 5,977.28 " " 5,977.28 " " 8,965.92 " " 10,752.53 " " 10,647.93 " Inpatient UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMY 513.1 " 77,466.47 " " 24,409.68 " " 8,439.58 " " 15,181.96 " " 8,861.56 " " 8,439.58 " " 8,439.58 " " 8,439.58 " " 8,988.15 " " 8,439.58 " " 8,439.58 " " 12,659.37 " " 15,181.96 " " 15,034.27 " Inpatient UTERINE & ADNEXA PROCEDURES FOR NON-MALIGNANCY EXCEPT LEIOMY 513.2 " 91,790.98 " " 28,923.34 " " 9,933.28 " " 17,868.98 " " 10,429.94 " " 9,933.28 " " 9,933.28 " " 9,933.28 " " 10,578.94 " " 9,933.28 " " 9,933.28 " " 14,899.92 " " 17,868.98 " " 17,695.14 " Inpatient OTHER FEMALE REPRODUCTIVE SYSTEM & RELATED PROCEDURES 518.1 " 54,740.50 " " 17,248.73 " " 7,650.71 " " 13,762.86 " " 8,033.25 " " 7,650.71 " " 7,650.71 " " 7,650.71 " " 8,148.01 " " 7,650.71 " " 7,650.71 " " 11,476.07 " " 13,762.86 " " 13,628.97 " Inpatient UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA 519.1 " 41,965.67 " " 13,223.38 " " 5,800.03 " " 10,433.67 " " 6,090.03 " " 5,800.03 " " 5,800.03 " " 5,800.03 " " 6,177.03 " " 5,800.03 " " 5,800.03 " " 8,700.05 " " 10,433.67 " " 10,332.17 " Inpatient UTERINE & ADNEXA PROCEDURES FOR LEIOMYOMA 519.2 " 55,870.76 " " 17,604.88 " " 7,476.80 " " 13,450.02 " " 7,850.64 " " 7,476.80 " " 7,476.80 " " 7,476.80 " " 7,962.79 " " 7,476.80 " " 7,476.80 " " 11,215.20 " " 13,450.02 " " 13,319.17 " Inpatient FEMALE REPRODUCTIVE SYSTEM MALIGNANCY 530.1 " 54,412.00 " " 17,145.22 " " 6,480.72 " " 11,658.17 " " 6,804.76 " " 6,480.72 " " 6,480.72 " " 6,480.72 " " 6,901.97 " " 6,480.72 " " 6,480.72 " " 9,721.08 " " 11,658.17 " " 11,544.75 " Inpatient FEMALE REPRODUCTIVE SYSTEM MALIGNANCY 530.2 " 44,663.80 " " 14,073.56 " " 7,681.50 " " 13,818.25 " " 8,065.58 " " 7,681.50 " " 7,681.50 " " 7,681.50 " " 8,180.80 " " 7,681.50 " " 7,681.50 " " 11,522.25 " " 13,818.25 " " 13,683.82 " Inpatient FEMALE REPRODUCTIVE SYSTEM MALIGNANCY 530.3 " 85,693.64 " " 27,002.07 " " 11,250.56 " " 20,238.63 " " 11,813.09 " " 11,250.56 " " 11,250.56 " " 11,250.56 " " 11,981.85 " " 11,250.56 " " 11,250.56 " " 16,875.84 " " 20,238.63 " " 20,041.75 " Inpatient FEMALE REPRODUCTIVE SYSTEM INFECTIONS 531.1 " 24,841.49 " " 7,827.55 " " 4,157.38 " " 7,478.71 " " 4,365.25 " " 4,157.38 " " 4,157.38 " " 4,157.38 " " 4,427.61 " " 4,157.38 " " 4,157.38 " " 6,236.07 " " 7,478.71 " " 7,405.96 " Inpatient FEMALE REPRODUCTIVE SYSTEM INFECTIONS 531.2 " 21,531.96 " " 6,784.72 " " 5,755.93 " " 10,354.34 " " 6,043.73 " " 5,755.93 " " 5,755.93 " " 5,755.93 " " 6,130.07 " " 5,755.93 " " 5,755.93 " " 8,633.90 " " 10,354.34 " " 10,253.61 " Inpatient MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS 532.2 " 20,355.89 " " 6,414.14 " " 5,253.31 " " 9,450.18 " " 5,515.98 " " 5,253.31 " " 5,253.31 " " 5,253.31 " " 5,594.78 " " 5,253.31 " " 5,253.31 " " 7,879.97 " " 9,450.18 " " 9,358.25 " Inpatient MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS 532.3 " 33,898.54 " " 10,681.43 " " 8,802.40 " " 15,834.64 " " 9,242.52 " " 8,802.40 " " 8,802.40 " " 8,802.40 " " 9,374.56 " " 8,802.40 " " 8,802.40 " " 13,203.60 " " 15,834.64 " " 15,680.60 " Inpatient CESAREAN SECTION W STERILIZATION 539.1 " 28,132.04 " " 8,864.41 " " 4,736.55 " " 8,520.58 " " 4,973.38 " " 4,736.55 " " 4,736.55 " " 4,736.55 " " 5,044.43 " " 4,736.55 " " 4,736.55 " " 7,104.83 " " 8,520.58 " " 8,437.69 " Inpatient CESAREAN SECTION W STERILIZATION 539.2 " 38,192.67 " " 12,034.51 " " 5,442.21 " " 9,789.99 " " 5,714.32 " " 5,442.21 " " 5,442.21 " " 5,442.21 " " 5,795.95 " " 5,442.21 " " 5,442.21 " " 8,163.32 " " 9,789.99 " " 9,694.75 " Inpatient CESAREAN SECTION W STERILIZATION 539.3 " 38,737.54 " " 12,206.20 " " 9,446.48 " " 16,993.27 " " 9,918.80 " " 9,446.48 " " 9,446.48 " " 9,446.48 " " 10,060.50 " " 9,446.48 " " 9,446.48 " " 14,169.72 " " 16,993.27 " " 16,827.96 " Inpatient CESAREAN SECTION W STERILIZATION 539.4 " 105,825.95 " " 33,345.76 " " 21,077.32 " " 37,915.99 " " 22,131.19 " " 21,077.32 " " 21,077.32 " " 21,077.32 " " 22,447.35 " " 21,077.32 " " 21,077.32 " " 31,615.98 " " 37,915.99 " " 37,547.14 " Inpatient CESAREAN SECTION W/O STERILIZATION 540.1 " 26,114.74 " " 8,228.76 " " 4,516.87 " " 8,125.40 " " 4,742.71 " " 4,516.87 " " 4,516.87 " " 4,516.87 " " 4,810.47 " " 4,516.87 " " 4,516.87 " " 6,775.31 " " 8,125.40 " " 8,046.35 " Inpatient CESAREAN SECTION W/O STERILIZATION 540.2 " 31,709.72 " " 9,991.73 " " 5,334.86 " " 9,596.88 " " 5,601.60 " " 5,334.86 " " 5,334.86 " " 5,334.86 " " 5,681.63 " " 5,334.86 " " 5,334.86 " " 8,002.29 " " 9,596.88 " " 9,503.52 " Inpatient CESAREAN SECTION W/O STERILIZATION 540.3 " 41,722.89 " " 13,146.88 " " 7,810.48 " " 14,050.27 " " 8,201.00 " " 7,810.48 " " 7,810.48 " " 7,810.48 " " 8,318.16 " " 7,810.48 " " 7,810.48 " " 11,715.72 " " 14,050.27 " " 13,913.59 " Inpatient CESAREAN SECTION W/O STERILIZATION 540.4 " 149,927.48 " " 47,242.15 " " 15,310.58 " " 27,542.20 " " 16,076.11 " " 15,310.58 " " 15,310.58 " " 15,310.58 " " 16,305.77 " " 15,310.58 " " 15,310.58 " " 22,965.87 " " 27,542.20 " " 27,274.27 " Inpatient VAGINAL DELIVERY W O.R. PROCEDURE EXCEPT STERILIZATION &/OR D&C 542.1 " 27,336.17 " " 8,613.63 " " 3,278.64 " " 5,897.95 " " 3,442.57 " " 3,278.64 " " 3,278.64 " " 3,278.64 " " 3,491.75 " " 3,278.64 " " 3,278.64 " " 4,917.96 " " 5,897.95 " " 5,840.57 " Inpatient VAGINAL DELIVERY W O.R. PROCEDURE EXCEPT STERILIZATION &/OR D&C 542.2 " 32,123.54 " " 10,122.13 " " 3,833.68 " " 6,896.41 " " 4,025.36 " " 3,833.68 " " 3,833.68 " " 3,833.68 " " 4,082.87 " " 3,833.68 " " 3,833.68 " " 5,750.52 " " 6,896.41 " " 6,829.32 " Inpatient VAGINAL DELIVERY W O.R. PROCEDURE EXCEPT STERILIZATION &/OR D&C 542.3 " 86,886.15 " " 27,377.83 " " 6,265.20 " " 11,270.47 " " 6,578.46 " " 6,265.20 " " 6,265.20 " " 6,265.20 " " 6,672.44 " " 6,265.20 " " 6,265.20 " " 9,397.80 " " 11,270.47 " " 11,160.83 " Inpatient VAGINAL DELIVERY 560.1 " 24,220.83 " " 7,631.98 " " 2,837.60 " " 5,104.56 " " 2,979.48 " " 2,837.60 " " 2,837.60 " " 2,837.60 " " 3,022.04 " " 2,837.60 " " 2,837.60 " " 4,256.40 " " 5,104.56 " " 5,054.90 " Inpatient VAGINAL DELIVERY 560.2 " 27,735.23 " " 8,739.37 " " 3,048.14 " " 5,483.30 " " 3,200.55 " " 3,048.14 " " 3,048.14 " " 3,048.14 " " 3,246.27 " " 3,048.14 " " 3,048.14 " " 4,572.21 " " 5,483.30 " " 5,429.96 " Inpatient VAGINAL DELIVERY 560.3 " 37,380.99 " " 11,778.75 " " 4,312.99 " " 7,758.64 " " 4,528.64 " " 4,312.99 " " 4,312.99 " " 4,312.99 " " 4,593.33 " " 4,312.99 " " 4,312.99 " " 6,469.49 " " 7,758.64 " " 7,683.16 " Inpatient VAGINAL DELIVERY 560.4 " 42,320.50 " " 13,335.19 " " 6,622.19 " " 11,912.66 " " 6,953.30 " " 6,622.19 " " 6,622.19 " " 6,622.19 " " 7,052.63 " " 6,622.19 " " 6,622.19 " " 9,933.29 " " 11,912.66 " " 11,796.77 " Inpatient POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE 561.1 " 23,078.07 " " 7,271.90 " " 2,646.21 " " 4,760.27 " " 2,778.52 " " 2,646.21 " " 2,646.21 " " 2,646.21 " " 2,818.21 " " 2,646.21 " " 2,646.21 " " 3,969.32 " " 4,760.27 " " 4,713.96 " Inpatient POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE 561.2 " 18,457.09 " " 5,815.83 " " 3,368.51 " " 6,059.61 " " 3,536.94 " " 3,368.51 " " 3,368.51 " " 3,368.51 " " 3,587.46 " " 3,368.51 " " 3,368.51 " " 5,052.77 " " 6,059.61 " " 6,000.66 " Inpatient POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE 561.3 " 58,417.44 " " 18,407.34 " " 5,379.80 " " 9,677.72 " " 5,648.79 " " 5,379.80 " " 5,379.80 " " 5,379.80 " " 5,729.49 " " 5,379.80 " " 5,379.80 " " 8,069.70 " " 9,677.72 " " 9,583.58 " Inpatient POSTPARTUM & POST ABORTION DIAGNOSES W/O PROCEDURE 561.4 " 35,523.41 " " 11,193.42 " " 11,719.89 " " 21,082.91 " " 12,305.88 " " 11,719.89 " " 11,719.89 " " 11,719.89 " " 12,481.68 " " 11,719.89 " " 11,719.89 " " 17,579.84 " " 21,082.91 " " 20,877.81 " Inpatient ANTEPARTUM W/O O.R. PROCEDURE 566.1 " 15,987.78 " " 5,037.75 " " 2,759.38 " " 4,963.85 " " 2,897.35 " " 2,759.38 " " 2,759.38 " " 2,759.38 " " 2,938.74 " " 2,759.38 " " 2,759.38 " " 4,139.07 " " 4,963.85 " " 4,915.56 " Inpatient ANTEPARTUM W/O O.R. PROCEDURE 566.2 " 25,355.37 " " 7,989.48 " " 3,490.84 " " 6,279.67 " " 3,665.38 " " 3,490.84 " " 3,490.84 " " 3,490.84 " " 3,717.74 " " 3,490.84 " " 3,490.84 " " 5,236.26 " " 6,279.67 " " 6,218.58 " Inpatient ANTEPARTUM W/O O.R. PROCEDURE 566.3 " 34,871.63 " " 10,988.05 " " 5,220.86 " " 9,391.81 " " 5,481.90 " " 5,220.86 " " 5,220.86 " " 5,220.86 " " 5,560.22 " " 5,220.86 " " 5,220.86 " " 7,831.29 " " 9,391.81 " " 9,300.44 " Inpatient ANTEPARTUM W/O O.R. PROCEDURE 566.4 " 51,894.45 " " 16,351.94 " " 10,529.92 " " 18,942.27 " " 11,056.42 " " 10,529.92 " " 10,529.92 " " 10,529.92 " " 11,214.36 " " 10,529.92 " " 10,529.92 " " 15,794.88 " " 18,942.27 " " 18,758.00 " Inpatient NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE 593.2 " 753,406.55 " " 237,398.40 " " 118,725.03 " " 213,574.46 " " 124,661.28 " " 118,725.03 " " 118,725.03 " " 118,725.03 " " 126,442.16 " " 118,725.03 " " 118,725.03 " " 178,087.55 " " 213,574.46 " " 211,496.77 " Inpatient NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE 593.3 " 792,507.38 " " 249,719.08 " " 138,472.59 " " 249,098.34 " " 145,396.22 " " 138,472.59 " " 138,472.59 " " 138,472.59 " " 147,473.31 " " 138,472.59 " " 138,472.59 " " 207,708.89 " " 249,098.34 " " 246,675.07 " Inpatient NEONATE BIRTHWT 750-999G W/O MAJOR PROCEDURE 593.4 " 1,215,376.77 " " 382,965.22 " " 180,786.18 " " 325,216.26 " " 189,825.49 " " 180,786.18 " " 180,786.18 " " 180,786.18 " " 192,537.28 " " 180,786.18 " " 180,786.18 " " 271,179.27 " " 325,216.26 " " 322,052.50 " Inpatient NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ AN 602.2 " 753,815.31 " " 237,527.20 " " 85,802.99 " " 154,351.00 " " 90,093.14 " " 85,802.99 " " 85,802.99 " " 85,802.99 " " 91,380.18 " " 85,802.99 " " 85,802.99 " " 128,704.49 " " 154,351.00 " " 152,849.45 " Inpatient NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ AN 602.3 " 530,823.26 " " 167,262.41 " " 107,541.87 " " 193,457.07 " " 112,918.96 " " 107,541.87 " " 107,541.87 " " 107,541.87 " " 114,532.09 " " 107,541.87 " " 107,541.87 " " 161,312.81 " " 193,457.07 " " 191,575.09 " Inpatient NEONATE BWT 1000-1249G W RESP DIST SYND/OTH MAJ RESP OR MAJ AN 602.4 " 256,295.78 " " 80,758.80 " " 152,626.49 " " 274,559.79 " " 160,257.81 " " 152,626.49 " " 152,626.49 " " 152,626.49 " " 162,547.21 " " 152,626.49 " " 152,626.49 " " 228,939.74 " " 274,559.79 " " 271,888.83 " Inpatient NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND 612.1 " 148,558.78 " " 46,810.87 " " 30,063.63 " " 54,081.46 " " 31,566.81 " " 30,063.63 " " 30,063.63 " " 30,063.63 " " 32,017.77 " " 30,063.63 " " 30,063.63 " " 45,095.45 " " 54,081.46 " " 53,555.35 " Inpatient NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND 612.2 " 281,424.23 " " 88,676.77 " " 40,862.33 " " 73,507.25 " " 42,905.45 " " 40,862.33 " " 40,862.33 " " 40,862.33 " " 43,518.38 " " 40,862.33 " " 40,862.33 " " 61,293.50 " " 73,507.25 " " 72,792.15 " Inpatient NEONATE BWT 1500-1999G W RESP DIST SYND/OTH MAJ RESP COND 612.3 " 409,353.33 " " 128,987.23 " " 54,622.63 " " 98,260.65 " " 57,353.76 " " 54,622.63 " " 54,622.63 " " 54,622.63 " " 58,173.10 " " 54,622.63 " " 54,622.63 " " 81,933.95 " " 98,260.65 " " 97,304.75 " Inpatient NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION 614.1 " 122,826.15 " " 38,702.52 " " 16,635.35 " " 29,925.33 " " 17,467.12 " " 16,635.35 " " 16,635.35 " " 16,635.35 " " 17,716.65 " " 16,635.35 " " 16,635.35 " " 24,953.03 " " 29,925.33 " " 29,634.21 " Inpatient NEONATE BWT 1500-1999G W OR W/O OTHER SIGNIFICANT CONDITION 614.2 " 196,392.91 " " 61,883.41 " " 28,112.25 " " 50,571.13 " " 29,517.86 " " 28,112.25 " " 28,112.25 " " 28,112.25 " " 29,939.55 " " 28,112.25 " " 28,112.25 " " 42,168.38 " " 50,571.13 " " 50,079.16 " Inpatient NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND 622.1 " 129,377.50 " " 40,766.85 " " 18,719.03 " " 33,673.66 " " 19,654.98 " " 18,719.03 " " 18,719.03 " " 18,719.03 " " 19,935.77 " " 18,719.03 " " 18,719.03 " " 28,078.55 " " 33,673.66 " " 33,346.08 " Inpatient NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND 622.2 " 146,005.40 " " 46,006.30 " " 25,262.17 " " 45,444.12 " " 26,525.28 " " 25,262.17 " " 25,262.17 " " 25,262.17 " " 26,904.21 " " 25,262.17 " " 25,262.17 " " 37,893.26 " " 45,444.12 " " 45,002.03 " Inpatient NEONATE BWT 2000-2499G W RESP DIST SYND/OTH MAJ RESP COND 622.4 " 126,969.29 " " 40,008.02 " " 63,684.66 " " 114,562.33 " " 66,868.89 " " 63,684.66 " " 63,684.66 " " 63,684.66 " " 67,824.16 " " 63,684.66 " " 63,684.66 " " 95,526.99 " " 114,562.33 " " 113,447.85 " Inpatient NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION 625.1 " 107,478.52 " " 33,866.48 " " 15,741.63 " " 28,317.62 " " 16,528.71 " " 15,741.63 " " 15,741.63 " " 15,741.63 " " 16,764.84 " " 15,741.63 " " 15,741.63 " " 23,612.45 " " 28,317.62 " " 28,042.14 " Inpatient NEONATE BWT 2000-2499G W OTHER SIGNIFICANT CONDITION 625.2 " 116,644.73 " " 36,754.76 " " 22,250.64 " " 40,026.68 " " 23,363.17 " " 22,250.64 " " 22,250.64 " " 22,250.64 " " 23,696.93 " " 22,250.64 " " 22,250.64 " " 33,375.96 " " 40,026.68 " " 39,637.29 " Inpatient "NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER " 626.1 " 13,303.95 " " 4,192.08 " " 1,888.96 " " 3,398.05 " " 1,983.41 " " 1,888.96 " " 1,888.96 " " 1,888.96 " " 2,011.74 " " 1,888.96 " " 1,888.96 " " 2,833.44 " " 3,398.05 " " 3,364.99 " Inpatient "NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER " 626.2 " 14,346.21 " " 4,520.49 " " 3,404.29 " " 6,123.98 " " 3,574.50 " " 3,404.29 " " 3,404.29 " " 3,404.29 " " 3,625.57 " " 3,404.29 " " 3,404.29 " " 5,106.44 " " 6,123.98 " " 6,064.40 " Inpatient "NEONATE BWT 2000-2499G, NORMAL NEWBORN OR NEONATE W OTHER " 626.3 " 83,205.65 " " 26,218.10 " " 9,517.21 " " 17,120.51 " " 9,993.07 " " 9,517.21 " " 9,517.21 " " 9,517.21 " " 10,135.83 " " 9,517.21 " " 9,517.21 " " 14,275.82 " " 17,120.51 " " 16,953.96 " Inpatient NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE 630.3 " 339,037.80 " " 106,830.81 " " 88,752.94 " " 159,657.66 " " 93,190.59 " " 88,752.94 " " 88,752.94 " " 88,752.94 " " 94,521.88 " " 88,752.94 " " 88,752.94 " " 133,129.41 " " 159,657.66 " " 158,104.49 " Inpatient NEONATE BIRTHWT >2499G W MAJOR CARDIOVASCULAR PROCEDURE 630.4 " 1,272,720.88 " " 401,034.35 " " 155,670.47 " " 280,035.61 " " 163,453.99 " " 155,670.47 " " 155,670.47 " " 155,670.47 " " 165,789.05 " " 155,670.47 " " 155,670.47 " " 233,505.71 " " 280,035.61 " " 277,311.38 " Inpatient NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE 631.2 " 250,407.34 " " 78,903.35 " " 37,929.86 " " 68,232.03 " " 39,826.35 " " 37,929.86 " " 37,929.86 " " 37,929.86 " " 40,395.30 " " 37,929.86 " " 37,929.86 " " 56,894.79 " " 68,232.03 " " 67,568.25 " Inpatient NEONATE BIRTHWT >2499G W OTHER MAJOR PROCEDURE 631.3 " 232,967.45 " " 73,408.04 " " 66,664.56 " " 119,922.88 " " 69,997.79 " " 66,664.56 " " 66,664.56 " " 66,664.56 " " 70,997.76 " " 66,664.56 " " 66,664.56 " " 99,996.84 " " 119,922.88 " " 118,756.25 " Inpatient NEONATE BIRTHWT >2499G W MAJOR ANOMALY 633.1 " 28,243.39 " " 8,899.49 " " 5,042.78 " " 9,071.46 " " 5,294.92 " " 5,042.78 " " 5,042.78 " " 5,042.78 " " 5,370.56 " " 5,042.78 " " 5,042.78 " " 7,564.17 " " 9,071.46 " " 8,983.21 " Inpatient NEONATE BIRTHWT >2499G W MAJOR ANOMALY 633.2 " 108,725.14 " " 34,259.29 " " 15,868.12 " " 28,545.16 " " 16,661.53 " " 15,868.12 " " 15,868.12 " " 15,868.12 " " 16,899.55 " " 15,868.12 " " 15,868.12 " " 23,802.18 " " 28,545.16 " " 28,267.47 " Inpatient NEONATE BIRTHWT >2499G W MAJOR ANOMALY 633.3 " 293,028.49 " " 92,333.28 " " 35,802.08 " " 64,404.36 " " 37,592.18 " " 35,802.08 " " 35,802.08 " " 35,802.08 " " 38,129.22 " " 35,802.08 " " 35,802.08 " " 53,703.12 " " 64,404.36 " " 63,777.83 " Inpatient NEONATE BIRTHWT >2499G W MAJOR ANOMALY 633.4 " 389,446.62 " " 122,714.63 " " 82,828.92 " " 149,000.94 " " 86,970.37 " " 82,828.92 " " 82,828.92 " " 82,828.92 " " 88,212.80 " " 82,828.92 " " 82,828.92 " " 124,243.38 " " 149,000.94 " " 147,551.44 " Inpatient "NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND " 634.1 " 61,591.58 " " 19,407.51 " " 8,321.42 " " 14,969.40 " " 8,737.49 " " 8,321.42 " " 8,321.42 " " 8,321.42 " " 8,862.31 " " 8,321.42 " " 8,321.42 " " 12,482.13 " " 14,969.40 " " 14,823.78 " Inpatient "NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND " 634.2 " 120,833.88 " " 38,074.75 " " 14,829.60 " " 26,676.97 " " 15,571.08 " " 14,829.60 " " 14,829.60 " " 14,829.60 " " 15,793.52 " " 14,829.60 " " 14,829.60 " " 22,244.40 " " 26,676.97 " " 26,417.45 " Inpatient "NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND " 634.3 " 184,860.61 " " 58,249.58 " " 22,149.12 " " 39,844.05 " " 23,256.58 " " 22,149.12 " " 22,149.12 " " 22,149.12 " " 23,588.81 " " 22,149.12 " " 22,149.12 " " 33,223.68 " " 39,844.05 " " 39,456.44 " Inpatient "NEONATE, BIRTHWT >2499G W RESP DIST SYND/OTH MAJ RESP COND " 634.4 " 159,530.82 " " 50,268.16 " " 55,390.70 " " 99,642.33 " " 58,160.24 " " 55,390.70 " " 55,390.70 " " 55,390.70 " " 58,991.10 " " 55,390.70 " " 55,390.70 " " 83,086.05 " " 99,642.33 " " 98,672.99 " Inpatient NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION 639.1 " 107,163.79 " " 33,767.31 " " 7,734.76 " " 13,914.06 " " 8,121.50 " " 7,734.76 " " 7,734.76 " " 7,734.76 " " 8,237.52 " " 7,734.76 " " 7,734.76 " " 11,602.14 " " 13,914.06 " " 13,778.70 " Inpatient NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION 639.2 " 133,363.60 " " 42,022.87 " " 13,751.15 " " 24,736.94 " " 14,438.71 " " 13,751.15 " " 13,751.15 " " 13,751.15 " " 14,644.97 " " 13,751.15 " " 13,751.15 " " 20,626.73 " " 24,736.94 " " 24,496.30 " Inpatient NEONATE BIRTHWT >2499G W OTHER SIGNIFICANT CONDITION 639.3 " 198,480.54 " " 62,541.22 " " 21,728.89 " " 39,088.10 " " 22,815.33 " " 21,728.89 " " 21,728.89 " " 21,728.89 " " 23,141.27 " " 21,728.89 " " 21,728.89 " " 32,593.34 " " 39,088.10 " " 38,707.84 " Inpatient "NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER " 640.1 " 13,683.95 " " 4,311.81 " " 1,062.65 " " 1,911.60 " " 1,115.78 " " 1,062.65 " " 1,062.65 " " 1,062.65 " " 1,131.72 " " 1,062.65 " " 1,062.65 " " 1,593.98 " " 1,911.60 " " 1,893.00 " Inpatient "NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER " 640.2 " 18,358.67 " " 5,784.82 " " 1,680.09 " " 3,022.31 " " 1,764.09 " " 1,680.09 " " 1,680.09 " " 1,680.09 " " 1,789.30 " " 1,680.09 " " 1,680.09 " " 2,520.14 " " 3,022.31 " " 2,992.91 " Inpatient "NEONATE BIRTHWT >2499G, NORMAL NEWBORN OR NEONATE W OTHER " 640.3 " 53,150.55 " " 16,747.74 " " 4,179.02 " " 7,517.64 " " 4,387.97 " " 4,179.02 " " 4,179.02 " " 4,179.02 " " 4,450.66 " " 4,179.02 " " 4,179.02 " " 6,268.53 " " 7,517.64 " " 7,444.51 " Inpatient SPLENECTOMY 650.3 " 130,551.89 " " 41,136.90 " " 28,749.67 " " 51,717.78 " " 30,187.15 " " 28,749.67 " " 28,749.67 " " 28,749.67 " " 30,618.40 " " 28,749.67 " " 28,749.67 " " 43,124.51 " " 51,717.78 " " 51,214.66 " Inpatient SPLENECTOMY 650.4 " 426,466.62 " " 134,379.63 " " 44,823.33 " " 80,632.69 " " 47,064.50 " " 44,823.33 " " 44,823.33 " " 44,823.33 " " 47,736.85 " " 44,823.33 " " 44,823.33 " " 67,235.00 " " 80,632.69 " " 79,848.28 " Inpatient OTHER PROCEDURES OF BLOOD & BLOOD-FORMING ORGANS 651.2 " 51,850.34 " " 16,338.04 " " 14,297.86 " " 25,720.42 " " 15,012.75 " " 14,297.86 " " 14,297.86 " " 14,297.86 " " 15,227.22 " " 14,297.86 " " 14,297.86 " " 21,446.79 " " 25,720.42 " " 25,470.21 " Inpatient MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & CO 660.1 " 27,850.09 " " 8,775.56 " " 7,159.75 " " 12,879.67 " " 7,517.74 " " 7,159.75 " " 7,159.75 " " 7,159.75 " " 7,625.13 " " 7,159.75 " " 7,159.75 " " 10,739.63 " " 12,879.67 " " 12,754.38 " Inpatient MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & CO 660.2 " 51,193.23 " " 16,130.99 " " 8,486.18 " " 15,265.79 " " 8,910.49 " " 8,486.18 " " 8,486.18 " " 8,486.18 " " 9,037.78 " " 8,486.18 " " 8,486.18 " " 12,729.27 " " 15,265.79 " " 15,117.28 " Inpatient MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & CO 660.3 " 67,951.61 " " 21,411.55 " " 13,935.88 " " 25,069.25 " " 14,632.67 " " 13,935.88 " " 13,935.88 " " 13,935.88 " " 14,841.71 " " 13,935.88 " " 13,935.88 " " 20,903.82 " " 25,069.25 " " 24,825.38 " Inpatient MAJOR HEMATOLOGIC/IMMUNOLOGIC DIAG EXC SICKLE CELL CRISIS & CO 660.4 " 123,817.46 " " 39,014.88 " " 36,532.70 " " 65,718.67 " " 38,359.34 " " 36,532.70 " " 36,532.70 " " 36,532.70 " " 38,907.33 " " 36,532.70 " " 36,532.70 " " 54,799.05 " " 65,718.67 " " 65,079.35 " Inpatient COAGULATION & PLATELET DISORDERS 661.1 " 37,090.08 " " 11,687.08 " " 7,617.43 " " 13,702.99 " " 7,998.30 " " 7,617.43 " " 7,617.43 " " 7,617.43 " " 8,112.56 " " 7,617.43 " " 7,617.43 " " 11,426.15 " " 13,702.99 " " 13,569.69 " Inpatient COAGULATION & PLATELET DISORDERS 661.2 " 70,579.00 " " 22,239.44 " " 10,751.27 " " 19,340.46 " " 11,288.83 " " 10,751.27 " " 10,751.27 " " 10,751.27 " " 11,450.10 " " 10,751.27 " " 10,751.27 " " 16,126.91 " " 19,340.46 " " 19,152.31 " Inpatient COAGULATION & PLATELET DISORDERS 661.3 " 274,478.57 " " 86,488.20 " " 20,451.55 " " 36,790.29 " " 21,474.13 " " 20,451.55 " " 20,451.55 " " 20,451.55 " " 21,780.90 " " 20,451.55 " " 20,451.55 " " 30,677.33 " " 36,790.29 " " 36,432.39 " Inpatient COAGULATION & PLATELET DISORDERS 661.4 " 249,722.73 " " 78,687.63 " " 33,318.13 " " 59,935.98 " " 34,984.04 " " 33,318.13 " " 33,318.13 " " 33,318.13 " " 35,483.81 " " 33,318.13 " " 33,318.13 " " 49,977.20 " " 59,935.98 " " 59,352.92 " Inpatient SICKLE CELL ANEMIA CRISIS 662.1 " 38,809.93 " " 12,229.01 " " 5,331.53 " " 9,590.89 " " 5,598.11 " " 5,331.53 " " 5,331.53 " " 5,331.53 " " 5,678.08 " " 5,331.53 " " 5,331.53 " " 7,997.30 " " 9,590.89 " " 9,497.59 " Inpatient SICKLE CELL ANEMIA CRISIS 662.2 " 61,706.20 " " 19,443.62 " " 7,193.87 " " 12,941.05 " " 7,553.56 " " 7,193.87 " " 7,193.87 " " 7,193.87 " " 7,661.47 " " 7,193.87 " " 7,193.87 " " 10,790.81 " " 12,941.05 " " 12,815.16 " Inpatient SICKLE CELL ANEMIA CRISIS 662.3 " 79,066.85 " " 24,913.97 " " 10,877.76 " " 19,568.00 " " 11,421.65 " " 10,877.76 " " 10,877.76 " " 10,877.76 " " 11,584.81 " " 10,877.76 " " 10,877.76 " " 16,316.64 " " 19,568.00 " " 19,377.64 " Inpatient SICKLE CELL ANEMIA CRISIS 662.4 " 146,773.71 " " 46,248.40 " " 22,913.03 " " 41,218.25 " " 24,058.68 " " 22,913.03 " " 22,913.03 " " 22,913.03 " " 24,402.38 " " 22,913.03 " " 22,913.03 " " 34,369.55 " " 41,218.25 " " 40,817.27 " Inpatient OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS 663.1 " 29,265.76 " " 9,221.64 " " 5,253.31 " " 9,450.18 " " 5,515.98 " " 5,253.31 " " 5,253.31 " " 5,253.31 " " 5,594.78 " " 5,253.31 " " 5,253.31 " " 7,879.97 " " 9,450.18 " " 9,358.25 " Inpatient OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS 663.2 " 31,081.46 " " 9,793.77 " " 6,667.95 " " 11,994.98 " " 7,001.35 " " 6,667.95 " " 6,667.95 " " 6,667.95 " " 7,101.37 " " 6,667.95 " " 6,667.95 " " 10,001.93 " " 11,994.98 " " 11,878.29 " Inpatient OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS 663.3 " 48,866.40 " " 15,397.80 " " 9,518.04 " " 17,122.00 " " 9,993.94 " " 9,518.04 " " 9,518.04 " " 9,518.04 " " 10,136.71 " " 9,518.04 " " 9,518.04 " " 14,277.06 " " 17,122.00 " " 16,955.44 " Inpatient OTHER ANEMIA & DISORDERS OF BLOOD & BLOOD-FORMING ORGANS 663.4 " 136,409.72 " " 42,982.70 " " 17,370.96 " " 31,248.62 " " 18,239.51 " " 17,370.96 " " 17,370.96 " " 17,370.96 " " 18,500.07 " " 17,370.96 " " 17,370.96 " " 26,056.44 " " 31,248.62 " " 30,944.63 " Inpatient MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEO 680.1 " 83,537.24 " " 26,322.58 " " 15,035.97 " " 27,048.21 " " 15,787.77 " " 15,035.97 " " 15,035.97 " " 15,035.97 " " 16,013.31 " " 15,035.97 " " 15,035.97 " " 22,553.96 " " 27,048.21 " " 26,785.08 " Inpatient MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEO 680.2 " 121,925.09 " " 38,418.60 " " 21,023.24 " " 37,818.71 " " 22,074.40 " " 21,023.24 " " 21,023.24 " " 21,023.24 " " 22,389.75 " " 21,023.24 " " 21,023.24 " " 31,534.86 " " 37,818.71 " " 37,450.80 " Inpatient MAJOR O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEO 680.3 " 210,235.68 " " 66,245.26 " " 34,722.79 " " 62,462.83 " " 36,458.93 " " 34,722.79 " " 34,722.79 " " 34,722.79 " " 36,979.77 " " 34,722.79 " " 34,722.79 " " 52,084.19 " " 62,462.83 " " 61,855.18 " Inpatient OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOP 681.2 " 179,698.40 " " 56,622.97 " " 16,541.32 " " 29,756.18 " " 17,368.39 " " 16,541.32 " " 16,541.32 " " 16,541.32 " " 17,616.51 " " 16,541.32 " " 16,541.32 " " 24,811.98 " " 29,756.18 " " 29,466.71 " Inpatient OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOP 681.3 " 357,307.68 " " 112,587.65 " " 31,078.01 " " 55,906.23 " " 32,631.91 " " 31,078.01 " " 31,078.01 " " 31,078.01 " " 33,098.08 " " 31,078.01 " " 31,078.01 " " 46,617.02 " " 55,906.23 " " 55,362.37 " Inpatient OTHER O.R. PROCEDURES FOR LYMPHATIC/HEMATOPOIETIC/OTHER NEOP 681.4 " 696,202.90 " " 219,373.53 " " 68,738.26 " " 123,653.26 " " 72,175.17 " " 68,738.26 " " 68,738.26 " " 68,738.26 " " 73,206.25 " " 68,738.26 " " 68,738.26 " " 103,107.39 " " 123,653.26 " " 122,450.34 " Inpatient ACUTE LEUKEMIA 690.1 " 140,303.52 " " 44,209.64 " " 16,649.50 " " 29,950.79 " " 17,481.98 " " 16,649.50 " " 16,649.50 " " 16,649.50 " " 17,731.72 " " 16,649.50 " " 16,649.50 " " 24,974.25 " " 29,950.79 " " 29,659.42 " Inpatient ACUTE LEUKEMIA 690.2 " 146,048.29 " " 46,019.82 " " 23,507.18 " " 42,287.07 " " 24,682.54 " " 23,507.18 " " 23,507.18 " " 23,507.18 " " 25,035.15 " " 23,507.18 " " 23,507.18 " " 35,260.77 " " 42,287.07 " " 41,875.69 " Inpatient ACUTE LEUKEMIA 690.3 " 196,961.63 " " 62,062.61 " " 40,063.48 " " 72,070.19 " " 42,066.65 " " 40,063.48 " " 40,063.48 " " 40,063.48 " " 42,667.61 " " 40,063.48 " " 40,063.48 " " 60,095.22 " " 72,070.19 " " 71,369.08 " Inpatient ACUTE LEUKEMIA 690.4 " 269,255.84 " " 84,842.51 " " 68,247.29 " " 122,770.05 " " 71,659.65 " " 68,247.29 " " 68,247.29 " " 68,247.29 " " 72,683.36 " " 68,247.29 " " 68,247.29 " " 102,370.94 " " 122,770.05 " " 121,575.72 " Inpatient "LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA " 691.1 " 52,718.07 " " 16,611.46 " " 11,016.73 " " 19,818.00 " " 11,567.57 " " 11,016.73 " " 11,016.73 " " 11,016.73 " " 11,732.82 " " 11,016.73 " " 11,016.73 " " 16,525.10 " " 19,818.00 " " 19,625.20 " Inpatient "LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA " 691.2 " 108,458.90 " " 34,175.40 " " 12,616.10 " " 22,695.10 " " 13,246.91 " " 12,616.10 " " 12,616.10 " " 12,616.10 " " 13,436.15 " " 12,616.10 " " 12,616.10 " " 18,924.15 " " 22,695.10 " " 22,474.32 " Inpatient "LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA " 691.3 " 162,731.59 " " 51,276.72 " " 20,054.62 " " 36,076.26 " " 21,057.35 " " 20,054.62 " " 20,054.62 " " 20,054.62 " " 21,358.17 " " 20,054.62 " " 20,054.62 " " 30,081.93 " " 36,076.26 " " 35,725.30 " Inpatient "LYMPHOMA, MYELOMA & NON-ACUTE LEUKEMIA " 691.4 " 221,557.19 " " 69,812.67 " " 40,467.90 " " 72,797.71 " " 42,491.30 " " 40,467.90 " " 40,467.90 " " 40,467.90 " " 43,098.31 " " 40,467.90 " " 40,467.90 " " 60,701.85 " " 72,797.71 " " 72,089.52 " Inpatient LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVI 694.1 " 58,492.20 " " 18,430.89 " " 7,034.10 " " 12,653.64 " " 7,385.81 " " 7,034.10 " " 7,034.10 " " 7,034.10 " " 7,491.32 " " 7,034.10 " " 7,034.10 " " 10,551.15 " " 12,653.64 " " 12,530.55 " Inpatient LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVI 694.2 " 51,100.62 " " 16,101.81 " " 8,434.59 " " 15,172.98 " " 8,856.32 " " 8,434.59 " " 8,434.59 " " 8,434.59 " " 8,982.84 " " 8,434.59 " " 8,434.59 " " 12,651.89 " " 15,172.98 " " 15,025.38 " Inpatient LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVI 694.3 " 75,186.58 " " 23,691.29 " " 12,611.11 " " 22,686.13 " " 13,241.67 " " 12,611.11 " " 12,611.11 " " 12,611.11 " " 13,430.83 " " 12,611.11 " " 12,611.11 " " 18,916.67 " " 22,686.13 " " 22,465.43 " Inpatient LYMPHATIC & OTHER MALIGNANCIES & NEOPLASMS OF UNCERTAIN BEHAVI 694.4 " 102,881.82 " " 32,418.06 " " 24,258.60 " " 43,638.80 " " 25,471.53 " " 24,258.60 " " 24,258.60 " " 24,258.60 " " 25,835.41 " " 24,258.60 " " 24,258.60 " " 36,387.90 " " 43,638.80 " " 43,214.27 " Inpatient CHEMOTHERAPY FOR ACUTE LEUKEMIA 695.2 " 68,978.76 " " 21,735.21 " " 9,381.57 " " 16,876.51 " " 9,850.65 " " 9,381.57 " " 9,381.57 " " 9,381.57 " " 9,991.37 " " 9,381.57 " " 9,381.57 " " 14,072.36 " " 16,876.51 " " 16,712.33 " Inpatient CHEMOTHERAPY FOR ACUTE LEUKEMIA 695.3 " 55,259.12 " " 17,412.15 " " 25,651.61 " " 46,144.68 " " 26,934.19 " " 25,651.61 " " 25,651.61 " " 25,651.61 " " 27,318.96 " " 25,651.61 " " 25,651.61 " " 38,477.42 " " 46,144.68 " " 45,695.78 " Inpatient CHEMOTHERAPY FOR ACUTE LEUKEMIA 695.4 " 166,807.08 " " 52,560.91 " " 66,940.83 " " 120,419.86 " " 70,287.87 " " 66,940.83 " " 66,940.83 " " 66,940.83 " " 71,291.98 " " 66,940.83 " " 66,940.83 " " 100,411.25 " " 120,419.86 " " 119,248.39 " Inpatient OTHER CHEMOTHERAPY 696.1 " 33,058.32 " " 10,416.68 " " 8,081.76 " " 14,538.28 " " 8,485.85 " " 8,081.76 " " 8,081.76 " " 8,081.76 " " 8,607.07 " " 8,081.76 " " 8,081.76 " " 12,122.64 " " 14,538.28 " " 14,396.85 " Inpatient OTHER CHEMOTHERAPY 696.2 " 56,182.35 " " 17,703.06 " " 10,332.71 " " 18,587.51 " " 10,849.35 " " 10,332.71 " " 10,332.71 " " 10,332.71 " " 11,004.34 " " 10,332.71 " " 10,332.71 " " 15,499.07 " " 18,587.51 " " 18,406.69 " Inpatient OTHER CHEMOTHERAPY 696.3 " 60,586.78 " " 19,090.90 " " 17,223.68 " " 30,983.68 " " 18,084.86 " " 17,223.68 " " 17,223.68 " " 17,223.68 " " 18,343.22 " " 17,223.68 " " 17,223.68 " " 25,835.52 " " 30,983.68 " " 30,682.26 " Inpatient OTHER CHEMOTHERAPY 696.4 " 78,711.62 " " 24,802.03 " " 38,033.05 " " 68,417.65 " " 39,934.70 " " 38,033.05 " " 38,033.05 " " 38,033.05 " " 40,505.20 " " 38,033.05 " " 38,033.05 " " 57,049.58 " " 68,417.65 " " 67,752.08 " Inpatient INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE 710.2 " 134,819.74 " " 42,481.70 " " 15,813.19 " " 28,446.35 " " 16,603.85 " " 15,813.19 " " 15,813.19 " " 15,813.19 " " 16,841.05 " " 15,813.19 " " 15,813.19 " " 23,719.79 " " 28,446.35 " " 28,169.62 " Inpatient INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE 710.3 " 216,855.18 " " 68,331.07 " " 25,262.17 " " 45,444.12 " " 26,525.28 " " 25,262.17 " " 25,262.17 " " 25,262.17 " " 26,904.21 " " 25,262.17 " " 25,262.17 " " 37,893.26 " " 45,444.12 " " 45,002.03 " Inpatient INFECTIOUS & PARASITIC DISEASES INCLUDING HIV W O.R. PROCEDURE 710.4 " 555,942.84 " " 175,177.59 " " 48,172.70 " " 86,657.87 " " 50,581.34 " " 48,172.70 " " 48,172.70 " " 48,172.70 " " 51,303.93 " " 48,172.70 " " 48,172.70 " " 72,259.05 " " 86,657.87 " " 85,814.85 " Inpatient "POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE " 711.1 " 63,297.22 " " 19,944.95 " " 10,167.11 " " 18,289.61 " " 10,675.47 " " 10,167.11 " " 10,167.11 " " 10,167.11 " " 10,827.97 " " 10,167.11 " " 10,167.11 " " 15,250.67 " " 18,289.61 " " 18,111.69 " Inpatient "POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE " 711.2 " 69,190.15 " " 21,801.82 " " 13,972.50 " " 25,135.13 " " 14,671.13 " " 13,972.50 " " 13,972.50 " " 13,972.50 " " 14,880.71 " " 13,972.50 " " 13,972.50 " " 20,958.75 " " 25,135.13 " " 24,890.61 " Inpatient "POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE " 711.3 " 151,217.79 " " 47,648.73 " " 24,835.28 " " 44,676.19 " " 26,077.04 " " 24,835.28 " " 24,835.28 " " 24,835.28 " " 26,449.57 " " 24,835.28 " " 24,835.28 " " 37,252.92 " " 44,676.19 " " 44,241.57 " Inpatient "POST-OP, POST-TRAUMA, OTHER DEVICE INFECTIONS W O.R. PROCEDURE " 711.4 " 331,026.36 " " 104,306.41 " " 48,615.40 " " 87,454.24 " " 51,046.17 " " 48,615.40 " " 48,615.40 " " 48,615.40 " " 51,775.40 " " 48,615.40 " " 48,615.40 " " 72,923.10 " " 87,454.24 " " 86,603.47 " Inpatient SEPTICEMIA & DISSEMINATED INFECTIONS 720.1 " 17,746.21 " " 5,591.83 " " 5,473.83 " " 9,846.87 " " 5,747.52 " " 5,473.83 " " 5,473.83 " " 5,473.83 " " 5,829.63 " " 5,473.83 " " 5,473.83 " " 8,210.75 " " 9,846.87 " " 9,751.08 " Inpatient SEPTICEMIA & DISSEMINATED INFECTIONS 720.2 " 41,135.27 " " 12,961.72 " " 7,320.35 " " 13,168.58 " " 7,686.37 " " 7,320.35 " " 7,320.35 " " 7,320.35 " " 7,796.17 " " 7,320.35 " " 7,320.35 " " 10,980.53 " " 13,168.58 " " 13,040.47 " Inpatient SEPTICEMIA & DISSEMINATED INFECTIONS 720.3 " 89,492.89 " " 28,199.21 " " 11,326.28 " " 20,374.85 " " 11,892.59 " " 11,326.28 " " 11,326.28 " " 11,326.28 " " 12,062.49 " " 11,326.28 " " 11,326.28 " " 16,989.42 " " 20,374.85 " " 20,176.64 " Inpatient SEPTICEMIA & DISSEMINATED INFECTIONS 720.4 " 179,218.00 " " 56,471.59 " " 21,323.64 " " 38,359.10 " " 22,389.82 " " 21,323.64 " " 21,323.64 " " 21,323.64 " " 22,709.68 " " 21,323.64 " " 21,323.64 " " 31,985.46 " " 38,359.10 " " 37,985.93 " Inpatient "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS " 721.1 " 20,041.64 " " 6,315.12 " " 5,527.09 " " 9,942.68 " " 5,803.44 " " 5,527.09 " " 5,527.09 " " 5,527.09 " " 5,886.35 " " 5,527.09 " " 5,527.09 " " 8,290.64 " " 9,942.68 " " 9,845.96 " Inpatient "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS " 721.2 " 43,695.26 " " 13,768.38 " " 7,651.55 " " 13,764.37 " " 8,034.13 " " 7,651.55 " " 7,651.55 " " 7,651.55 " " 8,148.90 " " 7,651.55 " " 7,651.55 " " 11,477.33 " " 13,764.37 " " 13,630.47 " Inpatient "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS " 721.3 " 74,044.43 " " 23,331.40 " " 12,710.14 " " 22,864.27 " " 13,345.65 " " 12,710.14 " " 12,710.14 " " 12,710.14 " " 13,536.30 " " 12,710.14 " " 12,710.14 " " 19,065.21 " " 22,864.27 " " 22,641.84 " Inpatient "POST-OPERATIVE, POST-TRAUMATIC, OTHER DEVICE INFECTIONS " 721.4 " 214,463.05 " " 67,577.31 " " 24,222.82 " " 43,574.43 " " 25,433.96 " " 24,222.82 " " 24,222.82 " " 24,222.82 " " 25,797.30 " " 24,222.82 " " 24,222.82 " " 36,334.23 " " 43,574.43 " " 43,150.53 " Inpatient FEVER & INFLAMMATORY CONDITIONS 722.1 " 18,796.00 " " 5,922.62 " " 3,936.03 " " 7,080.52 " " 4,132.83 " " 3,936.03 " " 3,936.03 " " 3,936.03 " " 4,191.87 " " 3,936.03 " " 3,936.03 " " 5,904.05 " " 7,080.52 " " 7,011.64 " Inpatient FEVER & INFLAMMATORY CONDITIONS 722.2 " 102,095.04 " " 32,170.15 " " 5,806.69 " " 10,445.65 " " 6,097.02 " " 5,806.69 " " 5,806.69 " " 5,806.69 " " 6,184.12 " " 5,806.69 " " 5,806.69 " " 8,710.04 " " 10,445.65 " " 10,344.04 " Inpatient FEVER & INFLAMMATORY CONDITIONS 722.3 " 27,856.32 " " 8,777.53 " " 8,247.36 " " 14,836.18 " " 8,659.73 " " 8,247.36 " " 8,247.36 " " 8,247.36 " " 8,783.44 " " 8,247.36 " " 8,247.36 " " 12,371.04 " " 14,836.18 " " 14,691.85 " Inpatient VIRAL ILLNESS 723.2 " 20,708.80 " " 6,525.34 " " 5,444.71 " " 9,794.49 " " 5,716.95 " " 5,444.71 " " 5,444.71 " " 5,444.71 " " 5,798.62 " " 5,444.71 " " 5,444.71 " " 8,167.07 " " 9,794.49 " " 9,699.21 " Inpatient VIRAL ILLNESS 723.3 " 59,133.49 " " 18,632.96 " " 8,908.91 " " 16,026.24 " " 9,354.36 " " 8,908.91 " " 8,908.91 " " 8,908.91 " " 9,487.99 " " 8,908.91 " " 8,908.91 " " 13,363.37 " " 16,026.24 " " 15,870.33 " Inpatient OTHER INFECTIOUS & PARASITIC DISEASES 724.1 " 30,632.62 " " 9,652.34 " " 5,929.01 " " 10,665.70 " " 6,225.46 " " 5,929.01 " " 5,929.01 " " 5,929.01 " " 6,314.40 " " 5,929.01 " " 5,929.01 " " 8,893.52 " " 10,665.70 " " 10,561.94 " Inpatient OTHER INFECTIOUS & PARASITIC DISEASES 724.2 " 31,298.33 " " 9,862.10 " " 7,030.77 " " 12,647.65 " " 7,382.31 " " 7,030.77 " " 7,030.77 " " 7,030.77 " " 7,487.77 " " 7,030.77 " " 7,030.77 " " 10,546.16 " " 12,647.65 " " 12,524.61 " Inpatient OTHER INFECTIOUS & PARASITIC DISEASES 724.3 " 114,569.24 " " 36,100.77 " " 12,605.29 " " 22,675.66 " " 13,235.55 " " 12,605.29 " " 12,605.29 " " 12,605.29 " " 13,424.63 " " 12,605.29 " " 12,605.29 " " 18,907.94 " " 22,675.66 " " 22,455.06 " Inpatient OTHER INFECTIOUS & PARASITIC DISEASES 724.4 " 91,223.66 " " 28,744.57 " " 29,188.21 " " 52,506.67 " " 30,647.62 " " 29,188.21 " " 29,188.21 " " 29,188.21 " " 31,085.44 " " 29,188.21 " " 29,188.21 " " 43,782.32 " " 52,506.67 " " 51,995.88 " Inpatient ACUTE ANXIETY & DELIRIUM STATES 756.1 " 22,746.00 " " 7,167.26 " " 4,820.60 " " 8,671.78 " " 5,061.63 " " 4,820.60 " " 4,820.60 " " 4,820.60 " " 5,133.94 " " 4,820.60 " " 4,820.60 " " 7,230.90 " " 8,671.78 " " 8,587.42 " Inpatient ACUTE ANXIETY & DELIRIUM STATES 756.2 " 63,222.71 " " 19,921.48 " " 5,804.19 " " 10,441.16 " " 6,094.40 " " 5,804.19 " " 5,804.19 " " 5,804.19 " " 6,181.46 " " 5,804.19 " " 5,804.19 " " 8,706.29 " " 10,441.16 " " 10,339.58 " Inpatient EATING DISORDERS 759.2 " 50,192.06 " " 15,815.52 " " 12,702.65 " " 22,850.80 " " 13,337.78 " " 12,702.65 " " 12,702.65 " " 12,702.65 " " 13,528.32 " " 12,702.65 " " 12,702.65 " " 19,053.98 " " 22,850.80 " " 22,628.50 " Inpatient EATING DISORDERS 759.3 " 108,874.25 " " 34,306.27 " " 19,563.66 " " 35,193.07 " " 20,541.84 " " 19,563.66 " " 19,563.66 " " 19,563.66 " " 20,835.30 " " 19,563.66 " " 19,563.66 " " 29,345.49 " " 35,193.07 " " 34,850.70 " Inpatient EATING DISORDERS 759.4 " 252,960.00 " " 79,707.70 " " 32,400.28 " " 58,284.86 " " 34,020.29 " " 32,400.28 " " 32,400.28 " " 32,400.28 " " 34,506.30 " " 32,400.28 " " 32,400.28 " " 48,600.42 " " 58,284.86 " " 57,717.86 " Inpatient OTHER MENTAL HEALTH DISORDERS 760.1 " 74,286.00 " " 23,407.52 " " 5,060.26 " " 9,102.90 " " 5,313.27 " " 5,060.26 " " 5,060.26 " " 5,060.26 " " 5,389.18 " " 5,060.26 " " 5,060.26 " " 7,590.39 " " 9,102.90 " " 9,014.35 " Inpatient OTHER MENTAL HEALTH DISORDERS 760.2 " 67,748.35 " " 21,347.51 " " 8,447.07 " " 15,195.43 " " 8,869.42 " " 8,447.07 " " 8,447.07 " " 8,447.07 " " 8,996.13 " " 8,447.07 " " 8,447.07 " " 12,670.61 " " 15,195.43 " " 15,047.61 " Inpatient OTHER MENTAL HEALTH DISORDERS 760.3 " 64,717.97 " " 20,392.63 " " 13,531.46 " " 24,341.74 " " 14,208.03 " " 13,531.46 " " 13,531.46 " " 13,531.46 " " 14,411.00 " " 13,531.46 " " 13,531.46 " " 20,297.19 " " 24,341.74 " " 24,104.94 " Inpatient "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVI " 770.1 " 15,135.35 " " 4,769.15 " " 2,032.92 " " 3,657.02 " " 2,134.57 " " 2,032.92 " " 2,032.92 " " 2,032.92 " " 2,165.06 " " 2,032.92 " " 2,032.92 " " 3,049.38 " " 3,657.02 " " 3,621.44 " Inpatient "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVI " 770.2 " 18,197.40 " " 5,734.00 " " 3,187.10 " " 5,733.27 " " 3,346.46 " " 3,187.10 " " 3,187.10 " " 3,187.10 " " 3,394.26 " " 3,187.10 " " 3,187.10 " " 4,780.65 " " 5,733.27 " " 5,677.50 " Inpatient "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVI " 770.3 " 34,421.54 " " 10,846.23 " " 5,847.46 " " 10,519.00 " " 6,139.83 " " 5,847.46 " " 5,847.46 " " 5,847.46 " " 6,227.54 " " 5,847.46 " " 5,847.46 " " 8,771.19 " " 10,519.00 " " 10,416.67 " Inpatient "DRUG & ALCOHOL ABUSE OR DEPENDENCE, LEFT AGAINST MEDICAL ADVI " 770.4 " 21,715.23 " " 6,842.47 " " 12,820.81 " " 23,063.36 " " 13,461.85 " " 12,820.81 " " 12,820.81 " " 12,820.81 " " 13,654.16 " " 12,820.81 " " 12,820.81 " " 19,231.22 " " 23,063.36 " " 22,838.99 " Inpatient OPIOID ABUSE & DEPENDENCE 773.1 " 30,409.76 " " 9,582.12 " " 2,542.19 " " 4,573.15 " " 2,669.30 " " 2,542.19 " " 2,542.19 " " 2,542.19 " " 2,707.43 " " 2,542.19 " " 2,542.19 " " 3,813.29 " " 4,573.15 " " 4,528.66 " Inpatient OPIOID ABUSE & DEPENDENCE 773.2 " 24,862.94 " " 7,834.31 " " 3,714.68 " " 6,682.34 " " 3,900.41 " " 3,714.68 " " 3,714.68 " " 3,714.68 " " 3,956.13 " " 3,714.68 " " 3,714.68 " " 5,572.02 " " 6,682.34 " " 6,617.33 " Inpatient OPIOID ABUSE & DEPENDENCE 773.3 " 48,780.41 " " 15,370.71 " " 7,392.75 " " 13,298.82 " " 7,762.39 " " 7,392.75 " " 7,392.75 " " 7,392.75 " " 7,873.28 " " 7,392.75 " " 7,392.75 " " 11,089.13 " " 13,298.82 " " 13,169.44 " Inpatient OPIOID ABUSE & DEPENDENCE 773.4 " 518,933.55 " " 163,515.96 " " 19,094.33 " " 34,348.79 " " 20,049.05 " " 19,094.33 " " 19,094.33 " " 19,094.33 " " 20,335.46 " " 19,094.33 " " 19,094.33 " " 28,641.50 " " 34,348.79 " " 34,014.64 " Inpatient ALCOHOL ABUSE & DEPENDENCE 775.1 " 23,064.76 " " 7,267.70 " " 3,467.54 " " 6,237.76 " " 3,640.92 " " 3,467.54 " " 3,467.54 " " 3,467.54 " " 3,692.93 " " 3,467.54 " " 3,467.54 " " 5,201.31 " " 6,237.76 " " 6,177.08 " Inpatient ALCOHOL ABUSE & DEPENDENCE 775.2 " 25,023.32 " " 7,884.85 " " 4,937.93 " " 8,882.84 " " 5,184.83 " " 4,937.93 " " 4,937.93 " " 4,937.93 " " 5,258.90 " " 4,937.93 " " 4,937.93 " " 7,406.90 " " 8,882.84 " " 8,796.43 " Inpatient ALCOHOL ABUSE & DEPENDENCE 775.3 " 33,591.19 " " 10,584.59 " " 8,471.21 " " 15,238.86 " " 8,894.77 " " 8,471.21 " " 8,471.21 " " 8,471.21 " " 9,021.84 " " 8,471.21 " " 8,471.21 " " 12,706.82 " " 15,238.86 " " 15,090.61 " Inpatient ALCOHOL ABUSE & DEPENDENCE 775.4 " 50,854.83 " " 16,024.36 " " 21,936.93 " " 39,462.34 " " 23,033.78 " " 21,936.93 " " 21,936.93 " " 21,936.93 " " 23,362.83 " " 21,936.93 " " 21,936.93 " " 32,905.40 " " 39,462.34 " " 39,078.45 " Inpatient EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 792.2 " 93,512.75 " " 29,465.87 " " 17,257.79 " " 31,045.04 " " 18,120.68 " " 17,257.79 " " 17,257.79 " " 17,257.79 " " 18,379.55 " " 17,257.79 " " 17,257.79 " " 25,886.69 " " 31,045.04 " " 30,743.03 " Inpatient EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 792.3 " 447,139.16 " " 140,893.55 " " 26,506.22 " " 47,682.04 " " 27,831.53 " " 26,506.22 " " 26,506.22 " " 26,506.22 " " 28,229.12 " " 26,506.22 " " 26,506.22 " " 39,759.33 " " 47,682.04 " " 47,218.18 " Inpatient EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREATMENT 792.4 " 476,534.90 " " 150,156.15 " " 54,687.54 " " 98,377.42 " " 57,421.92 " " 54,687.54 " " 54,687.54 " " 54,687.54 " " 58,242.23 " " 54,687.54 " " 54,687.54 " " 82,031.31 " " 98,377.42 " " 97,420.38 " Inpatient MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS O 793.1 " 58,948.71 " " 18,574.74 " " 9,013.76 " " 16,214.85 " " 9,464.45 " " 9,013.76 " " 9,013.76 " " 9,013.76 " " 9,599.65 " " 9,013.76 " " 9,013.76 " " 13,520.64 " " 16,214.85 " " 16,057.11 " Inpatient MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS O 793.2 " 87,797.90 " " 27,665.12 " " 12,752.58 " " 22,940.62 " " 13,390.21 " " 12,752.58 " " 12,752.58 " " 12,752.58 " " 13,581.50 " " 12,752.58 " " 12,752.58 " " 19,128.87 " " 22,940.62 " " 22,717.45 " Inpatient MODERATELY EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS O 793.3 " 181,839.67 " " 57,297.68 " " 20,365.01 " " 36,634.62 " " 21,383.26 " " 20,365.01 " " 20,365.01 " " 20,365.01 " " 21,688.74 " " 20,365.01 " " 20,365.01 " " 30,547.52 " " 36,634.62 " " 36,278.23 " Inpatient NON-EXTENSIVE OR PROCEDURES FOR OTHER COMPLICATIONS OF TREAT 794.2 " 27,860.10 " " 8,778.72 " " 10,764.59 " " 19,364.42 " " 11,302.82 " " 10,764.59 " " 10,764.59 " " 10,764.59 " " 11,464.29 " " 10,764.59 " " 10,764.59 " " 16,146.89 " " 19,364.42 " " 19,176.04 " Inpatient HEMORRHAGE OR HEMATOMA DUE TO COMPLICATION 810.2 " 32,365.35 " " 10,198.32 " " 6,994.15 " " 12,581.78 " " 7,343.86 " " 6,994.15 " " 6,994.15 " " 6,994.15 " " 7,448.77 " " 6,994.15 " " 6,994.15 " " 10,491.23 " " 12,581.78 " " 12,459.38 " Inpatient ALLERGIC REACTIONS 811.1 " 19,845.46 " " 6,253.30 " " 3,254.51 " " 5,854.54 " " 3,417.24 " " 3,254.51 " " 3,254.51 " " 3,254.51 " " 3,466.05 " " 3,254.51 " " 3,254.51 " " 4,881.77 " " 5,854.54 " " 5,797.58 " Inpatient POISONING OF MEDICINAL AGENTS 812.1 " 19,294.61 " " 6,079.73 " " 3,715.51 " " 6,683.83 " " 3,901.29 " " 3,715.51 " " 3,715.51 " " 3,715.51 " " 3,957.02 " " 3,715.51 " " 3,715.51 " " 5,573.27 " " 6,683.83 " " 6,618.81 " Inpatient POISONING OF MEDICINAL AGENTS 812.2 " 25,471.25 " " 8,025.99 " " 5,280.77 " " 9,499.58 " " 5,544.81 " " 5,280.77 " " 5,280.77 " " 5,280.77 " " 5,624.02 " " 5,280.77 " " 5,280.77 " " 7,921.16 " " 9,499.58 " " 9,407.16 " Inpatient POISONING OF MEDICINAL AGENTS 812.3 " 53,677.18 " " 16,913.68 " " 7,729.77 " " 13,905.08 " " 8,116.26 " " 7,729.77 " " 7,729.77 " " 7,729.77 " " 8,232.21 " " 7,729.77 " " 7,729.77 " " 11,594.66 " " 13,905.08 " " 13,769.81 " Inpatient POISONING OF MEDICINAL AGENTS 812.4 " 78,711.96 " " 24,802.14 " " 14,549.17 " " 26,172.50 " " 15,276.63 " " 14,549.17 " " 14,549.17 " " 14,549.17 " " 15,494.87 " " 14,549.17 " " 14,549.17 " " 21,823.76 " " 26,172.50 " " 25,917.89 " Inpatient OTHER COMPLICATIONS OF TREATMENT 813.1 " 24,857.16 " " 7,832.49 " " 5,564.53 " " 10,010.03 " " 5,842.76 " " 5,564.53 " " 5,564.53 " " 5,564.53 " " 5,926.22 " " 5,564.53 " " 5,564.53 " " 8,346.80 " " 10,010.03 " " 9,912.65 " Inpatient OTHER COMPLICATIONS OF TREATMENT 813.2 " 92,860.30 " " 29,260.28 " " 7,035.76 " " 12,656.63 " " 7,387.55 " " 7,035.76 " " 7,035.76 " " 7,035.76 " " 7,493.08 " " 7,035.76 " " 7,035.76 " " 10,553.64 " " 12,656.63 " " 12,533.50 " Inpatient OTHER COMPLICATIONS OF TREATMENT 813.3 " 93,649.20 " " 29,508.86 " " 10,610.64 " " 19,087.48 " " 11,141.17 " " 10,610.64 " " 10,610.64 " " 10,610.64 " " 11,300.33 " " 10,610.64 " " 10,610.64 " " 15,915.96 " " 19,087.48 " " 18,901.79 " Inpatient OTHER COMPLICATIONS OF TREATMENT 813.4 " 221,776.21 " " 69,881.68 " " 21,271.21 " " 38,264.78 " " 22,334.77 " " 21,271.21 " " 21,271.21 " " 21,271.21 " " 22,653.84 " " 21,271.21 " " 21,271.21 " " 31,906.82 " " 38,264.78 " " 37,892.53 " Inpatient "OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES " 815.2 " 38,630.66 " " 12,172.52 " " 6,060.49 " " 10,902.22 " " 6,363.51 " " 6,060.49 " " 6,060.49 " " 6,060.49 " " 6,454.42 " " 6,060.49 " " 6,060.49 " " 9,090.74 " " 10,902.22 " " 10,796.16 " Inpatient "OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES " 815.3 " 26,937.33 " " 8,487.95 " " 11,016.73 " " 19,818.00 " " 11,567.57 " " 11,016.73 " " 11,016.73 " " 11,016.73 " " 11,732.82 " " 11,016.73 " " 11,016.73 " " 16,525.10 " " 19,818.00 " " 19,625.20 " Inpatient "OTHER INJURY, POISONING & TOXIC EFFECT DIAGNOSES " 815.4 " 105,508.11 " " 33,245.60 " " 30,573.73 " " 54,999.08 " " 32,102.42 " " 30,573.73 " " 30,573.73 " " 30,573.73 " " 32,561.02 " " 30,573.73 " " 30,573.73 " " 45,860.60 " " 54,999.08 " " 54,464.04 " Inpatient TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES 816.2 " 86,490.66 " " 27,253.21 " " 5,887.40 " " 10,590.84 " " 6,181.77 " " 5,887.40 " " 5,887.40 " " 5,887.40 " " 6,270.08 " " 5,887.40 " " 5,887.40 " " 8,831.10 " " 10,590.84 " " 10,487.81 " Inpatient TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES 816.3 " 77,050.54 " " 24,278.63 " " 7,074.87 " " 12,726.98 " " 7,428.61 " " 7,074.87 " " 7,074.87 " " 7,074.87 " " 7,534.74 " " 7,074.87 " " 7,074.87 " " 10,612.31 " " 12,726.98 " " 12,603.17 " Inpatient TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES 816.4 " 39,231.07 " " 12,361.71 " " 13,961.68 " " 25,115.67 " " 14,659.76 " " 13,961.68 " " 13,961.68 " " 13,961.68 " " 14,869.19 " " 13,961.68 " " 13,961.68 " " 20,942.52 " " 25,115.67 " " 24,871.34 " Inpatient INTENTIONAL SELF-HARM & ATTEMPTED SUICIDE 817.1 " 37,245.87 " " 11,736.17 " " 3,642.29 " " 6,552.12 " " 3,824.40 " " 3,642.29 " " 3,642.29 " " 3,642.29 " " 3,879.04 " " 3,642.29 " " 3,642.29 " " 5,463.44 " " 6,552.12 " " 6,488.38 " Inpatient INTENTIONAL SELF-HARM & ATTEMPTED SUICIDE 817.2 " 45,359.46 " " 14,292.77 " " 4,729.90 " " 8,508.62 " " 4,966.40 " " 4,729.90 " " 4,729.90 " " 4,729.90 " " 5,037.34 " " 4,729.90 " " 4,729.90 " " 7,094.85 " " 8,508.62 " " 8,425.84 " Inpatient INTENTIONAL SELF-HARM & ATTEMPTED SUICIDE 817.3 " 49,460.29 " " 15,584.94 " " 8,038.49 " " 14,460.44 " " 8,440.41 " " 8,038.49 " " 8,038.49 " " 8,038.49 " " 8,560.99 " " 8,038.49 " " 8,038.49 " " 12,057.74 " " 14,460.44 " " 14,319.77 " Inpatient INTENTIONAL SELF-HARM & ATTEMPTED SUICIDE 817.4 " 71,462.93 " " 22,517.97 " " 16,295.84 " " 29,314.59 " " 17,110.63 " " 16,295.84 " " 16,295.84 " " 16,295.84 " " 17,355.07 " " 16,295.84 " " 16,295.84 " " 24,443.76 " " 29,314.59 " " 29,029.41 " Inpatient "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH " 850.1 " 190,978.44 " " 60,177.31 " " 17,479.97 " " 31,444.72 " " 18,353.97 " " 17,479.97 " " 17,479.97 " " 17,479.97 " " 18,616.17 " " 17,479.97 " " 17,479.97 " " 26,219.96 " " 31,444.72 " " 31,138.82 " Inpatient "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH " 850.2 " 137,083.49 " " 43,195.01 " " 23,314.95 " " 41,941.26 " " 24,480.70 " " 23,314.95 " " 23,314.95 " " 23,314.95 " " 24,830.42 " " 23,314.95 " " 23,314.95 " " 34,972.43 " " 41,941.26 " " 41,533.25 " Inpatient "PROCEDURE W DIAG OF REHAB, AFTERCARE OR OTH CONTACT W HEALTH " 850.3 " 329,541.87 " " 103,838.64 " " 30,790.92 " " 55,389.79 " " 32,330.47 " " 30,790.92 " " 30,790.92 " " 30,790.92 " " 32,792.33 " " 30,790.92 " " 30,790.92 " " 46,186.38 " " 55,389.79 " " 54,850.94 " Inpatient "SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS " 861.1 " 34,075.27 " " 10,737.12 " " 4,932.94 " " 8,873.87 " " 5,179.59 " " 4,932.94 " " 4,932.94 " " 4,932.94 " " 5,253.58 " " 4,932.94 " " 4,932.94 " " 7,399.41 " " 8,873.87 " " 8,787.54 " Inpatient "SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS " 861.2 " 67,338.39 " " 21,218.33 " " 5,958.97 " " 10,719.59 " " 6,256.92 " " 5,958.97 " " 5,958.97 " " 5,958.97 " " 6,346.30 " " 5,958.97 " " 5,958.97 " " 8,938.46 " " 10,719.59 " " 10,615.31 " Inpatient "SIGNS, SYMPTOMS & OTHER FACTORS INFLUENCING HEALTH STATUS " 861.3 " 80,558.55 " " 25,384.00 " " 8,402.14 " " 15,114.61 " " 8,822.25 " " 8,402.14 " " 8,402.14 " " 8,402.14 " " 8,948.28 " " 8,402.14 " " 8,402.14 " " 12,603.21 " " 15,114.61 " " 14,967.57 " Inpatient OTHER AFTERCARE & CONVALESCENCE 862.1 " 17,595.00 " " 5,544.18 " " 5,244.99 " " 9,435.21 " " 5,507.24 " " 5,244.99 " " 5,244.99 " " 5,244.99 " " 5,585.91 " " 5,244.99 " " 5,244.99 " " 7,867.49 " " 9,435.21 " " 9,343.43 " Inpatient OTHER AFTERCARE & CONVALESCENCE 862.2 " 38,886.86 " " 12,253.25 " " 6,576.42 " " 11,830.32 " " 6,905.24 " " 6,576.42 " " 6,576.42 " " 6,576.42 " " 7,003.89 " " 6,576.42 " " 6,576.42 " " 9,864.63 " " 11,830.32 " " 11,715.23 " Inpatient OTHER AFTERCARE & CONVALESCENCE 862.3 " 23,398.84 " " 7,372.97 " " 11,004.25 " " 19,795.55 " " 11,554.46 " " 11,004.25 " " 11,004.25 " " 11,004.25 " " 11,719.53 " " 11,004.25 " " 11,004.25 " " 16,506.38 " " 19,795.55 " " 19,602.97 " Inpatient OTHER AFTERCARE & CONVALESCENCE 862.4 " 32,479.25 " " 10,234.21 " " 19,134.27 " " 34,420.64 " " 20,090.98 " " 19,134.27 " " 19,134.27 " " 19,134.27 " " 20,378.00 " " 19,134.27 " " 19,134.27 " " 28,701.41 " " 34,420.64 " " 34,085.79 " Inpatient CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA 910.4 " 476,758.61 " " 150,226.64 " " 70,394.22 " " 126,632.16 " " 73,913.93 " " 70,394.22 " " 70,394.22 " " 70,394.22 " " 74,969.84 " " 70,394.22 " " 70,394.22 " " 105,591.33 " " 126,632.16 " " 125,400.26 " Inpatient EXTENSIVE ABDOMINAL/THORACIC PROCEDURES FOR MULT SIGNIFICANT 911.4 " 333,406.68 " " 105,056.44 " " 60,325.30 " " 108,519.18 " " 63,341.57 " " 60,325.30 " " 60,325.30 " " 60,325.30 " " 64,246.44 " " 60,325.30 " " 60,325.30 " " 90,487.95 " " 108,519.18 " " 107,463.49 " Inpatient MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT T 912.2 " 67,730.59 " " 21,341.91 " " 18,362.05 " " 33,031.49 " " 19,280.15 " " 18,362.05 " " 18,362.05 " " 18,362.05 " " 19,555.58 " " 18,362.05 " " 18,362.05 " " 27,543.08 " " 33,031.49 " " 32,710.16 " Inpatient MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT T 912.3 " 277,166.84 " " 87,335.27 " " 29,633.41 " " 53,307.54 " " 31,115.08 " " 29,633.41 " " 29,633.41 " " 29,633.41 " " 31,559.58 " " 29,633.41 " " 29,633.41 " " 44,450.12 " " 53,307.54 " " 52,788.96 " Inpatient MUSCULOSKELETAL & OTHER PROCEDURES FOR MULTIPLE SIGNIFICANT T 912.4 " 513,628.91 " " 161,844.47 " " 58,681.82 " " 105,562.73 " " 61,615.91 " " 58,681.82 " " 58,681.82 " " 58,681.82 " " 62,496.14 " " 58,681.82 " " 58,681.82 " " 88,022.73 " " 105,562.73 " " 104,535.79 " Inpatient MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE 930.2 " 20,273.79 " " 6,388.27 " " 9,024.58 " " 16,234.32 " " 9,475.81 " " 9,024.58 " " 9,024.58 " " 9,024.58 " " 9,611.18 " " 9,024.58 " " 9,024.58 " " 13,536.87 " " 16,234.32 " " 16,076.39 " Inpatient MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE 930.3 " 123,212.44 " " 38,824.24 " " 14,431.84 " " 25,961.44 " " 15,153.43 " " 14,431.84 " " 14,431.84 " " 14,431.84 " " 15,369.91 " " 14,431.84 " " 14,431.84 " " 21,647.76 " " 25,961.44 " " 25,708.88 " Inpatient MULTIPLE SIGNIFICANT TRAUMA W/O O.R. PROCEDURE 930.4 " 129,034.62 " " 40,658.81 " " 31,355.11 " " 56,404.71 " " 32,922.87 " " 31,355.11 " " 31,355.11 " " 31,355.11 " " 33,393.19 " " 31,355.11 " " 31,355.11 " " 47,032.67 " " 56,404.71 " " 55,855.99 " Inpatient EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 950.2 " 176,363.77 " " 55,572.22 " " 19,030.26 " " 34,233.53 " " 19,981.77 " " 19,030.26 " " 19,030.26 " " 19,030.26 " " 20,267.23 " " 19,030.26 " " 19,030.26 " " 28,545.39 " " 34,233.53 " " 33,900.51 " Inpatient EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 950.3 " 206,781.82 " " 65,156.95 " " 25,803.89 " " 46,418.62 " " 27,094.08 " " 25,803.89 " " 25,803.89 " " 25,803.89 " " 27,481.14 " " 25,803.89 " " 25,803.89 " " 38,705.84 " " 46,418.62 " " 45,967.05 " Inpatient EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 950.4 " 184,760.04 " " 58,217.89 " " 54,409.60 " " 97,877.43 " " 57,130.08 " " 54,409.60 " " 54,409.60 " " 54,409.60 " " 57,946.22 " " 54,409.60 " " 54,409.60 " " 81,614.40 " " 97,877.43 " " 96,925.26 " Inpatient MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNO 951.1 " 85,095.28 " " 26,813.52 " " 10,718.82 " " 19,282.09 " " 11,254.76 " " 10,718.82 " " 10,718.82 " " 10,718.82 " " 11,415.54 " " 10,718.82 " " 10,718.82 " " 16,078.23 " " 19,282.09 " " 19,094.51 " Inpatient MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNO 951.2 " 120,958.01 " " 38,113.87 " " 15,338.04 " " 27,591.60 " " 16,104.94 " " 15,338.04 " " 15,338.04 " " 15,338.04 " " 16,335.01 " " 15,338.04 " " 15,338.04 " " 23,007.06 " " 27,591.60 " " 27,323.18 " Inpatient MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNO 951.3 " 94,950.03 " " 29,918.75 " " 22,982.93 " " 41,343.99 " " 24,132.08 " " 22,982.93 " " 22,982.93 " " 22,982.93 " " 24,476.82 " " 22,982.93 " " 22,982.93 " " 34,474.40 " " 41,343.99 " " 40,941.79 " Inpatient MODERATELY EXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNO 951.4 " 327,582.00 " " 103,221.09 " " 45,670.45 " " 82,156.57 " " 47,953.97 " " 45,670.45 " " 45,670.45 " " 45,670.45 " " 48,639.03 " " 45,670.45 " " 45,670.45 " " 68,505.68 " " 82,156.57 " " 81,357.34 " Inpatient NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 952.2 " 60,692.34 " " 19,124.16 " " 12,932.32 " " 23,263.95 " " 13,578.94 " " 12,932.32 " " 12,932.32 " " 12,932.32 " " 13,772.92 " " 12,932.32 " " 12,932.32 " " 19,398.48 " " 23,263.95 " " 23,037.63 " Inpatient NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 952.3 " 153,890.65 " " 48,490.94 " " 20,785.24 " " 37,390.57 " " 21,824.50 " " 20,785.24 " " 20,785.24 " " 20,785.24 " " 22,136.28 " " 20,785.24 " " 20,785.24 " " 31,177.86 " " 37,390.57 " " 37,026.83 " Inpatient NONEXTENSIVE PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS 952.4 " 470,126.26 " " 148,136.78 " " 43,815.60 " " 78,819.88 " " 46,006.38 " " 43,815.60 " " 43,815.60 " " 43,815.60 " " 46,663.61 " " 43,815.60 " " 43,815.60 " " 65,723.40 " " 78,819.88 " " 78,053.11 "